Social determinants of health influence maternal health behaviors and engagement in an obesity prevention intervention

BACKGROUND: Mothers experience increased risk of obesity due to pregnancy and caregiving demands. Maternal obesity influences women's health, pregnancy outcomes, and children's obesity risk. Effective obesity prevention interventions rely on participant engagement. Research suggests that social determinants of health (SDOH) influence intervention engagement; however, research is limited on how SDOH influence engagement and ways interventions may help mothers navigate SDOH. PURPOSE: Understand how SDOH influence mothers' obesity risk and participation in the 24-month Healthy Eating and Active Living Taught at Home (HEALTH) intervention delivered by parent educators (PEs) through the Parents as Teachers home visiting organization. METHODS: Semistructured interviews were conducted with participants (mothers) from the HEALTH Dissemination and Implementation study. Interviews were recorded, transcribed, and analyzed in NVivo using a priori codes and a dual nonindependent approach. RESULTS: Thirteen mothers (five Spanish-speaking, eight English-speaking) were interviewed. The most common SDOH influencing health behaviors were neighborhood physical activity environment, food environment, and community/social context. Mothers felt that HEALTH was needed, available (PEs flexibility to meet in-person at home/other locations; virtual meetings), fit their needs/strengths (adapted to mothers' health behaviors; motivation for change), and provided actionable steps for navigating SDOH (incorporating short walks or stretching at home to overcome childcare/time demands). Spanish-speaking mothers benefited from shared language and community with PEs. CONCLUSIONS: Obesity prevention interventions for mothers may help minimize negative SDOH and leverage positive SDOH for health behaviors. Interventions delivered through community-based home visiting organizations may overcome SDOH barriers to intervention engagement through availability and relational connections with providers. CLINICAL TRIAL INFORMATION: The Clinical Trials Registration #NCT03758638.