Lorraine O Walker | The University of Texas at Austin (original) (raw)

Papers by Lorraine O Walker

Promoting weight loss among overweight low-income postpartum women has proven difficult. The stud... more Promoting weight loss among overweight low-income postpartum women has proven difficult. The study’s aims were to pilot-test ethnic-specific weight-loss interventions using randomized control-group designs for White/Anglo (n = 23), African American (n = 25), and Hispanic low-income postpartum women (n = 23) and draw lessons from psychosocial data and follow-up interviews. Interventions lasting 13 weeks were offered in group settings in the community. Similar to other randomized trials with low-income mothers, weight changes between intervention and control groups were nonsignificant in each ethnic group; however, changes correlated sig-nificantly with self-efficacy (Spearman r =.50) for White/Anglo women and self-efficacy (Spearman r = −.48) and perceived stress (Spearman r =.48) for African American women. In follow-up interviews, women felt inter-ventions gave a good foundation for weight loss, but program and situational factors affected participation and weight loss. Control gro...

Maternal and Child Health Journal

Introduction Excessive and inadequate gestational weight gain (GWG) are associated with a number ... more Introduction Excessive and inadequate gestational weight gain (GWG) are associated with a number of negative health outcomes for mother and infant. Approximately two-thirds or more of Latinas gain outside of GWG guidelines. Acculturation plays a role in GWG-related factors, however the views of Latinas are often aggregated in overall study samples, thus trivializing the specific needs of this demographic group. The purpose of the present meta-ethnography was to better understand GWG beliefs, attitudes, and practice among Latinas by synthesizing extant qualitative findings on this topic. Methods Qualitative studies offer an important window into Latinas' views and practices related to GWG. A qualitative meta-ethnography (a form of meta-synthesis) was implemented to synthesize qualitative studies about Latinas' views of GWG-related factors. An initial sample of articles was distilled based on meta-ethnography guidelines from Noblit and Hare (1988) to a final sample of six qualitative articles that included perspectives from Latinas. Results Six concepts emerged across the studies, they included: shifts in feeling control, inconsistent/lacking information, self vs. other, applied wisdom, isolation vs. support, and everyday practicality. Studies met most quality assessment criteria (Atkins et al., BMC Medical Research Methodology 8:21, 2008). Discussion The views of Latinas about GWG-related factors are often buried in with perspectives of other women, which hides important details that are valuable for health program interventions designed to support these women. Future research should further explore the cultural differences in experience among Latinas to produce information and resources that are culturally relevant and relatable.

Nursing for women's health, 2021

Approximately half of pregnant individuals in the United States exceed recommendations for gestat... more Approximately half of pregnant individuals in the United States exceed recommendations for gestational weight gain (GWG). Excessive GWG is associated with negative outcomes for maternal and infant health. In this article, we provide guidance to nurses who counsel patients about GWG. Because of negative bias toward persons with obesity, nurses need to understand their own attitudes toward obesity to provide supportive GWG counseling. The use of words such as weight is preferred to obese, and recommended GWG goals should be consistent with established guidelines. The setting of specific, measurable, attainable, realistic, and trackable behavioral goals can help translate a goal for GWG into practical actions in daily living. Mobile phone apps, if carefully chosen, may help individuals learn about and track GWG.

Journal of Women's Health, 2019

Background: Studies examining postpartum retained weight referenced to prepregnant body mass inde... more Background: Studies examining postpartum retained weight referenced to prepregnant body mass index (BMI) may mask weight gained after 6 weeks postpartum, a potential unrecognized factor contributing to weight increases after pregnancy. Materials and Methods: Using data from a longitudinal study, we examined three weight patterns from 6 weeks to 6 months postpartum (>2.3 kg gain; >2.3 kg loss; and ±2.3 kg as stable weight) in 302 low-income women. Predictor variables included perinatal variables, health habits, and depression risk at 3 and 6 months postpartum. Results: Mean weight changes were weight-gain group: 5.77 kg, standard deviation (SD) = 2.57; weight loss group: -4.79 kg, SD = 2.10; and stable group: 0.05 kg, SD = 1.24. The odds of gaining weight compared with stable weight increased with prepregnant overweight/obesity (adjusted odds ratio [aOR] = 3.22, 95% confidence interval [CI] = 1.74-6.00), and decreased with a first birth (aOR = 0.47, 95% CI = 0.24-0.93). The odds of losing weight increased with excessive gestational weight gain (aOR = 2.40, 95% CI = 1.10-5.21) and depression risk at 6 months (aOR = 2.57, 95% CI = 1.40-4.72), and decreased with prepregnant overweight/obesity (aOR = 0.49, 95% CI = 0.25-0.94). Health habits were not associated with weight gain or loss. Conclusions: Women with high BMIs may need added postpartum care to avoid gaining weight. Weight loss, although welcomed, may be secondary to depression risk. In both cases, low-cost, effective, and targeted care during the extended postpartum period could benefit women's health.

