Using implementation science to identify clinician-reported barriers to discussing safe fish consumption during routine prenatal care [abstract] Abstract uri icon
  • Background: Fish consumption during pregnancy is beneficial for mothers and developing fetuses; however, care should be taken to choose low-mercury fish. The complexity and importance of this message make it ideal for clinician discussions during routine prenatal care. This project measures clinician-reported behaviors and barriers related to fish consumption conversations, guided by implementation science theory (the Capability, Opportunity, and Motivation Behaviour, or COM-B, model).
    Methods: A representative sample of 400 obstetrics/gynecology and family medicine clinicians across Minnesota were surveyed using a sequential, mixed-mode design with a small token incentive. Questions asked how often clinicians discussed fish consumption and the prevalence of various barriers to these discussions. Reported behaviors and barriers were categorized into the COM-B model. Descriptive and chi-squared statistics were used to report prevalence and differences across clinician characteristics. Responses to open-ended items were coded into COM-B categories using content analysis.
    Results: A total of 219 clinicians completed the survey (55% response rate), with no differences by specialty or geography. Most clinicians reported the “behavior” of discussing nutrition generally, but the most common topic was weight management (89%), with only 35% discussing the benefits of fish and 27% discussing risks. Aligning with other COM-B constructs, commonly reported “capability” barriers included knowledge (67% did not strongly agree it was important for pregnant women to eat fish); “opportunity” barriers related to context and resources (82% said not enough time, 63% said topic not built into encounters, 41% said topic was not a leadership priority), and “motivation” barriers included lack of perceived professional role (91% said dietitians were an ideal source for patient diet information). Qualitative responses reiterated these findings, adding additional context, “It’s not prioritized by my employer, perhaps because it’s not related to insurance company compensation.” Differences by clinician characteristics also will be presented.
    Conclusion: Opportunities exist to increase clinician recommendation of healthy and safe fish consumption during pregnancy, but a number of barriers across all COM-B model domains constrain the frequency of these conversations. This presentation will discuss the implications of this work and how results may be used to develop theory-informed intervention strategies to facilitate effective, high-quality information sharing about fish consumption around the point of care.

  • Link to Article
    publication date
  • 2021
  • Research
  • Diet
  • Food
  • Perinatal Care
  • Pregnancy
  • Questionnaires
  • Safety
  • Additional Document Info
  • 8
  • issue
  • 2