Addressing embodied inequities in health: How do we enable improvement in women's diet in pregnancy?

L. McKerracher; S. Oresnik; T. Moffat; B. Murray-Davis; J. Vickers-Manzin; L. Zalot; D. Williams; D. M. Sloboda; M. E. Barker

doi:10.1017/S1368980020001093

Addressing embodied inequities in health: How do we enable improvement in women's diet in pregnancy?

L. McKerracher, S. Oresnik, T. Moffat, B. Murray-Davis, J. Vickers-Manzin, L. Zalot, D. Williams, D. M. Sloboda^*, M. E. Barker^*

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

7 Citationer (Scopus)

Abstract

Objective: To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities. Design: We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development. Setting: FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada. Participants: All local, comprising twenty-two lower SEP PPP and forty-three HSCP. Results: Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes. Conclusions: Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

Originalsprog	Engelsk
Tidsskrift	Public Health Nutrition
Vol/bind	23
Nummer	16
Sider (fra-til)	2994-3004
Antal sider	11
ISSN	1368-9800
DOI	https://doi.org/10.1017/S1368980020001093
Status	Udgivet - 1 nov. 2020
Udgivet eksternt	Ja

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10.1017/S1368980020001093

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title = "Addressing embodied inequities in health: How do we enable improvement in women's diet in pregnancy?",

abstract = "Objective: To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities. Design: We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development. Setting: FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada. Participants: All local, comprising twenty-two lower SEP PPP and forty-three HSCP. Results: Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes. Conclusions: Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.",

keywords = "Community engagement, Developmental origins, Dietary inequities, Health inequities, Pregnancy",

author = "L. McKerracher and S. Oresnik and T. Moffat and B. Murray-Davis and J. Vickers-Manzin and L. Zalot and D. Williams and Sloboda, {D. M.} and Barker, {M. E.}",

note = "Funding Information: Acknowledgements: The study reported here would have been impossible without the support of a number of people and organisations. Next, we express our gratitude for the practical and logistical support we received from our partners in Hamilton{\textquoteright}s Public Health Services and in Hamilton{\textquoteright}s Ontario Early Years Centres. We would especially like to highlight the integral roles of Michaela Servos, Kathy Pierce, Laura Wilson and their staff and colleagues who collectively run a variety of programmes aimed at improving maternal–child health, wellbeing and nutrition in the city of Hamilton. Much of our study promotion was carried out through and with these organisations, with the support and encouragement of their leaders and staff. We also thank other members of the M2B study team, especially Debbie Kao and Fei Fei Xia, along with members of the Sloboda Lab, for insightful comments on earlier presentations of our data. Finally, our deepest gratitude goes to the twenty-two PPP who took time from their hectic lives to participate in FGD and a stakeholder meeting with members of our team. Financial support: We acknowledge the contributions of our funders – the Canadian Institutes for Health Research (Hugs for Health Team Grant, no. 146333), the Women{\textquoteright}s College Hospital (XChange Grant 15k Challenge) and McMaster University (Provost{\textquoteright}s Award). Conflict of interest: We have no conflicts of interest to declare. Authorship: All authors contributed to the design of the study, spearheaded by D.M.S. and M.B. Additionally, all authors participated in a minimum of one analytical discussion session, and agreed on data interpretation and data presentation strategy. L.M. and M.B. wrote the manuscript and sketched first drafts of the figures. L.M. and S.O. constructed data tables. S.O. developed the final digital versions of figures. All authors read, edited, discussed and approved the submitted manuscript. Ethics of human subject participation: The current study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving research study participants were approved by the Hamilton Integrated Research Ethics Board. Written informed consent was obtained from all subjects. Publisher Copyright: {\textcopyright} ",

year = "2020",

month = nov,

day = "1",

doi = "10.1017/S1368980020001093",

language = "English",

volume = "23",

pages = "2994--3004",

journal = "Public Health Nutrition",

issn = "1368-9800",

publisher = "Cambridge University Press",

number = "16",

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T1 - Addressing embodied inequities in health

T2 - How do we enable improvement in women's diet in pregnancy?

AU - McKerracher, L.

AU - Oresnik, S.