Journal of Behavioral Medicine, 2018

The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial healt... more The well-being of mothers and infants is influenced by mothers' behavioral and psychosocial health (B&PH), yet it is often neglected during healthcare visits. To address this gap, this study aimed to develop and evaluate acceptability of a postpartum toolkit (screening questionnaire, feedback template, and decision aid) to promote B&PH. Using a decision-making model and participatory design (N = 24), a B&PH screening questionnaire was refined, and prototypes of feedback templates and decision aids for selecting health goals were developed. Most mothers in this multi-ethnic sample rated the resulting toolkit as easy to understand/use and useful, and reported they were likely to act on their health goals. Toolkit ease of use and usefulness ratings were largely unrelated to education, ethnicity, and acculturation. In conclusion, findings support the toolkit's acceptability and applicability to women of diverse backgrounds. The toolkit is a promising strategy to engage mothers in setting goals to promote B&PH.

Western Journal of Nursing Research, 2019

Using a weight resilience framework, health habits of diet and physical activity, social support,... more Using a weight resilience framework, health habits of diet and physical activity, social support, and perceived stress were compared in women who lost weight (resilient) and those who did not lose or gained weight (nonresilient) during a weight-loss intervention. Participants were low-income postpartum women participating in a 13-week randomized treatment-control group intervention, with 20 of 50 classified as resilient in losing weight. Measures included the Postpartum Support Scale, the Perceived Stress Scale, and health habit items from the Self Care Inventory. Weight-loss resilient women showed significantly more frequent healthful dietary habits, such as eating a nutritious breakfast, and less frequent unhealthy habits, such as substituting junk food for meals, and less perceived stress than their nonresilient counterparts at both the midpoint and end of the study. Weight-loss resilient women also showed significantly more frequent physical activity habits at the end of the stu...

The Journal of Perinatal Education, 2016

ABSTRACTFew women gain the recommended amount of weight during pregnancy, which has health implic... more ABSTRACTFew women gain the recommended amount of weight during pregnancy, which has health implications for mothers and their newborns. Work in this area focuses on factors that are difficult to change. The purpose of this project was to review literature on a more patient-centered concept—health literacy. A scoping review was conducted to determine whether aspects of health literacy are included in gestational weight gain (GWG) research. Thirty articles were selected for review. Although these studies included health literacy aspects indirectly, only 2 directly measured health literacy using existing measures. Work that incorporates health literacy in a GWG context is needed. Health literacy may be a critical, yet understudied, factor in understanding why GWG falls outside of the recommendations.

Public Health Nursing, 2007

The concept of positive deviance (PD), which highlights uncommon practices that reduce risk in lo... more The concept of positive deviance (PD), which highlights uncommon practices that reduce risk in low-resource communities, has been effective in community mobilization and programming to improve health outcomes. We present a protocol for extending the concept to analysis of existing public health data. The protocol includes assessing whether PD fits the situation, identifying positive deviants, and identifying behaviors associated with positive deviants' healthy outcomes. Analyzing existing datasets from a PD perspective may aid public health nurses in efforts to reduce health disparities. The effectiveness of our protocol will be clarified in future research.

