Patient–Provider Prenatal Nutrition Conversations Using a Human Factors Approach

Objective

To examine patient-provider nutrition conversations at initial prenatal visits.

Design

Convergent mixed methods observational study.

Setting

Two large metropolitan clinics in the midwestern United States.

Participants

Sixteen providers and 20 racially diverse pregnant women.

Methods

Guided by the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model, we observed and audio-recorded initial prenatal visits with obstetric providers. Patients completed post-visit surveys and interviews, and providers completed post-visit interviews. Finally, we sent a practice-wide electronic survey to all providers. We completed quantitative data analysis for descriptive statistics of observation and survey results. We completed qualitative thematic analysis of visit and interview transcripts and combined and categorized results into components of the SEIPS 2.0 model.

Results

We identified multiple dynamic and interacting factors relevant to the work system and processes in the SEIPS 2.0 model in patient–provider conversations about nutrition. Although nutrition was covered in all visits, most conversations were provider-centered and covered basic, general recommendations related to a limited number of topics. Few individualized collaborative discussions that addressed contextual factors occurred.

Conclusion

Finding ways to incorporate and address contextual factors into patient-centered conversations about nutrition is vital to optimize the dietary habits of women, especially those from vulnerable populations. To do this, multidisciplinary teams that include nurse practitioners, nurses, obstetricians, and registered dietitians who can address the multiple social determinants of health that affect dietary choices are needed.