Health at Every Size Principles: Clinician Perspectives To Limit Weight Stigma in Medical Care.

OBJECTIVE: Health At Every Size is a paradigm that encourages body acceptance, intuitive eating, and other principles to increase healthy, peaceful living. The model is accepted by many in the mental health field, but in order for its principles to become standard in clinical (medical) care, clinician perspectives on Health at Every Size should be sought and understood. METHODS: Ten clinicians were interviewed (4 physicians, 2 nurse practitioners, and 4 physician assistants). Participants reviewed the HAES principles, and identified facilitators and barriers to respectful, weight-inclusive care. RESULTS: Most clinicians felt that body mass index is a useful, standard metric, but it is inadequate and can be a cause of distress. Providing non-weight-focused care was identified as the primary facilitator to respectful care. DISCUSSION: Participants viewed body mass index as useful in some scenarios but do not think it encompass a patient's well-being and has the potential to cause the patient distress (eg, perpetuating weight stigma). Barriers to using Health At Every Size in clinical practice included the need for clinician education, bias/stigma, and a focus on weight.

A socioecological framework for engaging substance-using pregnant persons in longitudinal research: Multi-stakeholder perspectives.

OBJECTIVE: Understanding the impact of substance use during pregnancy on fetal development and child health is essential for designing effective approaches for reducing prenatal substance exposures and improving child outcomes. Research on the developmental impacts of prenatal substance exposure has been limited by legal, ethical, and practical challenges. This study examined approaches to engage substance-using (with an emphasis on opioids) pregnant persons in longitudinal research, from multi-stakeholder perspectives. METHODS: The present study solicited the expertise of 1) an advisory group of community stakeholders, including people with lived experienced of opioid/substance use; and 2) an online survey with content experts. Qualitative analysis examined facilitators and barriers to recruiting and retaining substance-using pregnant persons through a socioecological lens at the individual, interpersonal, organizational, community, and policy levels. RESULTS: Stakeholders (N = 19) prioritized stigma, loss of confidentiality, legal consequences, and instability (e.g., homelessness and poverty) as important barriers that prevent substance-using persons from enrolling in research studies. Of 70 survey respondents, most self-identified as researchers (n = 37), followed by clinicians (n = 19), and 'others' (n = 14). Survey respondents focused on retention strategies that build trusting relationships with participants, including incentives (e.g., transportation and childcare support), participant-friendly study design, and team-related factors, (e.g., attitudes and practices). CONCLUSION: The stakeholder input and survey data offer key insights strengthening our understanding of facilitators and barriers to research participation, and ways to overcome barriers among substance-using pregnant persons. A socioecological framework can be used to identify and address these factors to increase recruitment and long-term retention of high-risk populations.

Recruitment and retention of pregnant women in prospective birth cohort studies: A scoping review and content analysis of the literature.

Longitudinal cohort studies present unique methodological challenges, especially when they focus on vulnerable populations, such as pregnant women. The purpose of this review is to synthesize the existing knowledge on recruitment and retention (RR) of pregnant women in birth cohort studies and to make recommendations for researchers to improve research engagement of this population. A scoping review and content analysis were conducted to identify facilitators and barriers to the RR of pregnant women in cohort studies. The search retrieved 574 articles, with 38 meeting eligibility criteria and focused on RR among English-speaking, adult women, who are pregnant or in early postpartum period, enrolled in birth cohort studies. Selected studies were birth cohort (including longitudinal) (n = 20), feasibility (n = 14), and other (n = 4) non-interventional study designs. The majority were from low-risk populations. Abstracted data were coded according to emergent theme clusters. The majority of abstracted data (79%) focused on recruitment practices, with only 21% addressing retention strategies. Overall, facilitators were reported more often (75%) than barriers (25%). Building trusting relationships and employing diverse recruitment methods emerged as major recruitment facilitators; major barriers included heterogeneous participant reasons for refusal and cultural factors. Key retention facilitators included flexibility with scheduling, frequent communication, and culturally sensitive practices, whereas participant factors such as loss of interest, pregnancy loss, relocation, multiple caregiver shifts, and substance use/psychiatric problems were cited as major barriers. Better understanding of facilitators and barriers of RR can help enhance the internal and external validity of future birth/pre-birth cohorts. Strategies presented in this review can help inform investigators and funding agencies of best practices for RR of pregnant women in longitudinal studies.