Improving Data Integrity and Quality From Online Health Surveys of Women With Infant Children.

BACKGROUND: Online surveys have proven to be an efficient method to gather health information in studies of various populations, but these are accompanied by threats to data integrity and quality. We draw on our experience with a nefarious intrusion into an online survey and our efforts to protect data integrity and quality in a subsequent online survey. OBJECTIVES: We aim to share lessons learned regarding detecting and preventing threats to online survey data integrity and quality. METHODS: We examined data from two online surveys we conducted, as well as findings of others reported in the literature, to delineate threats to and prevention strategies for online health surveys. RESULTS: Our first survey was launched inadvertently without available security features engaged in Qualtrics, resulting in a number of threats to data integrity and quality. These threats included multiple submissions, often within seconds of each other, from the same internet protocol (IP) address; use of proxy servers or virtual private networks, often with suspicious or abusive IP address ratings and geolocations outside the United States; and incoherent text data or otherwise suspicious responses. After excluding fraudulent, suspicious, or ineligible cases, as well as cases that terminated before submitting data, 102 of 224 (45.5%) eligible survey respondents remained with partial or complete data. In a second online survey with security features in Qualtrics engaged, no IP addresses were associated with any duplicate submissions. To further protect data integrity and quality, we added items to detect inattentive or fraudulent respondents and applied a risk scoring system in which 23 survey respondents were high risk, 16 were moderate risk, and 289 of 464 (62.3%) were low or no risk and therefore considered eligible respondents. DISCUSSION: Technological safeguards, such as blocking repeat IP addresses and study design features to detect inattentive or fraudulent respondents, are strategies to support data integrity and quality in online survey research. For online data collection to make meaningful contributions to nursing research, it is important for nursing scientists to implement technological, study design, and methodological safeguards to protect data integrity and quality and for future research to focus on advancing data protection methodologies.

Qualitative Research on Self-Transcendence in Older Adults: A Scoping Review.

The current scoping review describes qualitative research on self-transcendence (ST) in older adults. Articles from five databases were independently screened and data were extracted from predetermined categories. Results were compared and consensus reached through discussion. The two leading theorists guiding the chosen studies were Pamela Reed and Lars Tornstam. Experiential language in the studies most often touched on intrapersonal and interpersonal ST. Two main gaps identified in the literature were: (a) limited coverage of transpersonal aspects of ST, and (b) limited inclusion of experiential language of study participants. More qualitative research, phenomenology in particular, can shed light on the topic of ST. A deeper understanding of all aspects of ST, including experiential language used to describe it, can lay a foundation for nursing to advance with theory formation, scale construction, and interventions to better promote spiritual and psychological well-being in older adults. [Journal of Gerontological Nursing, 49(9), 43-48.].

Term Newborn Care Recommendations Provided in a Kenyan Postnatal Ward: A Rapid, Focused Ethnographic Assessment.

BACKGROUND: Neonatal mortality (death within 0-28 d of life) in Kenya is high despite strong evidence that newborn care recommendations save lives. In public healthcare facilities, nurses counsel caregivers on term newborn care, but knowledge about the content and quality of nurses' recommendations is limited. PURPOSE: To describe the term newborn care recommendations provided at a tertiary-level, public referral hospital in Western Kenya, how they were provided, and related content taught at a university nursing school. METHODS: A rapid, focused ethnographic assessment, guided by the culture care theory, using stratified purposive sampling yielded 240 hours of participant observation, 24 interviews, 34 relevant documents, and 268 pages of field notes. Data were organized using NVivo software and key findings identified using applied thematic analysis. RESULTS: Themes reflect recommendations for exclusive breastfeeding, warmth, cord care, follow-up examinations, and immunizations, which were provided orally in Kiswahili and some on a written English discharge summary. Select danger sign recommendations were also provided orally, if needed. Some recommendations conflicted with other providers' guidance. More recommendations for maternal care were provided than for newborn care. IMPLICATIONS FOR PRACTICE: There is need for improved consistency in content and provision of recommendations before discharge. Findings should be used to inform teaching, clinical, and administrative processes to address practice competency and improve nursing care quality. IMPLICATIONS FOR RESEARCH: Larger studies are needed to determine whether evidence-based recommendations are provided consistently across facilities and other populations, such as community-born and premature newborns, who also experience high rates of neonatal mortality in Kenya.

