院内助産システムで出産予定の初産婦が食生活を変容させるプロセス

Abstract

院内助産システムで出産予定の初産婦が食生活を変容させるプロセスを明らかにし、効果的な保健指導のあり方の示唆を得ることを目的に、大学病院の院内助産にて妊婦健康診査を受診している妊娠35週以降の初産婦9名に面接調査を行いModified Grounded Theory Approach(M-GTA)で分析した。分析した結果、19の概念が抽出され6つのカテゴリーが生成された。初産婦が食生活を変容させるプロセスには、初産婦自身の自発的な行動変容や胎児への思い、家族環境、妊娠に伴う身体の変化、保健指導による意識変化、気持ちの揺れがあり、一進一退を繰り返しながら徐々に食生活は変容していた。効果的な保健指導として、初産婦自身が具体的なルールを決めることが、自発的な行動変容につながることが明らかとなった。今後は、非妊娠時の食生活を把握したうえで、初産婦自身が継続できそうなルールを決められるよう支援していくこと、また具体的な献立や胎児に影響を与える食材に関する保健指導が必要であると示唆された。

The purpose of this study was to clariy the process of changing the dietary habits of primiparas through a midwife-led birth system and to assess the effectiveness of the health education provided. In the midwife-led birth system of one university hospital, nine primiparas after the 35th week of pregnancy were interviewed and analyzed using Modified Grounded Theory Approach(M-GTA). As a result, six categories and 19 sub-categories were identified. The process of changing the dietary habits of primiparas consisted of "voluntary behavioral changes of the primiparas themselves," "thoughts of the fetus," "family environment," "physical changes accompanying pregnancy," "a change in consciousness due to health education," and "a change in feelings." Eating habits gradually changed as the primipara progressed through each of the categories". As for health education, it became clear that primiparas being able to decide specific rules themselves led to voluntary behavioral change. It was suggested that knowing the pre-pregnancy eating habits and helping primipara determine the rules that they can continue to follow, as well as providing health education on specific menus and foods affecting the fetus, are effective in helping change dietary habits.