How Culture Influences Choice Of Intervention Sequencing In Pregnant Arab Muslim Individuals

Previous work with the Nutrition and Exercise Lifestyle Intervention Program (NELIP) for pregnant Caucasian women showed that if the exercise component (walking, start at 25 min increasing 2 min/week until 40 min, 3 times/week) of the program was introduced first (12-18 weeks’ gestation) and nutrition (modified diabetic meal plan) introduced at 25 weeks’ gestation, achieved greater adherence than introducing the nutrition and exercise components together or offering the nutrition component first followed by exercise. Pregnant Arab Muslim (AM) individuals are at high risk for developing diabetes therefore co-designing a culturally sensitive intervention to promote high adherence is crucial. PURPOSE: To ask AM individuals who are currently or recently pregnant about their preference regarding mode of delivery of NELIP while considering their culture, where; A) nutrition and exercise are offered simultaneously; B) Nutrition is offered first followed by exercise; or C) Exercise is offered first followed by nutrition. METHODS: AM individuals were recruited via community events and purposive sampling and asked (in Arabic or English) in an interview which intervention strategy they preferred and why. After translation and transcription of the interview, content and thematic analysis was executed using NVivo software. RESULTS: Mean age was 30.9 ± 6.5 years (11 pregnant; 21 recently pregnant) with a household size of about 5 people. Mean time since immigration was 7.4 ± 7.5 years. Of the 32 interviews conducted, 18 participants (56%) preferred simultaneous and 13 (41%) preferred nutrition first before exercise, while only 1 preferred exercise first. Analysis found that: 1. Nutrition is a priority for this population over physical activity; 2. Nutrition and exercise should be given simultaneously; 3. Exercise is not encouraged in this population during pregnancy; and 4. The health of the baby is most important which is secured by adequate nutrition. CONCLUSIONS: Exercise is not considered as important as nutrition and thus for an intervention to be successful in this population, nutrition should also be included with exercise to accommodate cultural factors. Funding Source: Children’s Health Research Institute, Canadian Institutes of Health Research, Social Sciences and Humanities Research Council Supported by: Children’s Health Research Institute, Canadian Institutes of Health Research, Social Sciences and Humanities Research Council