Exploring Preventive Strategies of Childhood Obesity through Prenatal Education Ann Lambert MSN, CRNP & Chih-hsuan Wang, PhD Auburn University School of Nursing & College of Education, Auburn, Alabama

Purpose Phase one of this project used a focus group to assess perceptions among local obstetrical healthcare providers related to preventing early childhood obesity. Data collected was utilized to create a survey assessment tool. Phase two of the project assessed the perceptions of prenatal factors and the risk of childhood obesity, among regional healthcare providers, caring for pregnant women. Phase three developed an evidence-based educational intervention and evaluated the effectiveness of the intervention through a pilot study. IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Background Childhood obesity: Alabama 14th highest rate in the US Alabama 2nd most obese state in US Childhood obesity rates have doubled in past 30 years Priority goal is early preventive strategies Intervention prenatally should be a focus IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Methods One 45-minutes focus group was conducted with five open-ended questions discussed. The session was recorded, transcribed & analyzed for common themes. Survey for professionals was developed based on the focus group results and literature review. 683 professionals in the State of Alabama were invited to participate in the survey with a response rate of 13.03% (89 surveys returned). Among these returned surveys, only 73 of them (10.69%) were completed and analyzed. Pilot study participants completed a pre-post survey regarding the educational materials. IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Focus Group Results Regarding Educational Materials Physicians considered that providing verbal and written education materials were more feasible in their practice than providing video educational materials or referring their patients to a specialist. Most physicians did not believe it was useful to use video educational materials. Physicians overestimated the helpfulness of verbal and written educational materials, as compared to patients, and underestimated the helpfulness of video educational materials for patients. IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Focus Group Summary This group reported poor food choices, lack of exercise, excess weight gain, gestational diabetes, smoking and bottle feeding as compared to breastfeeding as prenatal factors affecting childhood obesity. Physicians were also asked how to intervene with patients who have one or more risk factors. The focus group suggested verbal, written/brochure and video media for education. They also suggested referral to a specialist if needed. A survey was conducted to ascertain perceptions among regional obstetrical healthcare providers, including physicians and certified nurse midwives (CNM), related to preventing early childhood obesity. IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Professional Survey Results Table 1: Prenatal risk factors for childhood obesity IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Professional Survey Results Table 2: How to intervene for a patient with a risk factor(s) IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Professional Survey Results Table 3: Most effective method in providing educational information IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Professional Survey Results Table 4: Most feasible method in providing educational information IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Educational Materials Developed IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Results for Pilot Study Pregnancy Week: ranged from 9 ~ 39 weeks; Mean=27.19 SD=9.57 IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Knowledge of Risk Factors (Reliability for: pre: α=.69, post: α=.36) Pre-Survey Post-Survey p Increase No Influence Decrease Do not Know Maternal Diabetes. 34 (94.44%) 1 (2.78%) (0%) 1.00 Maternal Malnutrition. 24 (66.67%) 4 (11.11%) 5 (13.89%) 3 (8.33%) 28 (77.78%) 2 (5.56%) .39 Maternal Smoking. 18 (50.00%) 7 (19.44%) 6 (16.67%) 8 (22.22%) .03* Maternal Alcohol use. 25 (69.44%) .02* Gestational Diabetes. 30 (83.33%) .13 Excess gestational weight gain. 29 (80.56%) 35 (97.22%) Mother’s lack of awareness that excess weight gain during pregnancy can adversely affect her baby. .06 High birth weight of infant. 15 (41.67%) 19 (52.78%) 52.78%) 16 (44.44%) .29 Breast Feeding. 11 (30.56%) 9 (25.00%) 23 (63.89%) IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Attitudes toward Preventing Childhood Obesity from Prenatal Stage   Mean SD t(35) p-value Pre-Attitude 4.16 0.35 1.05 .30 Post-Attitude 4.20 0.29 IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Perceived Usefulness of Educational Materials IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Perceived Attractiveness of Educational Materials IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015

Perceived Helpfulness and Preferences in the Educational Materials IRB Approval: #14-154 EP 1405 Auburn University Intramural Grants Program 2014-2015