Beliefs, Attitudes, and Practices of Latinas Related to Gestational Weight Gain: A Qualitative Meta-Synthesis.

INTRODUCTION: Excessive and inadequate gestational weight gain (GWG) are associated with a number of negative health outcomes for mother and infant. Approximately two-thirds or more of Latinas gain outside of GWG guidelines. Acculturation plays a role in GWG-related factors, however the views of Latinas are often aggregated in overall study samples, thus trivializing the specific needs of this demographic group. The purpose of the present meta-ethnography was to better understand GWG beliefs, attitudes, and practice among Latinas by synthesizing extant qualitative findings on this topic. METHODS: Qualitative studies offer an important window into Latinas' views and practices related to GWG. A qualitative meta-ethnography (a form of meta-synthesis) was implemented to synthesize qualitative studies about Latinas' views of GWG-related factors. An initial sample of articles was distilled based on meta-ethnography guidelines from Noblit and Hare (1988) to a final sample of six qualitative articles that included perspectives from Latinas. RESULTS: Six concepts emerged across the studies, they included: shifts in feeling control, inconsistent/lacking information, self vs. other, applied wisdom, isolation vs. support, and everyday practicality. Studies met most quality assessment criteria (Atkins et al., BMC Medical Research Methodology 8:21, 2008). DISCUSSION: The views of Latinas about GWG-related factors are often buried in with perspectives of other women, which hides important details that are valuable for health program interventions designed to support these women. Future research should further explore the cultural differences in experience among Latinas to produce information and resources that are culturally relevant and relatable.

Gifts of wise women: A reflection on enduring ideas in nursing that transcend time.

In this essay, I propose there are enduring ideas in the works of nurse theorists from the 1960s and 1970s that were valuable not only in the past, but in nursing today as well as in possibly shaping the future of nursing knowledge development. I identify these as gift ideas and draw on the work of Wiedenbach for the gift of dignity in nursing philosophy, and the gifts of dialogue from Orlando, behavioral systems from Johnson, context from Roy, self-care from Orem, and finally the gift of nursing science as emergent in understanding life processes from Rogers. Although the core of nursing knowledge may be elusive, the gift ideas mentioned in this essay provide some guideposts in articulating and developing that core in the present as well as in the future.

Development and evaluation of a mother-centered toolkit for postpartum behavioral and psychosocial health.

The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N = 24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit's acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH.

A systematic method for reviewing and analysing health information on consumer-oriented websites.

AIM: A discussion of a proposed method for analysing the quality of consumer-oriented websites that provide health-related information. BACKGROUND: The quality of health information available to consumers online varies widely in quality. In an effort to improve the quality of online information, experts have undertaken systematic reviews on selected health topics; however, no standardized comprehensive methodology currently exists for such review. DESIGN: An eight-step method is recommended embracing the following steps: (a) select topic; (b) determine the purpose of the analysis; (c) select search terms and engines; (d) develop and apply website inclusion and exclusion criteria; (e) develop processes and tools to manage search results; (f) specify measures of quality; (g) compute readability; (h) evaluate websites. Each of these steps is illustrated in relation to the health topic of gynaecomastia, a physical and mental health challenge for many adolescent males and young men. IMPLICATIONS FOR NURSING: Although most extant analyses of consumer-oriented websites have focused on disease conditions and their treatment, website analysis methodology would encourage analyses that fall into the nursing care domain. CONCLUSION: The method outlined in this paper is intended to provide nurses and others who work with specific patient populations with the tools needed for website analytic studies. Such studies provide a foundation for making recommendations about quality websites, and identifying gaps in online information for health consumers.

e-Health and new moms: Contextual factors associated with sources of health information.

