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Factors Associated with Effective Nutrition Interventions for Pregnant Indigenous Women: A Systematic Review



      Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously.


      The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries, and to identify positive factors contributing to successful programs.


      Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively.


      Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia, Canada, and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2), peer counselor (n=3), or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3).


      Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes, as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols.


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      A. M. Ashman is a PhD candidate with the Gomeroi gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Tamworth, New South Wales, Australia; the School of Health Sciences, Faculty of Health and Medicine; and the Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.


      L. J. Brown is academic team leader, Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, New South Wales, Australia.


      C. E. Collins is director of research, School of Health Sciences, Faculty of Health and Medicine, and acting director, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.


      M. E. Rollo is a postdoctoral research fellow, School of Health Sciences, Faculty of Health and Medicine, and a postdoctoral research fellow, Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.


      K. M. Rae is Gomeroi gaaynggal program director, Gomeroi gaaynggal Centre, Faculty of Health and Medicine, and associate professor, Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, New South Wales, Australia; Priority Research Centre in Reproduction, University of Newcastle, Callaghan, New South Wales, Australia; and Mothers and Babies Research Centre, Faculty of Health and Medicine, University of Newcastle, New Lambton, New South Wales, Australia.