Optimizing Low–Socioeconomic Status Pregnant Women’s Dietary Intake in the Netherlands: Protocol for a Mixed-Methods Study

Although the importance of maternal nutrition is evident, adherence to dietary guidelines is limited in pregnant women, especially in those with a low socioeconomic status. Promotion of a healthy diet in midwifery practice is promising, as prenatal diet affects both maternal and child health, pregnant women are open to dietary changes during this critical transition, and midwives are their first and most important source of information. Unfortunately, nutrition communication by Dutch midwives is limited.Objective: The objective of this study is to optimize the dietary intake of low–socioeconomic status pregnant women by contributing to the further development and adjustment of a tool or toolbox to support midwives in providing nutrition communication.Methods: This interdisciplinary, mixed-methods study includes 2 phases, in which quantitative and qualitative research are complementary. In phase 1, we will conduct a literature study and interviews to gain insight into midwives’ knowledge, needs, and practice. We will obtain data on the dietary intake of low–socioeconomic status pregnant women and factors influencing this intake from another literature study, an interviewer-administered meal-based food frequency questionnaire, and qualitative interviews with pregnant women. We will identify the availability of suitable tools to improve pregnant women’s dietary intake from the literature, interviews, focus groups, and expert meetings. In phase 2, we shall adapt an existing tool or develop a new tool(box), depending on the results of phase 1, and implement it in 5 midwifery practices. Ultimately, a process evaluation will provide insight into barriers and facilitating factors playing a role in the implementation of the tool(box).Results: The main outcome of this study will be a tool(box) to optimize the dietary intake of Dutch pregnant women. We anticipate that the developed or adjusted tool(s) will be available in February 2020. After we implement the tool(s) and evaluate the implementation process, the final results should be available by February 2021.Conclusions: This study is scientifically and socially relevant, as we will study low–socioeconomic status pregnant women’s contextual dietary intake in-depth from an ecological perspective on health. The results obtained will lead to recommendations for multidisciplinary strategies to promote a healthy maternal dietary intake in low–socioeconomic status populations.