1. Healthy Eating Among Low-Income Pregnant Women: Using a Positive Deviance Approach to Customize Nutrition Education Materials Jaimee Ryan, BS, Rickie G. Kashdan, MPH, M. Jane Lewis, DrPH, Donna Hayek, RD INTRODUCTION Positive Deviance A qualitative approach to research characterized by the assumption that solutions to specific problems are present within the community. Steps in a positive deviance approach: finding positive deviants, identifying factors that enable positive deviants to be successful, designing interventions enabling others to implement desired behaviors, assessing effectiveness of the intervention, and disseminating the intervention. Positive Deviants: Individuals who defy community norms and are successful at overcoming the identified problem. In this case, “healthy eaters” are the positive deviants. RESULTS: Environmental, Personal, Behavioral Factors DISCUSSION While our initial research question dealt with customizing educational materials, our findings indicate that information alone may not suffice to enable low-income pregnant women to eat healthfully. Although materials will still be customized, attention to social support, motivation, and self-efficacy is needed as well. In addition to education, services such as home visitation, WIC, or mentoring relationships would increase the social support available to those women with little to no support. Assessing women’s motivation to eat well during pregnancy could help them set appropriate, attainable goals, thus increasing self-efficacy. Caution needs to be taken when generalizing results to similar populations because the sample size was small, the data were self- reported, and responses could have been affected by the language/cultural barrier. For more information, please contact Jaimee Ryan: reedyjr@umdnj.edu Nation’s First Collaborative School of Public Health METHODS RESEARCH APPROACH Results are based on qualitative analysis of 30 individual interviews with low-income, pregnant “healthy eaters.” Participants (15 Spanish-speaking and 15 English-speaking) were recruited from a community clinic in Neptune, NJ. A Spanish interpreting service was utilized for interviews with Spanish speakers. Interview recordings were reviewed and coded using SPSS software. Background Although barriers to good nutrition among low-income pregnant women exist, some women are still successful in consuming a healthy diet. Using a positive deviance approach, this project aimed to identify factors that enabled some pregnant women within a low- income community to maintain a healthy diet during pregnancy. Personal, environmental, and behavioral factors that enable “healthy eaters” to eat healthfully were identified. This information will be used to customize nutrition education materials for the prenatal clinic that serves the same population from which the “healthy eaters” were derived. Research Question What are the personal, environmental, and behavioral factors that influence healthy eating among low-income pregnant women? Physical Environment 96.7% have space and appliances to prepare meals 93.3% can easily get to the store to buy food Social Support 100% have friends or family nearby 87% are married/partnered Self-efficacy 93.1% believe they are successful at eating healthy meals 83.3% ate healthy meals prior to becoming pregnant Skills 93.3% regularly cook for their families 96.7% regularly go food shopping Healthy eating behaviors Frequently eats at home (86.7%), eats breakfast (83..3%), and snacks (70.0%) Rarely eats fast food (86.7%), skips meals (79.3%), or drinks soft drinks (73.3%) 67% changed eating habits once becoming pregnant Mean Age 24.7 ±4.2 yrs WIC Participation83.3% (25) Married/Couple86.7% (26) Race/Ethnicity Caucasian23.3% (7) African American10.0% (3) Hispanic53.3% (16) Other13.3% (4) Education Less than high school43.3% (13) High school graduate23.3% (7) Some college+33.3% (10) Demographic Characteristics (n=30) RESULTS: In their own words What special things do you do to be sure that you eat healthy meals during your pregnancy? “I have a book and an app on my phone and it tells a lot of healthy foods, so I always write them down and try…to get those foods…” “If I’m going to be out and about, I always pack lots of snacks…fruit, granola bars, cereals…stuff like that” What makes it hard to eat healthy meals during pregnancy? “Sometimes it takes too much time to cook…sometimes the cost is high…it’s more expensive to buy healthy food than fast food…” “Sometimes I get cravings for junk food…” “Because it doesn’t taste good.” Why do you think some mothers are successful at eating healthy foods during pregnancy? “Maybe support…family encouraging you to eat healthy…not being counterproductive…” “I think it’s based on self-control…I also think it’s based on what’s going on during the pregnancy…you know, if the father is there, it’s a lot easier, you’re not so stressed out.” “I think you have to make an effort to eat well…”