OBJECTIVE: Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-Health media, and associated contextual factors. DESIGN AND SAMPLE: Cross-sectional survey of 165 mothers (White, African-American, and Hispanic) from a stratified random sample. MEASURES: Use of online media about mother-baby care; favorite websites about motherhood and best-liked features of Web sites; channel preferences (Web site, postal mail, text) for receiving three types of health information; and contextual factors, e.g., education. RESULTS: Media use ranged from 96% for health information searches about babies to 46% for YouTube viewing about mother-baby topics. Contextual factors, such as education, were associated with media use. Babycenter was the most frequently reported favorite Web site and rich, relevant information was the best-liked feature. Across three health topics (weight, stress/depression, parenting) mothers preferred receiving information by Web site, followed by postal mail and least by text messaging (χ2 statistics, p < .001). Stress and race/ethnicity were among factors associated with preferences. CONCLUSIONS: Mothers widely used e-Health related media, but use was associated with contextual factors. In public health efforts to reach new mothers, partnering with mother-favored Web sites, focusing on audience-relevant media, and adopting attributes of successful sites are recommended strategies.

Mental health literacy and postpartum depression: a qualitative description of views of lower income women.

The purpose of this study is to understand mental health literacy (MHL) (Jorm, 2000) in lower income women postpartum and share participant experiences of recognizing and seeking help for depressive symptoms. Focus group textual data were received from 25 participants who completed a weight and psychosocial health longitudinal study. Iterative content data analysis using Jorm's framework provided thematic understandings descriptive of MHL. Women recognized behavioral changes indicating mental distress, but fears prevented them from seeking help, and some resorted to risky behaviors. This framework could guide providers to identify women who may benefit from early intervention for postpartum depressive symptoms.

Leading Stressors and Coping Strategies Associated With Maternal Physical and Mental Health During the Extended Postpartum Period.

INTRODUCTION: A critical gap exists in understanding stressors and coping that affect women's health beyond 6 weeks postpartum. Using new stressor and coping scales tailored to postpartum women, we examined the relationship of postpartum-specific stressors and coping to women's physical and mental health between 2 to 22 months after childbirth. METHODS: A total of 361 women of diverse race, ethnicity, and functional abilities recruited through clinical and online methods completed online surveys that included Sources of Stress-Revised subscales, such as overload, changes after pregnancy, and low support resources; Postpartum Coping Scale subscales, such as self-regulation, self-care, and health promotion; Patient-Reported Outcomes Measurement Information System Global Health, covering physical and mental health dimensions; and social demographic items. Analyses included hierarchical linear regression models adjusted for social factors. RESULTS: Education and employment were the only social factors associated with physical and mental health, respectively. After adjusting for social factors, overload (P < .001) and coping through health promotion (P = .020) were the only additional variables associated with physical health. After adjusting for social factors, overload (P < .001) and low support resources (P = .002) and coping through self-care (P = .036) were the only additional variables associated with mental health. Thus, being overloaded was the key stressor associated with decreases in physical and mental health. Health promotion was associated with increases in physical health, and self-care was associated with increases in mental health. DISCUSSION: These findings point to directions for health care and community interventions to promote health for postpartum women under stress. Strengths of our study include application of stress and coping scales tailored to postpartum women, whereas a limitation is use of a cross-sectional design.

Cumulative poor psychosocial and behavioral health among low-income women at 6 weeks postpartum.

BACKGROUND: During the postpartum period, women may experience unfavorable psychosocial and behavioral health in multiple domains with adverse effects on parenting and maternal and infant health. Yet, little is known about the accumulation of poor health across the domains of depressive symptoms; body image; diet and physical activity; substance use including smoking and alcohol; and general self-care at 6 weeks postpartum, the usual end of maternity care. OBJECTIVES: The aims of this study were to evaluate relationships among the domains comprising psychosocial and behavioral health and to examine the distribution and risk factors associated with cumulative poor psychosocial and behavioral health at 6 weeks postpartum. METHODS: This study was a secondary analysis of cumulative poor health assessed by self-report scales for depressive symptoms, body image dissatisfaction, diet and exercise, substance use, and general self-care among 419 low-income White, African American, and Hispanic women at 6 weeks postpartum. Multivariable Poisson and logistic regression were used in key analyses. RESULTS: The correlation among psychosocial and behavioral domains had a range of r = .50-.00. In this sample of women, 45% had two or more domains in which they had poor health. The model testing risk factors for cumulative poor health was significant (likelihood ratio chi-square = 39.26, df = 11, p < 0.05), with two significant factors: not exclusively breastfeeding (odds ratio [OR] = 1.459, 95% confidence interval [CI] [1.119, 1.901]) and Hispanic ethnicity (OR = 0.707, 95% CI [0.582, 0.858], psuedo-R = .029). Within individual domains, significant risk factors (body mass index, not exclusively breastfeeding, ethnicity, education level, and parity) varied by domain. DISCUSSION: Many low-income women postpartum have poor psychosocial and behavioral health in multiple domains, which constitute areas for health promotion and early disease prevention.