AU - Moffat, T.

AU - Murray-Davis, B.

AU - Vickers-Manzin, J.

AU - Zalot, L.

AU - Williams, D.

AU - Sloboda, D. M.

AU - Barker, M. E.

N1 - Funding Information: Acknowledgements: The study reported here would have been impossible without the support of a number of people and organisations. Next, we express our gratitude for the practical and logistical support we received from our partners in Hamilton’s Public Health Services and in Hamilton’s Ontario Early Years Centres. We would especially like to highlight the integral roles of Michaela Servos, Kathy Pierce, Laura Wilson and their staff and colleagues who collectively run a variety of programmes aimed at improving maternal–child health, wellbeing and nutrition in the city of Hamilton. Much of our study promotion was carried out through and with these organisations, with the support and encouragement of their leaders and staff. We also thank other members of the M2B study team, especially Debbie Kao and Fei Fei Xia, along with members of the Sloboda Lab, for insightful comments on earlier presentations of our data. Finally, our deepest gratitude goes to the twenty-two PPP who took time from their hectic lives to participate in FGD and a stakeholder meeting with members of our team. Financial support: We acknowledge the contributions of our funders – the Canadian Institutes for Health Research (Hugs for Health Team Grant, no. 146333), the Women’s College Hospital (XChange Grant 15k Challenge) and McMaster University (Provost’s Award). Conflict of interest: We have no conflicts of interest to declare. Authorship: All authors contributed to the design of the study, spearheaded by D.M.S. and M.B. Additionally, all authors participated in a minimum of one analytical discussion session, and agreed on data interpretation and data presentation strategy. L.M. and M.B. wrote the manuscript and sketched first drafts of the figures. L.M. and S.O. constructed data tables. S.O. developed the final digital versions of figures. All authors read, edited, discussed and approved the submitted manuscript. Ethics of human subject participation: The current study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving research study participants were approved by the Hamilton Integrated Research Ethics Board. Written informed consent was obtained from all subjects. Publisher Copyright: ©

PY - 2020/11/1

Y1 - 2020/11/1

N2 - Objective: To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities. Design: We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development. Setting: FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada. Participants: All local, comprising twenty-two lower SEP PPP and forty-three HSCP. Results: Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes. Conclusions: Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

AB - Objective: To disrupt cycles of health inequity, traceable to dietary inequities in the earliest stages of life, public health interventions should target improving nutritional wellbeing in preconception/pregnancy environments. This requires a deep engagement with pregnant/postpartum people (PPP) and their communities (including their health and social care providers, HSCP). We sought to understand the factors that influence diet during pregnancy from the perspectives of PPP and HSCP, and to outline intervention priorities. Design: We carried out thematic network analyses of transcripts from ten focus group discussions (FGD) and one stakeholder engagement meeting with PPP and HSCP in a Canadian city. Identified themes were developed into conceptual maps, highlighting local priorities for pregnancy nutrition and intervention development. Setting: FGD and the stakeholder meeting were run in predominantly lower socioeconomic position (SEP) neighbourhoods in the sociodemographically diverse city of Hamilton, Canada. Participants: All local, comprising twenty-two lower SEP PPP and forty-three HSCP. Results: Salient themes were resilience, resources, relationships and the embodied experience of pregnancy. Both PPP and HSCP underscored that socioeconomic-political forces operating at multiple levels largely determined the availability of individual and relational resources constraining diet during pregnancy. Intervention proposals focused on cultivating individual and community resilience to improve early-life nutritional environments. Participants called for better-integrated services, greater income supports and strengthened support programmes. Conclusions: Hamilton stakeholders foregrounded social determinants of inequity as main factors influencing pregnancy diet. They further indicated a need to develop interventions that build resilience and redistribute resources at multiple levels, from the household to the state.

KW - Community engagement

KW - Developmental origins

KW - Dietary inequities

KW - Health inequities

KW - Pregnancy

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DO - 10.1017/S1368980020001093

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SN - 1368-9800

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JO - Public Health Nutrition

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ER -

Addressing embodied inequities in health: How do we enable improvement in women's diet in pregnancy?

Abstract

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