Improving outcomes for pregnant teenagers: development of a complex intervention to improve quality of diet

Teenage girls have the poorest quality diets of any group in the UK. Besides having to meet the demands of a growing baby whilst they are themselves still growing, the poor diets of pregnant teenagers increase the chance that they will have babies who are born small or may die in the first months of life. Teenage pregnancy is much more common amongst the poorest in our society. Pregnant teenagers have told us that they want to improve their diets and trust advice from their midwives, but midwives feel they don't have time or opportunity to discuss diet and nutrition or the confidence and knowledge to do so. We have developed and tested skills training to help health care professionals engage with and support 'hard-to-reach' groups of clients change their lifestyles. This 'Healthy Conversation Skills' training equips professionals to explore why people might want to change, to identify things that make it harder or easier for people to change, and to support them find ways to overcome their barriers to change, whatever they might be. We have shown that such conversations add little or nothing to the time taken by a standard consultation and that they increase people's confidence that they can improve their diet and lifestyle. We have also shown that additional support may be needed to sustain changes.
In partnership with pregnant teenagers and midwives, this project aims to develop an intervention from existing tools which we will modify and combine to provide pregnant teenagers with the support they tell us they need to make long-lasting improvements to their diets. We will train midwives in a modified version of Healthy Conversation Skills training so that they can explore with pregnant teenagers their wish to change their diets and lifestyles, identify with them what might make it more difficult or easier to change, support them to find their own solutions to overcoming these difficulties and help them set goals on the path to achieving change. Since pregnant teenagers are more likely than others to be from disadvantaged communities, these difficulties are likely to include lack of money and lack of support for change from family and friends. We will also provide pregnant teenagers with access to 24-hour sources of information and tools to help them sustain changes to their diets. Pregnant teenagers will be introduced to these sources by their midwives to use between appointments, and which may be booklets, websites or mobile apps. The form of this information will be decided during this development project in discussions with teenagers and their midwives, and will be based on modifications of existing resources.
We will do this by (i) including midwives, pregnant teenagers and others involved in providing care to pregnant teenagers in developing an intervention, (ii) discussing with pregnant teenagers and midwives what they need to help improve teenagers' diets, (iii) using these discussions to modify Healthy Conversation Skills training to make it suitable for use by midwives in supporting pregnant teenagers improve their diets, and to develop materials for the 24-hour source of information and support, (iv) checking with teenagers and midwives that the training and materials are acceptable and finding out whether they would like material in the form of booklets, on the internet or in mobile apps, (v) together with people who provide care for pregnant teenagers, working out how such an intervention could become part of usual maternity care across the UK, and (vi) designing in detail a study to test how effective this two-part intervention is in improving the quality of pregnant teenagers' diets. This study will be conducted by a partnership of charities, researchers, pregnant teenagers and those who provide them with maternity care, overseen by a steering group.

Teenage girls have the poorest quality diets of any group in the UK. The demands of a growing baby, their own rising nutritional needs and poor quality diet increase their risk of poor pregnancy outcomes. Our work shows that pregnant teenagers want to improve their diets and trust advice from their midwives, but midwives struggle to find opportunities to discuss diet and often lack confidence and knowledge to do so. We have developed and tested training in skills designed to help health care professionals engage with and support change in hard-to-reach clients. Use of these skills increases clients' confidence that they can improve their diets and lifestyles, but they may need additional support to achieve sustained change. In partnership with pregnant teenagers and midwives, and using a person-based approach, this early phase study will develop a theoretically-driven, evidence-based intervention that combines skills training for midwives with digital or print support for pregnant teenagers to facilitate sustained dietary improvement. The support needs of pregnant teenagers and an appropriate means of providing support (e.g. web, app, print) will be determined through stakeholder engagement using qualitative research. Existing resources on which this support will be based, will then be adapted to include appropriate behaviour change and nutrition content relevant to the behavioural and social context of pregnant teenagers. Paths to implementing the intervention in maternity services will be investigated in three areas of the UK with high teenage pregnancy rates, as will the feasibility of evaluating its effectiveness in a randomised controlled trial. The main study will test the effectiveness of skills training midwives in combination with a means of additional support for change in improving pregnant teenagers' dietary quality. This work will be conducted by a partnership of charities, researchers, user groups and practitioners, overseen by a steering group.