What new mothers' favorite web sites and features tell us about designing web-based health promotion: a content analysis.

OBJECTIVE: Unmet health needs experienced by new mothers may potentially be reduced by the use of Internet-based information, advice, decision support, and social networking. New mothers' Web site preferences must be understood in order to develop successful Internet-delivered healthcare information. The purpose of this study is to determine the Web site preferences of new mothers in order to better design health resources distributed through the Internet. MATERIALS AND METHODS: Data were derived from two open-ended questions in a larger survey of new mothers of varying incomes and racial/ethnic groups (n=145). The questions focused on mothers' favorite Web sites and their favorite aspect of the Web sites. Content analysis was used to condense data into descriptive categories. RESULTS: Mothers most frequently chose commercial search engines, followed by social networking sites, as their favorite Web sites. Mothers' most frequently mentioned favorite attributes of the Web sites were, first, the ability to interact with other users, and then ease of navigation, access, and use. Except for a difference in favorite Web site associated with maternal age, Web sites and their most liked attributes did not differ by demographic characteristics. CONCLUSIONS: New mothers' Web site preferences offer preliminary guidance for designers of e-health resources for this population. An expanded survey with more detailed questions about preferences and devices would further refine this knowledge base.

Physical conditions and depressive symptoms of Chinese postpartum mothers in the United States and Taiwan.

In this study, we aimed to determine commonalities and differences in physical conditions and depressive symptoms of Chinese postpartum mothers in the United States and Taiwan, and whether their relationship differs by country. Data from 151 Chinese mothers in the United States and 238 Taiwanese mothers were analyzed. A physical health condition checklist and the Center for Epidemiologic Studies Depression (CESD) scale were used. More Taiwanese mothers experienced depression. Depression scores were correlated with physical conditions. Over 50% of mothers with depression experienced physical exhaustion, sleep disturbances, interrupted sleep, and decreases in memory. Active assessments and cultural care for managing physical conditions may prevent postpartum depression.

Modification and Psychometric Analyses of Stress and Coping Scales for the Extended Postpartum Period.

OBJECTIVE: To modify and psychometrically assess two scales that are used to measure stress and coping during the extended postpartum period. DESIGN: Instrument modification and psychometric assessment. SETTING: Online, community, and health care settings. PARTICIPANTS: Mothers with infants who were 2 to 22 months old: 20 in Phase 1 and 373 in Phase 2. METHODS: In Phase 1, participants from diverse backgrounds served as content experts to recommend modifications of items on two scales: Sources of Stress-Revised (SoS-R) and Postpartum Coping Scale (PCS). The results were 32-item modified versions of each scale. In Phase 2, we conducted a psychometric analysis of both revised scales using principal components analysis to identify dimensionality, Cronbach's alphas to estimate internal consistency reliability, and Pearson correlations to estimate validity of the SoS-R and PCS with the Perceived Stress Scale and the Brief COPE, respectively. RESULTS: We identified six components for the SoS-R: Overload, Changes After Pregnancy, Baby-Related Concerns, Working Mother Concerns, Low Support Resources, and Isolated Motherhood. The Cronbach's alpha for the SoS-R was .94. The SoS-R subscales demonstrated correlations with the Perceived Stress Scale that ranged from 0.55 to 0.30. We identified six components for the PCS: Self-Regulation, Spiritual Care, Self-Care, Use and Seek Support, Internal and External Resources, and Health Promotion. The Cronbach's alpha coefficients for the PCS ranged from .84 to .66. The highest correlations observed between the PCS subscales and the Brief COPE subscales ranged from 0.67 to 0.26. CONCLUSION: The SoS-R and PCS each include six components. Internal consistency reliability for all SoS-R subscales and four of six PCS subscales exceeded .70. The dimensions of each scale highlight areas of clinical and research concern.

Relationships among maternal nutrient intake and placental biomarkers during the 1st trimester in low-income women.