Public Health Nursing, 2010

Developing focused and relevant health promotion interventions is critical for behavioral change ... more Developing focused and relevant health promotion interventions is critical for behavioral change in a low-resource or special population. Evidence-based interventions, however, may not match the specific population or health concern of interest. This article describes the Multi-Source Method (MSM) which, in combination with a workshop format, may be used by health professionals and researchers in health promotion program development. The MSM draws on positive deviance practices and processes, focus groups, community advisors, behavioral change theory, and evidence-based strategies. Use of the MSM is illustrated in development of ethnicspecific weight loss interventions for low-income postpartum women. The MSM may be useful in designing future health programs designed for other special populations for whom existing interventions are unavailable or lack relevance.

Journal of Nutrition Education and Behavior, 2011

Journal of Obstetric, Gynecologic & Neonatal Nursing, 2016

To test the association of behavioral and psychosocial health domains with contextual variables a... more To test the association of behavioral and psychosocial health domains with contextual variables and perceived health in ethnically and economically diverse postpartum women. Mail survey of a stratified random sample. Southwestern community in Texas. Non-Hispanic White, African American, and Hispanic women (N = 168). A questionnaire was sent to a sample of 600 women. The adjusted response rate was 32.8%. The questionnaire covered behavioral (diet, physical activity, smoking, and alcohol use) and psychosocial (depression symptoms and body image) health, contextual variables (race/ethnicity, income, perceived stress, and social support), and perceived health. Hypotheses were tested using linear and logistic regression. Body image, dietary behaviors, physical activity behaviors, and depression symptoms were all significantly correlated (Spearman ρ = -.15 to .47). Higher income was associated with increased odds of higher alcohol use (more than 1 drink on 1 to 4 days in a 14-day period). African American ethnicity was correlated with less healthy dietary behaviors and Hispanic ethnicity with less physical activity. In multivariable regressions, perceived stress was associated with less healthy dietary behaviors, increased odds of depression, and decreased odds of higher alcohol use, whereas social support was associated with less body image dissatisfaction, more physical activity, and decreased odds of depression. All behavioral and psychosocial domains were significantly correlated with perceived health, with higher alcohol use related to more favorable perceived health. In regressions analyses, perceived stress was a significant contextual predictor of perceived health. Stress and social support had more consistent relationships to behavioral and psychosocial variables than race/ethnicity and income level.

Journal of Obstetric, Gynecologic & Neonatal Nursing, 2010

This article presents health disparities and social inequities that may underlie adverse outcomes... more This article presents health disparities and social inequities that may underlie adverse outcomes for childbearing women and infants in the United States. It also presents Internet-accessible databases that nurses can use to assess maternal and infant health disparities at a national or state level. Such assessments are basic to planning programs to address gaps in health care and advocating for practice and policy changes to improve the health care of childbearing women and infants.

The Journal of Perinatal Education, 2017

ABSTRACTTo support optimal health outcomes during pregnancy, understanding obstetricians’ (OBs) r... more ABSTRACTTo support optimal health outcomes during pregnancy, understanding obstetricians’ (OBs) recommendations for and barriers to managing gestational weight gain (GWG) can benefit childbirth educators. This mailed survey examined OBs’ practices (n = 63) for managing GWG along with perceived barriers. The most frequent recommendations were (a) increase activity (76.2%), (b) aerobic activity (63.5%), (c) patient education about weight management (61.9%), (d) increase fiber intake (61.3%), and (e) use of guidelines for weight gain (58.7%). Self-tracking weight gain charts were the least used. Greatest barriers to GWG management were (a) patients not interested in changing behavior (77.8%), (b) high relapse rates (66.7%), (c) lack of community resources (60.3%), (d) patients cannot afford referrals (58.7%), and (e) lack of time (53.9%).

Journal of Community Health Nursing, 2009

and-conditions-of-access.pdf This article may be used for research, teaching and private study pu... more and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, redistribution , reselling , loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material.

