Francine E. Darroch, M.Ed, MPH, PhD (Cand.) Audrey R. Giles, PhD A qualitative analysis of the barriers to physical activity and optimal weight gain in pregnant urban First Nations women: Service and care providers’ perspective Public Health 2014 This study was supported by the Canadian Institutes of Health Research This presentation is supported by NCCPH

Community-based Participatory Research with the Odawa Native Friendship Centre

Why should Physical Activity be a Priority in Pregnancy? 41% of First Nations women are obese 1 First Nations women have among the highest birth rates in Canada 2 First Nations women often exceed recommended weight-gain guidelines in pregnancy 3 Pregnant First Nations women have significantly lower levels of recreational physical activity than non-First Nations women 4

Benefits of Physical Activity in Pregnancy The benefits of physical activity include increased physical, mental, and social well-being 5 Reduction in risk of gestational diabetes 6 Prevents excessive weight gain 7

Historical Positioning Class Race Gender Postcolonial Feminism Theoretical Perspective

Focus of this Presentation FOCUS POPULATION Service and Care Providers FOCUS POPULATION Service and Care Providers METHOD Semi-structured interviews with 15 service and care providers METHOD Semi-structured interviews with 15 service and care providers QUESTION What are the barriers to optimal weight gain and physical activity in pregnancy for urban First Nations women?

Analysis Data were transcribed verbatim and reviewed NVivo10 TM Qualitative software data analysis program Critical discourse analysis 8 was conducted Findings were shared and discussed with members of the advisory board Artist – Leah Dorian

Discourses in the Data Poverty is a barrier to physical activity in pregnancy Overweight and obesity are normalized within First Nations communities Positive and culturally safe messaging about First Nations women and physical activity is needed

Poverty is a barrier to physical activity in pregnancy PovertyFood InsecurityChildcare Issues Transportation Issues Housing Education/Health Literacy

Overweight and obesity are normalized within First Nations communities “Not enough of the mothers see obesity as an issue in the community. Gaining excessive weight is not an issue- in fact I have yet to meet a mother that worries about that!” -Dietitian “Sadly I think it [obesity] is not perceived as much as an issue because obesity has almost been widely accepted and normalized - it is very alive in our culture. So I think pregnant or not it is very prevalent and not perceived as big an issues as other various issues that exist.” -Healthy Living Director

Positive and culturally safe messaging about First Nations women and Physical activity in pregnancy is needed Need for culturally safe resources that reflect the community Need more emphasis on culture in physical activity Often a strong desire for pregnant women to return to culture Women are more likely to use the resources if they can identify with them “Many of the mothers are afraid to go to non-Aboriginal programs for healthcare and programs” -Social worker Photo I took at Tyendinaga Pow-wow in Deseronto 2013

Photo I took at Tyendinaga Pow-wow in Deseronto 2013 Importance of Physical Activity in the Community “If I was to see an Indigenous woman being strong, and active during her pregnancy, even in her 8th month of pregnancy, I would have been so inspired to see that. But I didn’t. And not to be negative, but we’re just not there yet. And by me being there, I have pictures of myself training with kettle bells when I was 9 months pregnant, and I’m going to keep those for my family and my community to say you can do this, but I would have loved to have that for myself. Going through it.” - Tricia McGuire-Adams (Key Informant)

First Nations women continue to be marginalized Disadvantages rooted in historical and political factors Health/program providers efforts are undermined by systemic issues Social determinants of Aboriginal health Discussion

Resources must be guided by First Nations women and First Nations health care providers Create resources/programs that are representative of determinants of First Nations health Create better supports for organizations Resources need diverse and positive representation of First Nation female images Address physical activity in pregnancy as a tool for overall health Creation of culturally safe resources Free and widespread distribution of resources Recommendations from the Key Informants:

Solutions are more relevant to the community if they come from the community Electronic weekly pregnancy resource that is grounded in Indigenous ways of knowing Personal is the political! Conclusion

Thank-you! Questions?

References 1. First Nations Regional Longitudinal Health Survey (2003) 2. Statistics Canada. (2005). Projections of the Aboriginal populations, Canada, provinces and territories: 2001 to Statistics Canada catalogue no XIE. 3. Lowell, H., & Miller, D.C. (2010) Weight gain during pregnancy: Adherence to Health Canada’s guidelines. Statistics Canada Health Reports, 21(2). 4. Back, L., Hui, A., Reid, A., Sevenhuysen, G., Gardiner, P., Ludwig, S., & Shen, G.X. (2012). Comparison of Physical Activity and Nutritional Intake in First Nations Pregnant Women in Remote Communities and Urban-Living Pregnant Women. Canadian Journal of Diabetes. 36(2): Warbuton, D.E., Nicol, C.W., & Bredin, S.S. (2006). Health benefits of physical activity: the evidence. Canadian Medical Association Journal, 174(6), Brunette, E.L., Kotze, J. Wood, P.S., du Toit, P.J., & Grant, C.C. (2012). An epidemiological study of physical activity patterns and weight gain in physically active and sedentary pregnant women in Tshwane, South Africa. African Journal for Physical, Health Education, Recreation and Dance. 18(1), Petersen, B.K. (2012). Physical activity in pregnancy. Maternal Obesity and Pregnancy In P.G Ovesen & D.M. Jensen (Eds.), Maternal Obesity and Pregnancy, (pp ). New York, NY: Springer. 8. Davies, G.A., Wolfe, L.A., Mottola, M.F., & MacKinnon, C. (2003). Exercise in pregnancy and the postpartum period. Journal of Obstetrics and Gynaecology Canada, 25(6) 1-7.

Key Informant Interviews o Social Worker o Healthy Living Program Director o Pre/post natal program Coordinator o Dietician o Nurse Practitioner o Midwife o Healthy Living Program Coordinator o Government Health Worker o Parenting Program Coordinator o PRO Trainer for Canfitpro o Family Outreach Coordinator