PURPOSE: Pre-eclampsia is a multi-system disorder caused by inadequate placentation in early pregnancy; however, little is known about the influence of nutrient intake on placental development during the crucial 1st trimester. The objective of this study was to examine the relationships between nutrient intake and the raw values and ratios of angiogenic [placental growth factor (PlGF)] and antiangiogenic [soluble fms-like tyrosine kinase-1 (sFlt-1) and soluble endoglin (sEng)] placental biomarkers in the 1st trimester. METHODS: A cross-sectional study of low-income, pregnant women (n = 118). Average nutrient intake was calculated from three 24-h dietary recalls. Biomarker values were adjusted for gestational age and nutrients were adjusted for energy. RESULTS: The angiogenic to antiangiogenic ratio [PlGF/(sFlt-1 × sEng)] was positively related to intake of vitamin D (r = 0.24), vitamin B(2) (r = 0.25), B(12) (r = 0.20), dietary folate equivalents (r = 0.19), iron (r = 0.19), and zinc (r = 0.19) and negatively related to transfats (r = -0.24). Principal component analysis revealed that a vitamin/mineral factor [t (112) = 2.58, p = 0.011] and transfats factor [t (112) = -2.03, p = 0.045] were significant predictors of the PlGF/(sFlt-1 × sEng) ratio. The vitamin and mineral factor was a significant predictor of sFlt-1 [t (122) = 2.29, p = 0.024]. CONCLUSIONS: Expression of placental biomarkers in the early weeks of pregnancy may be influenced by intake of nutrients. Understanding the influence of maternal nutrient intake and placental development in the 1st trimester may provide the opportunity to avert the development or blunt the severity of preeclampsia.

New mothers' interest in web-based health promotion: association with healthcare barriers, risk status, and user characteristics.

OBJECTIVE: Our first aim was to assess the contributions of health-related risks, barriers to healthcare, and user characteristics to new mothers' interest in two Web-based health programs: postpartum weight loss or parenting advice. Our second aim was to determine if the preceding proximal variables diminished associations of income level with interest in Web-based health programs. SUBJECTS AND METHODS: A mail survey of a stratified random sample was conducted with a resulting analytic sample that included 121 white/Anglo, African American, or Hispanic women of higher and lower income. Weight risk (being overweight or obese) and psychosocial/behavioral risk (alcohol use, depression, smoking) were the predictors of interest in a weight loss program and parenting advice, respectively. Financial, structural, and function factors served as barriers to care. Frequency of Internet use assessed user characteristics. Hierarchical logistic regression analysis was used to evaluate predictors. RESULTS: Being overweight (adjusted odds ratio [OR], 5.55; 95% confidence interval [CI], 2.18, 14.11) was the only variable to affect likelihood of interest in an Internet-based weight loss program; income level was not a significant predictor. Having two or more psychosocial/behavioral risks (adjusted OR, 0.22; 95% CI, 0.50, 0.92) was the only predictor of interest in Internet-based parenting advice; income level was not a significant predictor after adjusting for other variables (OR, 0.55; 95% CI, 0.19, 1.55). CONCLUSIONS: The type of risk and program topic decreased or increased likelihood of interest in Internet-based programming. Weight risks increased interest in weight loss programming, but psychosocial/behavioral risks deceased interest in parenting advice.

Maternal Stressors and Coping Strategies During the Extended Postpartum Period: A Retrospective Analysis with Contemporary Implications.

Background: Despite recent emphasis on the "fourth trimester" and beyond, most knowledge of stressors affecting women is focused on the first 6 postpartum weeks. Our aim was to identify postpartum-specific stressors and coping over the extended postpartum period. Methods: We analyzed data from two surveys for a combined sample of 346 postpartum women. Principal components analysis of survey items on sources of stress was used to identify categories of postpartum-specific stressors. Content analysis was used to categorize text data on coping strategies. Results: Seven stressors were identified: Overload, Working mother concerns, Isolated motherhood, Limited supportive resources, Exhaustion, Parenting demands, and Changes in body and sexuality. Overload was the most frequent stressor (F = 49.32, p < 0.001) and was significantly higher at 9-12 months than at 5-8 months or at 13 months or more (F = 6.42, p = 0.002). Fulltime employment and having more than one child were associated with elevated scores on several stressors. Content analysis yielded seven coping strategies, such as Take time alone or with others, Manage emotions and thoughts, and Maintain a manageable workload. Five of the seven stressors were associated with at least one of the top five coping strategies; none was associated with Overload or Limited supportive resources. Conclusions: Women's predominant source of stress was from overload and was highest at 9 to 12 months postpartum. Community resources and public health policy and programming are needed to prepare and support women during the challenging first postpartum year.

