University of Wollongong Research Online University of Wollongong Thesis Collection 2017+ University of Wollongong Thesis Collections 2017 Prenatal nutrition: Exploring midwives’ role, knowledge and nutrition education Jamila Mustafa Arrish University of Wollongong Follow this and additional works at: https://ro.uow.edu.au/theses1 University of Wollongong Copyright Warning You may print or download ONE copy of this document for the purpose of your own research or study. The University does not authorise you to copy, communicate or otherwise make available electronically to any other person any copyright material contained on this site. You are reminded of the following: This work is copyright. Apart from any use permitted under the Copyright Act 1968, no part of this work may be reproduced by any process, nor may any other exclusive right be exercised, without the permission of the author. Copyright owners are entitled to take legal action against persons who infringe their copyright. 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For further information contact the UOW Library: [email protected] UNIVERSITY OF WOLLONGONG AUSTRALIA Prenatal nutrition: Exploring midwives’ role, knowledge and nutrition education This thesis is presented in fulfilment of the requirements for the Award of the Degree of Doctor of Philosophy from the University of Wollongong by Jamila Mustafa Arrish Bachelor of Public Health (Nutrition) Master of Public Health Master of Science (Nutrition and Dietetics) School of Health and Society 2017 CERTIFICATION I, Jamila Mustafa Arrish, declare that this thesis, submitted in fulfilment of the requirements for the award of Doctor of Philosophy in the School of Health and Society, University of Wollongong, is wholly my own work unless otherwise referenced or acknowledged. The document has not been submitted for qualifications at any other academic institution. Jamila Mustafa Arrish 31 March 2017 ii DEDICATION To my parents, my husband and my brothers and sisters iii ABSTRACT Background: Good nutrition during pregnancy is considered one aspect of lifestyle that contributes to the health and wellbeing of the mother and the developing baby. In Australia and globally, most pregnant women enter pregnancy overweight or obese and do not meet dietary recommendations. Pregnant women may not receive nutrition advice despite being perceived as receptive to nutrition messages. Midwives are ideally positioned to provide nutrition advice during pregnancy as they provide antenatal care to pregnant women. According to the International Confederation of Midwives core competencies, midwives are expected to have the knowledge and skills to assess maternal nutrition and provide nutrition advice accordingly. However, there has been limited literature, especially in Australia, about midwives’ role in this important area. Aim: To explore the role of midwives in providing nutrition advice, their nutrition knowledge, the nutrition education the midwives receive during pre-registration education or during practice, and the nutrition education provided in midwifery programmes. Research questions: The research addressed three main questions: what are Australian midwives’ knowledge of and attitudes towards nutrition during pregnancy and their confidence in providing nutrition advice and what education did they receive in nutrition pre and post registration? What are midwives’ perceptions of their role in providing nutrition advice? And how is nutrition positioned within midwifery programmes in Australia? Theoretical framework: The study was underpinned by a conceptual framework based on a review of the literature. The central focus of the framework was exploring the factors influencing midwives’ behaviour of providing nutrition advice. The framework was a combination of the Knowledge-Attitude-Behaviour (KAB) model and other elements such as education, confidence, model of care, role perceptions, and barriers/facilitators. Methods: The research was exploratory and descriptive with three linked phases. It included three studies using a mixed-methods approach incorporating both quantitative and qualitative methods. Phase one included a study that used an online survey sent to the members of the Australian College of Midwives (respondents: n = 329) to determine their received nutrition education, knowledge, attitudes, and confidence in the provision of nutrition advice during pregnancy. Phase two involved a study that was an in-depth exploration of Australian midwives’ perceptions of their role in discussing nutrition issues with pregnant women. iv Semi-structured interviews were conducted with a sample of the members of the Australian College of Midwives who completed the online survey (respondents: n = 16). Phase three included a study that used a mixed-methods approach incorporating an online survey with 23 midwifery course coordinators (representing 24 Australian midwifery programmes) and telephone interviews conducted with seven of those coordinators to review how nutrition content was incorporated in midwifery education. Findings: Several key findings were identified. In phase one, the majority of Australian midwives believed prenatal nutrition was ‘very important’ (86.6%) and that they had a ‘very significant’ role in educating women about it (75.7%) but most had substantial knowledge gaps and were not confident discussing nutrition with pregnant women. The majority of the midwives provided nutrition advice (93%). This advice was classified as ‘basic’ and ‘general’, and was focused on general topics. Only half of the midwives reported receiving nutrition education during their pre-registration education or during practice. When the education was described, midwives reported it as limited and lacking focus on key contemporary issues. Some midwives undertook personal initiatives to address this gap. In phase two, midwives perceived their role in providing nutrition advice to pregnant women as a vital part of their practice but many barriers restricted the expansion and the efficacy of such a role. The accounts of many midwives revealed that their nutrition advice tended to be medically-oriented and not focused on wellbeing or health promotion. In phase three, nutrition was taught within all midwifery programmes surveyed but was limited by low number of hours allocated (half of the programmes had only 5 to <10 hours for nutrition education) and its tendency to be problem-oriented and based on various assumptions. Collaboration with nutrition experts was lacking, as was the development of nutrition assessment skills or practical training for midwifery students in the provision of nutrition advice or support. Discussion and Conclusion: Midwives provide regular care to pregnant women and have the opportunity to positively influence women’s and babies’ health by providing effective nutrition advice. However, the findings of this research indicated that midwives might not be adequately supported to do so. This research had not been undertaken previously in Australia. Three main recommendations emerged from the three phases of the research on the way nutrition could be integrated into midwifery curricula and practice in a manner that could help midwives deliver better nutrition education services to pregnant women in accordance v with the women’s expectations of midwives’ expertise and professional role. It was evident from the findings of phase one that practising midwives need to be provided with continuing nutrition education; to increase their knowledge and confidence and improve their practice in providing nutrition advice and support to pregnant women. In order to reduce midwives over reliance on personal initiatives and improve their access to the latest evidence-based updates in term of nutrition, reliable and trusted sources, such as the Australian College of Midwives and midwives’ workplaces need to be actively involved in the provision of continuing nutrition education to midwives. Continuing nutrition education needs to be focused on general and specific nutrition topics as well as contemporary areas; to be in line with the advances in nutrition knowledge and the challenges faced by midwives in their practice. Findings from phase two indicated the need for more reform in the provision of health care services, such as, involving more dietitians in antenatal care settings to provide resources and education for both pregnant women and the midwives. Phase three highlighted the necessity of including nutrition knowledge and skills as core competency areas in Australian midwifery competency standards and involving food and nutrition experts in the development and provision of nutrition curricula in midwifery