Keep Fit works! Our brief (<15 minutes), computerized, multi-media Video Doctor intervention was integrated into prenatal practices and successfully assisted pregnant women to improve their dietary habits and increase their exercise! In our Video Doctor group, there were significant within group increases in exercise, intake of fruits and vegetables, whole grains, fish, avocado and nuts and significant decreases in intake of sugary foods, refined grains, high fat meats, fried foods, solid fats and fast food. In contrast, there were no within group differences for any of these outcomes in the control group. Clinician-patient discussions about these topics occurred more frequently in the intervention group.
As with substance abuse and intimate partner violence (IPV), regularly scheduled prenatal visits offer multiple opportunities for providers to deliver and reinforce behavior change messages regarding gestational weight gain, dietary habits, and physical activity. In recent years, the number of Americans facing health risks related to their weight has risen rapidly, and this alarming trend has become increasingly prominent among women entering pregnancy. In addition to pre-pregnancy weight, inappropriate weight gain during pregnancy is also associated with adverse outcomes for both the mother and child.
In order to improve appropriate weight gain, dietary habits, and physical activity among pregnant women, we developed HIP-Keep Fit, a second arm to the Health in Pregnancy (HIP) study. Paralleling the design and methods of HIP, though targeting different behavioral risks, Keep Fit is a randomized controlled trial to determine whether a brief motivational intervention, delivered at prenatal visits and featuring a Video Doctor and Cueing Sheets for providers, can improve womenís attainment of recommended gestational weight gain, while improving womenís self-reported healthy diet and physical activity, compared with usual care. The Keep Fit intervention delivers information tailored to the participantís pre-pregnancy Body Mass Index (the ratio of weight to height), and then delivers interactive advice about eating healthy and staying active during pregnancy.
(Click here for visual of the HIP-Keep Fit study design.)
This video clip depicts the Video Doctor giving the pregnant woman feedback on her Body Mass Index, BMI, and her target weight gain range, based on the guidelines.
In this next clip, the Video Doctor suggests that the woman not drink sugary drinks such as soda and fruit juice, and that she hydrate with water.
The Video Doctor explains briefly why it is important for the pregnant woman to try to prevent excessive weight gain and gestational diabetes.
The Video Doctor clips are interactive, and subsequent branching is directed by patient input. Women are asked what might be their barriers or roadblocks to their eating healthfully during pregnancy. One option is because “they feel they are eating for two and, therefore, pregnancy is a good time to eat.” Here the Video Doctor explains why this approach can be harmful to the woman and to her baby.
In the following video clip, the Video Doctor closes her discussion with the pregnant woman by suggesting that the woman continue the discussion about diet and exercise with her clinician.
At the conclusion of each intervention session, the program automatically printed 2 documents: 1) an “Educational Worksheet” for participants with questions for self-reflection, and local resources; and 2) a “Cueing Sheet” for providers, which offered a summary of the patient’s risk profile and readiness to change, and suggested behavior change counseling statements. The Cueing Sheet was placed in the patient’s medical record for the provider’s use during the medical appointment. (To view a sample Worksheet, click here. For a sample Cueing Sheet, click here.)
Improving nutrition and exercise in pregnancy
with Video Doctor counseling: A Randomized Trial
Rebecca A. Jackson, MD,1,2 Naomi Stotland, MD,1,
Barbara Gerbert, PhD3
OBJECTIVE To determine whether an interactive, multi-media Video Doctor intervention would decrease excessive weight gain and improve women’s diet and exercise knowledge and behaviors during pregnancy.
METHODS A randomized clinical trial comparing the Video Doctor intervention to usual care was conducted in an ethnically diverse, low-income sample of English speaking women at 5 sites. Brief messages about weight gain, exercise, grains, fats, and sugars were given at an average of 19 weeks gestation with one follow-up about 6 weeks later.
RESULTS We enrolled 327 pregnant women; 158 were assigned to the Video Doctor and 163 to usual care. Twelve percent withdrew or were lost to follow-up. Just over half of each group gained more than the IOM recommends (RR =1.06 (0.83-1.36)). In the Video Doctor group, there were significant within group increases in exercise, intake of fruits and vegetables, whole grains, fish, avocado and nuts and significant decreases in intake of sugary foods, refined grains, high fat meats, fried foods, solid fats and fast food. In contrast, there were no within group differences for any of these outcomes in the control group. Nutrition knowledge improved significantly over time in both groups but more so in the Video Doctor group. Clinician-patient discussions about these topics occurred more frequently in the intervention group.
CONCLUSION A brief computerized intervention that can be integrated into a prenatal practice can successfully assist pregnant women to improve their dietary habits and increase their exercise.