Barriers and Facilitators to the uptake of healthy eating messages by Black African Immigrant pregnant women living in the UK: Perspectives of women and midwives.

Abstract

Background Research shows that modifying health behaviours such as dietary behaviour can have a huge impact on pregnancy outcomes and be protective against obesity and other metabolic disorders. Despite midwives being strategically placed to offer healthy eating advice in pregnancy and the existence of pregnancy healthy eating guidelines, obesity statistics still show that Black pregnant women in the United Kingdom (UK) make up about 66.6% of the obesity population in pregnancy and have an increased risk of gestational diabetes and hypertension. At the moment, there is limited data on healthy eating adherence and healthy eating interventions in pregnancy for this group in the UK. This study therefore explored the uptake and offer of healthy eating messages by Black African immigrant pregnant women in the UK and midwives who provide their care. Methods Using the methodological principles of the Constructivist Grounded Theory (CGT), twenty-six semi-structured interviews were conducted with pregnant women and midwives. Participants were recruited using convenience sampling and snowballing from NHS Trusts and the community in the South of London. Data was analysed using constant comparative analysis towards the development of a substantive theory. Findings A substantive theory: “the concept of identity, the black immigrant woman” explained the intersecting identities of the Black immigrant woman whilst trying to navigate healthy eating needs and the antenatal care system in the UK. The theory explained how categories which emerged from the analysis such as: "shifting cultural landscape", "negotiating for help", "blending in", "meeting healthy eating needs", “there are cultural needs”, “hard to engage” and “system” acted as barriers and facilitators to receiving and offering healthy eating advice. Conclusion The findings highlight the importance of the intersecting identities of the Black Immigrant pregnant woman and its influence on healthy eating needs and navigating the antenatal care system. Understanding, the concept of identity for these women is an important step towards supporting their healthy eating needs and their transition in the antenatal care system and the society in general.