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“We Know but We Don’t Really Know”: Diet, Physical Activity and Cardiovascular Disease Prevention Knowledge and Beliefs Among Underserved Pregnant Women


To describe the knowledge of underserved pregnant women related to diet, physical activity, and cardiovascular disease (CVD). Underserved pregnant women from the University of North Carolina and Pitt County, North Carolina participated in 9 focus group interviews. Focus group questions focused on knowledge of CVD risk factors, lifestyle prevention strategies such as diet and physical activity, and the sources of such knowledge. Data were analyzed with the constant comparative method. Prior to the focus group, each woman was invited to complete a telephone survey to collect demographic information and responses to a 13-item CVD knowledge questionnaire. Means and frequency procedures were used to analyze demographic information. Fifty women participated in nine focus group interviews. Participants possessed basic knowledge of CVD risk factors and preventive strategies, such as basic guidelines and recommendations for healthy diet and physical activity in pregnancy. However, women often receive incomplete guidance from obstetric providers, and women, therefore, desired more information on these topics. Some gaps were filled by nurses and nutritionists. Women also sought information from female friends and relatives. Incorrect knowledge was demonstrated in all groups and led to less healthful behaviors in some cases. Underserved pregnant women have basic knowledge about healthy lifestyle and CVD prevention behaviors; however important gaps and misinformation exist.

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The authors thank Elizabeth Woods and Elizabeth C. Jensen for their assistance with focus group moderation, Brynna Waters, Sarah Melvin, and Sue Ellsworth for transcription, and Jenae Theraldsen for note-taking. This research project was supported by NC TraCS Institute Grant #550KR11131 from the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health and by the Bowes Cefalo Young Researcher Award, Department of Obstetrics and Gynecology, University of North Carolina.

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Correspondence to A. Jenna Beckham.


Appendix 1: Focus Group Script

Introductory Questions

1. Let’s go around the table, starting with ______. Please introduce yourself using your first name only and tell us how many children you have, how old they are or whether this is your first baby.

2. What are you most looking forward to about this pregnancy or your new baby?

3. While you are pregnant, what are the health issues that most concern you?

Risk Factors

4. When you hear the term “heart disease”, what things come to mind?

5. What do you think are the reasons someone might develop “CVD/Heart Disease?”


1. What do you believe your chances are for developing “CVD/Heart Disease,” compared to other women like you (your friends, members of your family)? Why?

2. When you hear the term, “My Heart Belongs to Baby”, what does that make you think about? How do you think your heart health might affect your baby’s health?

3. Is heart disease inevitable or can you do anything to prevent it? Do you think people have any control over whether they get heart disease?

Nature/Seriousness of Potential Harm

8. How do you imagine it would impact you to be diagnosed with “CVD/Heart Disease”?


9. There are many things that can be done to prevent CVD. Some are taking medicines and some have to do with changing your behavior. What are some of the behaviors you have heard about to prevent CVD/Heart Disease?

10. Lets take exercise as an example. What have you heard about exercise in pregnancy?

11. What things would motivate you to get more exercise during pregnancy?

12. What things would keep you from doing exercise in pregnancy? What makes it hard to do exercise during pregnancy?

13. Where do you prefer getting exercise?

14. With whom do you prefer getting exercise?

15. Let’s take healthy eating as an example. What have you heard about healthy eating in pregnancy?

15b. Do you cook? Where do you grocery shop? Do you ever shop at the farmer’s market or farm stands?

16. What kinds of things would or do motivate you to eat more healthfully during pregnancy?

17. What kinds of things would or do keep you from eating more healthfully during pregnancy?

18. Are there any ways that you feel you are not able to control being able to exercise or eat healthy? Is it in your control to exercise or change the way you eat?

19. Has there ever been a time when you have tried to change your behavior in order to be healthier? If you have an example in your mind, can you tell me what made you want to make this change? Would it have been different in pregnancy?

20. Are there any things that would worry you about changing the way you eat during pregnancy

21. What about exercising during pregnancy?

Program Development

22. What would be the best way to motivate you or other pregnant women to participate in a heart diseases prevention program?

23. What would you tell a pregnant friend to help her think more about heart disease in her life?

24. Imagine you were going to participate in a program to improve your heart health during pregnancy. What would you want this program to be like?

25. Who would you prefer to run or be involved in running a program like this?

Appendix 2: Codebook Excerpt: Knowledge-Specific Codes

Descriptive Knowledge

This code should be applied to any discussion which provides information about the participant’s knowledge about cardiovascular disease, pregnancy, diet, physical activity or any other health issue related to cardiovascular or pregnancy health (e.g. breastfeeding). This code should be applied for directly stated knowledge and may be applied for indirectly stated knowledge with the interpretive sub-code and a comment.

Incorrect Knowledge

This code may be applied when a discussion evidences knowledge that is felt by the coder to be interesting in one of the following ways: correct knowledge according to current health recommendations, incorrect knowledge that the patient perceive to be correct, or incomplete knowledge. A comment should be added to the section that is coded to describe the coder’s interpretation. In the comment, the coder should include one of the following keywords to distinguish the type of interpretive knowledge—correct, incorrect, or incomplete.

Knowledge Gaps

This code should be applied when the participants explicitly state a gap in their knowledge or a desire for more knowledge on a certain topic. It should not be used when this is implied (the interpretive code above should be used in this situation).

Information Sources

This code should be applied to discussion around obtaining information related to heart disease, pregnancy, diet, exercise, etc. Can include ways that they currently access information or ways that they desire to access knowledge.

Traditional Cultural Beliefs

This code should be applied to statements or explanations that seem to be mythical or based in family/cultural folklore rather than in science or evidence.

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Beckham, A.J., Urrutia, R.P., Sahadeo, L. et al. “We Know but We Don’t Really Know”: Diet, Physical Activity and Cardiovascular Disease Prevention Knowledge and Beliefs Among Underserved Pregnant Women. Matern Child Health J 19, 1791–1801 (2015).

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  • Cardiovascular disease
  • Health knowledge
  • Health attitudes
  • Health practice
  • Pregnancy
  • Risk reduction behavior
  • Diet
  • Exercise