Provider and participant views and experiences of the ESTEEM dietary intervention for pregnant women with metabolic risk factors: a qualitative study

Abstract

Background ESTEEM (Effect of Simple, Targeted diEt in prEgnant women with Metabolic risk factors on pregnancy outcomes), was a randomised controlled trial of a dietary intervention based on the Mediterranean diet. Intervention programmes like this are recognised in the literature as complex to evaluate and engagement and adherence are problematic. There is a need for dietary interventions in pregnancy which are simple and effective. The aim The aim of this study was to explore the views and experiences of the ESTEEM dietary intervention in a pregnant cohort with metabolic risk factors. Methods Qualitative methods using interviews with women, partners (separately) and focus groups with health care professionals were carried out. Data were analysed using thematic analysis. The findings Women were able to plan and adapt their food and use the ESTEEM diet to their own and their family’s advantage. Conversely, some of the information provided during the ESTEEM intervention made women more aware of their metabolic risk factors and more anxious. Women found solutions to their individual concerns during the ESTEEM intervention, by sharing information and ideas, and by supporting each other. Partners perceived the dietary intervention as having benefits for themselves, the mother as well as their children. Men appeared to hold mothers to be mainly responsible for feeding the children and ensuring that what they ate was healthy. Health care professionals considered that developing and maintaining good relationships with women, and skilful and flexible approaches to enable dietary change were needed. They also emphasised the need to include family and friends, and in particular, children in interventions. Conclusions In order to effect dietary change, the material context in which people live must be taken into consideration. Diet and lifestyle interventions will become truly effective if they are codesigned with women and families and health care is co-produced with people.