2025 Theses Doctoral

Design and Evaluation of a Theory-based Nutrition Education Intervention Among Pregnant and Pre-pregnant Women in Beijing, China

Gao, Xiaoge

Pregnancy constitutes a critical period during which maternal nutrition plays a pivotal role in both fetal and maternal well-being. However, many pregnant women in China fail to achieve a balanced dietary pattern as recommended by the Chinese dietary guidelines for pregnancy, consequently placing them at a higher risk of adverse maternal and fetal outcomes. Interventions beginning as early as the "pre-pregnant" period ("备孕期")—when women prepare for pregnancy—are essential to promote healthy eating habits and improve nutritional status. Despite the potential of theory-based nutrition education, few interventions in China have targeted pregnant women, and none have included pre-pregnant women.

The main purpose of this study was to understand the nutritional needs of women in China and understand if nutrition interventions can be effective. The study had three parts and was conducted with different groups of participants. Part 1 was a cross-sectional study to serve as a need assessment to evaluate the nutritional status of pre-pregnant and pregnant women in Beijing, China, enrolling 32 women (Group 1). Part 2 was a pre-post study investigating whether the newly developed online six-session intervention impacted pre-pregnant and pregnant women’s psychosocial determinants, eating behaviors, healthy weight status, and satisfaction with the program, with 71 participants initially enrolled and 40 completing both pre- and post-tests (Group 2). Part 3 was a descriptive study using discussion-based interviews to understand pregnant women’s knowledge about nutrition and their perceptions and expectations regarding nutrition support; 21 women participated (Group 3).

The need assessment for Group 1 showed that our target population had an unbalanced dietary pattern that failed to meet many recommendations from the Chinese dietary guidelines. The intervention for Group 2 significantly improved most psychosocial determinants, including attitudes (p=0.018), perceived norms (p=0.002), perceived behavioral control (p=0.008), self-depictions (p=0.028), behavioral intention (p=0.035), and skills and abilities (p=0.027). The environment was the only psychosocial determinant that showed no change (p=0.532). It also demonstrated effectiveness in promoting healthy eating behaviors, such as increased soy and soy products consumption (p=0.008), milk and dairy products consumption (p=0.003), and fish and other seafood consumption (p=0.010). However, no significant positive change was found in the consumption of vegetables, fruits, nuts, lean meat, and fatty meat (p>0.05). Participants reported reading nutrition labels more frequently (p=0.007) and paying greater attention to fat content when shopping (p=0.021). However, the intervention was less effective in reducing unhealthy cooking methods, dining out, and the intake of ultra-processed foods (p>0.05). It also did not succeed in helping pregnant women with excessive weight gain achieve a healthy weight gain (p>0.05).

Nevertheless, the intervention achieved acceptable attendance and engagement and high satisfaction rates among those who retained. Participants also provided positive feedback concerning the course content, format, and teaching and offered constructive suggestions for future courses.

The discussion-based interview for Group 3 also enriched our understanding of the target population and offered valuable insights for future interventions. While most pregnant women expressed concerns or worries about nutrition during pregnancy, many had limited knowledge or held misconceptions about it. Despite these concerns, a significant number of participants did not feel the need for or desire nutritional support. This reluctance was often due to a lack of awareness about the potential risks of their current behaviors or low self-efficacy in making dietary changes.

The study's findings suggested the efficacy of a TPB-based online nutrition education intervention in improving participants’ psychosocial determinants related to healthy eating and some dietary behaviors. This could inform future studies, which should adopt a more rigorous study design, implement longer and more intense interventions, and follow up for more long-term effects.