Healthcare providers' gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study.

OBJECTIVE: To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes. DESIGN: Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews. PARTICIPANTS: Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings. RESULTS: Typically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (P<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointment times which allowed them to provide more in-depth counselling. Regression results identified that the higher priority level that healthcare providers place on GWG, the more likely they were to report providing GWG advice and discussing risks of GWG outside recommendations (ß=0.71, P<0.001) and discussing physical activity and food requirements (ß=0.341, P<0.001). Interview data linked the priority level of GWG to length of appointments, financial compensation methods for healthcare providers and the midwifery versus medical model of care. CONCLUSIONS: Interventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.

Evaluation of the health promotion model to predict physical activity in Iranian adolescent boys.

Promoting sustainable physical activity (PA) behavior change is challenging, and a number of theoretical models have been developed and applied to this problem. Pender's health promotion model (HPM) is a relatively new model that is based on Bandura's social cognitive theory but includes the additional construct of competing demands, which are viewed as alternative behaviors (e.g., watching television) that have powerful reinforcing properties. This study evaluates the HPM as a means to predict PA in a sample of Iranian adolescent boys. Participants were 515 boys from 100 junior high and high schools in Sanandaj, Iran. Participants' mean age was 14.33 years (SD = 1.6, range = 12-17). Participants completed questions assessing social cognitive variables, and structural equation modeling was used to fit the data to the HPM. The HPM accounted for 37% of the variance in PA but did not represent a good data fit (chi(2) = 913.85, df = 473, p < .001). There were significant pathways between PA and self-efficacy (beta = .25, p < .001), enjoyment (beta = .22, p < .01), and PA modeling (beta = -.13, p < .05). A revised model that included the indirect effects of competing demands explained 34% of the variance in PA and represented a good data fit (chi( 2) = 9.12, df = 4, p = .058). In the revised model, self-efficacy, commitment to planning, and enjoyment were associated with PA. According to the HPM, competing demands influence PA. In the study sample, competing demands were not related to PA but were inversely associated with commitment to planning.