Exploring Prenatal Nutrition Counseling Using a Human Factors Approach

Abstract Introduction: Pregnancy people may be uniquely motivated to make positive lifestyle choices, and obstetric providers are positioned to offer support and information. Multiple contextual factors impact prenatal nutrition counseling, yet little is known about the provider-pregnant person interactions during prenatal nutrition counseling. The field of human factors (HF) considers people’s abilities, characteristics, and limitations with the equipment they use, environments in which they function, and jobs they perform. Using a HF approach, this study examined in real-time patient-provider interactions related to prenatal nutrition counseling at the initial prenatal visit. Methods: A convergent mixed methods longitudinal study using a HF framework was conducted. Initial pregnancy visits among a sample of obstetric providers at two large urban university clinics were observed and audio recorded from January to April 2023. Observed providers were interviewed and surveyed to evaluate their knowledge and practices related to pregnancy nutrition counseling; additional providers completed surveys. Patients were interviewed immediately after the visit to capture their comprehension, understanding, and perspectives related to prenatal nutrition. Results: Sixteen providers participated in the observations, including seven nurse-midwives (n=7), attending physicians (n=5), and resident physicians (n=4), and a diverse group of pregnant people (n=20) was recruited. Forty-five providers completed surveys. Themes of communication, content, and inconsistencies were identified in how pregnancy nutrition counseling was completed. Providers made efforts to provide patient-centered pregnancy nutrition counseling, but most discussions were brief, generic, and provider-centered. While patients reported satisfaction with their providers and the information received, there were multiple knowledge gaps and missed patient contextual factors. Discussion: Inadequate provider training and limited time in visits left many gaps in the provision of pregnancy nutrition counseling. A HF framework is a novel approach to investigating how providers approach pregnancy nutrition counseling and may be useful in researching patient-centered approaches to dietary habits that include contextual factors.