Women's Health Reports

Background: Despite recent emphasis on the ''fourth trimester'' and beyond, most knowledge of str... more Background: Despite recent emphasis on the ''fourth trimester'' and beyond, most knowledge of stressors affecting women is focused on the first 6 postpartum weeks. Our aim was to identify postpartum-specific stressors and coping over the extended postpartum period. Methods: We analyzed data from two surveys for a combined sample of 346 postpartum women. Principal components analysis of survey items on sources of stress was used to identify categories of postpartum-specific stressors. Content analysis was used to categorize text data on coping strategies. Results: Seven stressors were identified: Overload, Working mother concerns, Isolated motherhood, Limited supportive resources, Exhaustion, Parenting demands, and Changes in body and sexuality. Overload was the most frequent stressor (F = 49.32, p < 0.001) and was significantly higher at 9-12 months than at 5-8 months or at 13 months or more (F = 6.42, p = 0.002). Fulltime employment and having more than one child were associated with elevated scores on several stressors. Content analysis yielded seven coping strategies, such as Take time alone or with others, Manage emotions and thoughts, and Maintain a manageable workload. Five of the seven stressors were associated with at least one of the top five coping strategies; none was associated with Overload or Limited supportive resources. Conclusions: Women's predominant source of stress was from overload and was highest at 9 to 12 months postpartum. Community resources and public health policy and programming are needed to prepare and support women during the challenging first postpartum year.

Disability and Health Journal

BACKGROUND Mothers with physical disabilities (MPDs) face the behavioral and psychosocial changes... more BACKGROUND Mothers with physical disabilities (MPDs) face the behavioral and psychosocial changes of the motherhood transition with fewer resources, additional barriers, and higher risks than nondisabled mothers. In this study we sought guidance from MPDs on adaptations needed to a health promotion toolkit for behavioral and psychosocial health that was originally developed for nondisabled, primarily low-income, women. OBJECTIVE To identify general themes for adaptations that would increase the suitability of the toolkit for MPDs. METHODS 11 MPDs were interviewed by videoconferencing in a mixed-methods study about their perspectives on improving relevance of the existing toolkit for this population. The toolkit contained three components: assessment scale, feedback template on assessment results, and a decision aid related to behavior change. Interviews were analyzed using qualitative content analysis. RESULTS Nine themes for improving suitability of the toolkit for MPDs were identified. Themes covered: Using non-judgment language; including strengths, not just risks; using exercise items applicable to persons with physical disabilities; being aware that functional ability was the key body image concern; considering motivational stages of behavioral change; providing choice in goal-setting for change; including suggestions for social support; identifying resources for health and adaptive parenting; and making health promotion resources available in alternative platforms (paper, electronic). CONCLUSIONS The MPDs' feedback revealed ways that our toolkit for behavioral and psychosocial health could be improved to be inclusive of MPDs. The participatory methods utilized here are also recommended in designing new or revising existing materials aimed at enhancing health promotion for people with disabilities.

Public health nursing (Boston, Mass.), 2017

Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-H... more Guided by the Uses and Gratifications approach, to examine mothers' use and preference of e-Health media, and associated contextual factors. Cross-sectional survey of 165 mothers (White, African-American, and Hispanic) from a stratified random sample. Use of online media about mother-baby care; favorite websites about motherhood and best-liked features of Web sites; channel preferences (Web site, postal mail, text) for receiving three types of health information; and contextual factors, e.g., education. Media use ranged from 96% for health information searches about babies to 46% for YouTube viewing about mother-baby topics. Contextual factors, such as education, were associated with media use. Babycenter was the most frequently reported favorite Web site and rich, relevant information was the best-liked feature. Across three health topics (weight, stress/depression, parenting) mothers preferred receiving information by Web site, followed by postal mail and least by text messagi...

The Canadian Journal of Nursing Research Revue Canadienne De Recherche En Sciences Infirmieres, Jun 1, 2007

Accurately assessing dietary intake is an essential component of international health research to... more Accurately assessing dietary intake is an essential component of international health research to identify nutritional deviations that may place people at risk for developing chronic diseases. Accurate assessment may be hampered by failure to address known measurement problems with traditional dietary assessment tools. This article describes the application and advantages and disadvantages of 5 frequently used dietary assessment methods, discusses the management of measurement error common to each, and recommends use of these methods in community-based health research. Using complementary assessment methods at multiple measurement points enhances the reliability of the findings. Assessing overall dietary quality is consistent with a holistic approach to interventions designed to improve health and is a valuable methodology for nutritional research. Using innovative approaches may more accurately identify dietary patterns that contribute to disease development. Although complex, examining nutritional intake in health research is essential to determining an individual's disease risk status and response to treatment.