Systematic Review of Health Promotion Frameworks Focused on Health in the Postpartum Period.

OBJECTIVE: To systematically review the scope and development of frameworks to promote health during the postpartum period. DATA SOURCES: We searched PubMed, CINAHL, and American Psychological Association PsycInfo during May 2021. STUDY SELECTION: We included English-language, peer-reviewed articles focused on frameworks for health promotion in the postpartum period. We placed no time limit on publication date. Our search resulted in 2,355 articles after we removed duplicates. After excluding articles based on titles and abstracts, we conducted full-text reviews of 23 articles. Three articles met inclusion criteria and addressed the following frameworks: Integrated Perinatal Health Framework, Perinatal Maternal Health Promotion Model, and Maternal Self-Care Framework. DATA EXTRACTION: We extracted data into analytic tables that included categories for the scope, such as time frame, and criteria for the level of development of the frameworks, including the origins, concept definitions and theoretical linkages among concepts, and evidence of application in research or practice. DATA SYNTHESIS: The three frameworks described in the articles included in our review covered various periods, including the reproductive life span, the first year after birth, and the first 6 weeks after birth. Overall, the frameworks were comprehensive. Most key concepts in the frameworks were defined, and some degree of relationships linking concepts was specified. Empirical referents were provided for most but not all concepts in the frameworks. Developers of the three frameworks elaborated on application in practice or health services, but only the developers of the Maternal Self-Care Framework indicated how their framework might be used in research. The Integrated Perinatal Health Framework and Maternal Self-Care Framework were partially derived from existing general theories; the methods used to develop the Perinatal Maternal Health Promotion Model were less clear. CONCLUSION: The frameworks met most criteria and together provided a comprehensive strategy for health promotion during the postpartum period. Elaboration of the frameworks for application in research is needed.

Predictors of dietary quality in low-income pregnant women: a path analysis.

BACKGROUND: Despite the potential importance of nutrition to pregnancy outcomes, little is known about the factors influencing dietary quality, especially during the first trimester. OBJECTIVE: The aim of this study was to examine the relationships of distress (an index of depression and stress), social support, and eating habits with dietary quality in low-income pregnant women. METHOD: A cross-sectional design and path analytic methods was used in a clinic-based sample of low-income women (n = 118) in their first trimester of pregnancy. Women completed questionnaires and received training on estimating food portion sizes. Three 24-hour dietary recalls were collected over 2 weeks. Overall dietary quality was assessed using the Dietary Quality Index-Pregnancy. RESULTS: The final path model fit well (comparative fit index [CFI] = .97, root mean square error of approximation [RMSEA] = .05) and revealed that distress had a direct effect on poor eating habits (ß = .36) and a direct (ß = -.23) and indirect effect on dietary quality (ß = -.30). Poor eating habits had a direct effect on dietary quality (ß = -.18). Social support had no effect on dietary quality. Age had significant direct effects on education (ß = .39) and nutritional knowledge (ß = .18) and an indirect effect on dietary quality (total effect, ß = .19). Maternal age, education, and nutritional knowledge did not have significant effects on psychosocial variables. DISCUSSION: Psychosocial distress and poor eating habits contributed to inadequate dietary quality. Assessing for depression, stress, poor eating habits, and overall dietary quality during the crucial first trimester may identify women needing more intensive dietary monitoring and intervention throughout pregnancy.

Cluster analysis identifies subpopulations for health promotion campaign design.

While health communication campaigns have been effective in addressing a variety of health concerns, even broadly successful campaigns can miss particular subpopulations. The statistical technique of cluster analysis, which makes it possible to group individuals based on sets of identifying variables, is a statistical method that could prove useful in the design of more effective communication campaigns. This paper illustrates the use of cluster analysis to group women based on their (1) prepregnancy weight, (2) weight gain during pregnancy, and (3) weight retention after giving birth as it relates to the process of targeting subpopulations and developing more effective health communication campaigns and interventions. The implications of cluster analysis, from guiding additional formative research to development of health communication strategies, are discussed.