Date of Award

1-1-2021

Language

English

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

Department of Psychology

Program

Clinical Psychology

Content Description

1 online resource (iv, 160 pages) : forms.

Dissertation/Thesis Chair

Julia M Hormes

Committee Members

Drew Anderson, Alix Timko

Keywords

Acceptance and Commitment Therapy, excess gestational weight gain, food cravings, health coaching, Compulsive eating, Pregnant women, Pregnancy, Food preferences, Obesity, Acceptance and commitment therapy, Health promotion, Health counseling

Subject Categories

Psychology

Abstract

Excess gestational weight gain (GWG) is the leading high-risk condition in pregnancy in the United States and associated with a variety of poor delivery and health outcomes for the mother and infant. The majority of interventions addressing diet and physical activity in pregnancy have at best small effects on weight gain and pregnancy health outcomes. Past studies on weight loss in non-pregnant samples have demonstrated the utility of addressing psychological factors to modify eating behaviors. Currently, there is a lack of research to evaluate the efficacy of targeting psychological factors to improve cognitive and affective coping skills when attempting to facilitate health behavioral change specifically in pregnancy. Food cravings, an affective-laden cognitive experience, have been shown to account for over 30% of the variance in excess GWG and could therefore serve as useful targets for weight management among women in the perinatal period. The current studies sought to determine the acceptability and feasibility of an acceptance-based health coaching workshop targeting food cravings in pregnancy via community-based recruitment. Feasibility was addressed through examining the recruitment process, resources, retention rates, and measurement burden. Acceptability was evaluated through measures of credibility and expectancy and perceptions of appropriateness and utility of the intervention. Study 1 examined concurrent and retrospective acceptability for pregnant women while study 2 addressed prospective acceptability, with pregnant women and perinatal providers as identified stakeholders. Pregnant women in study 1 (n=4) were recruited through various sites in the community and provided detailed feedback on the proposed intervention. Recruitment for study 2 was conducted online in response to restrictions placed by the COVID-19 pandemic (n= 47) and sought to address limitations that arose in study 1. Pregnant women in study 1 conducted a pre- and post-intervention assessment battery including measures of food cravings, eating patterns, thought suppression, acceptance and willingness, and obsessive- compulsive aspects of eating. Pregnant women and perinatal providers in study 2 completed a series of questions developed by study coordinators to assess acceptability and perceived need of the proposed intervention. Results from study 1 showed that the proposed intervention was generally feasible and acceptable. Measures of feasibility showed treatment retention as adequate, and measurements were generally appropriate and minimally burdensome. Participants deemed the intervention credible for coping with food cravings and expected the skills learned to be helpful in the future. Recruitment for the intervention was a major barrier, with attempts to connect with sites in the community proving to be difficult. Study 2 provided some understanding related to issues with recruitment in study 1. Specifically, pregnant women preferred to participate in this intervention at their Ob/Gyn’s office and overwhelmingly stated that having the time to participate would be a major barrier. Lack of sufficient responses prevented us from reaching saturation in the sample of perinatal providers, but preliminary evidence suggests that they appeared willing to refer their patients to this workshop. Overall, the proposed acceptance- based health coaching study targeting food cravings in pregnancy appeared feasible, and future research should examine the efficacy of the proposed intervention in preventing excess GWG and associated adverse health outcomes on a larger scale.

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