Fetal exposure to an intrauterine environment affected by maternal obesity and excessive gestational weight gain (GWG) pose several adverse short- and long-term health risks to infants. Excessive GWG and maternal obesity are of high priority to public health across many nations. Improving maternal and child health can be achieved by encouraging women to meet Institute of Medicine (IOM) weight gain recommendations, sound clinical guidance, and other forms of support. Another means of helping women adhere to weight gain guidelines is by making use of the near ubiquitous nature of mobile technology and promoting healthy pregnancies through reliable mobile health (mHealth) applications (apps). The objective of the first study of this thesis was to examine the associations between psychosocial factors and achieving IOM-recommended weight gain during pregnancy. Cross-sectional data were collected from pregnant and postpartum women who responded to a validated questionnaire, the Electronic Maternal health survey. Multiple linear logistic regression analyses were used to determine correlates associated with meeting IOM guidelines. The objective of the second study was to conduct a preliminary exploration of women’s attitudes towards an evidence-based, mHealth app, SmartMoms Canada, as a valid source of pregnancy-related information and its ability to offer physical activity, nutrition, and lifestyle support. Focus groups were organized to assess women’s attitudes towards the app and inductive thematic content analysis was utilized to interpret focus group data. It was found that self-efficacy and perceived controllability of behaviours are important factors contributing to whether women meet IOM weight gain recommendations. Further, pregnant women are quite receptive to mHealth technology and positively viewed the future prospective of SmartMoms Canada as a means of promoting overall maternal health. Combined, these findings will contribute to our understanding of how to best improve maternal-fetal health outcomes in the near future.

The Institute of Medicine identifies nurses as being in a position to become a powerful force for change in our healthcare system through their leadership. The impostor phenomenon is a psychological pattern in which individuals doubt their skills, talents, or accomplishments, or may have internalized fears of being exposed. In a time when nurse leaders are needed the most, these feelings may prevent nurses from advancing their careers and to lead. While a plethora of studies have examined this phenomenon and its negative impacts to mental health and career progression, there is little on the experience among nurses and none among nursing leaders or how to manage it effectively. Fellows of the American Academy of Nurses are considered nursing’s most accomplished leaders in education, management, practice, and research. These successful leaders have been recognized for their extraordinary contributions to nursing and health care. This qualitative study used a phenomenological method designed to gain insight into how these successful leaders have experienced impostor feelings. Ten nurse leaders were interviewed about their career progression, and their experiences with the impostor phenomenon were revealed. Findings were analyzed and the six essential themes that were illuminated from those shared experiences were: (a) Welcoming Opportunities, (b) Extended Sphere of Support, (c) Willingness to be Courageous, (d) Embracing the Journey, (e) Willingly Expressing Humility and Authenticity, and (f) Navigating the Impostor Process. The findings from this study will contribute to the body of knowledge about the impostor phenomenon within the context of the nursing profession and leadership and may benefit other nursing professionals experiencing similar feelings to mitigate them.

The Institute of Medicine (IOM) and National Research Council (NRC) established guidelines for weight gain during pregnancy to maximize positive health outcomes for mothers and their offspring. However, in the US, about half of all pregnant women exceed these recommendations. Excessive weight gain during pregnancy is associated with various negative outcome for mothers and their children. Research in recent years has begun to explore the relationship between both diet quality and ultra-processed food (UPF) intake during pregnancy with gestational weight gain (GWG). However, research is scarce, especially pertaining to UPF intake and GWG. Additionally, there is no research which explores these relationships among Latina women living within the US. The purpose of this study is to explore the relationships between prenatal diet quality, measured with the Healthy Eating Index-2020 (HEI), and intake of UPF, based on the Nova classification system, with the adequacy of GWG among a predominantly Latina sample of adult pregnant women living within the US. Additionally, the association between social determinants of health with diet quality and with UPF intake were also explored. The study is a secondary-data analysis of data from a longitudinal study. The sample analyzed includes 118 pregnant women between the ages of 18-45 years old (mean = 29.9, SD = 6.1). Mean pre-pregnancy body mass index (pBMI) for the total sample was 25.8 kg/m2 (overweight). 67% of the sample identified as Hispanic/Latina. Overall, 22% of the sample were classified with inadequate GWG; 17% with adequate GWG; and 61% with excessive GWG. The mean total HEI score for the sample was 54.1 out of 100, where higher scores reflect higher diet quality and adherence to the Dietary Guidelines for Americans. There was a statistically significant difference across GWG groups (inadequate/adequate/excessive) in mean total HEI scores (p < .05). The adequate GWG group had the highest total HEI scores and the excessive GWG group had the lowest total HEI scores. Variables that were found to be univariately associated with excessive gestational weight gain included: average total HEI score, pBMI, ethnicity; education; and income (p < .05). A 1-point increase in mean total HEI scores was associated with a 5% lower chance of excessive GWG (p = .02). However, after adjustment for covariates (maternal age; pBMI; income; education; race and ethnicity), the association between average total HEI score and excessive gestational weight gain was attenuated and no longer statistically significant. There was a statistically significant difference across GWG groups (inadequate, adequate, or excessive) in their scores of two HEI components: Greens and Beans (p < .01); and Seafood and Plant Proteins (p < .01). The adequate GWG group had the highest scores and the excessive GWG group had the lowest scores in these HEI components. In simple logistic regressions of excessive GWG versus adequate GWG on HEI components, the Greens and Beans scores and the Seafood and Plant Protein scores were significantly associated with excessive GWG. After adjustment, the Greens and Beans scores and Seafood and Plant Proteins scores indicated strong estimated negative associations with excessive GWG, OR = 0.61, 〖 χ〗_1^2= 8.07, p < 0.01 and OR = 0.60, 〖 χ〗_1^2= 7.84, p < 0.01, respectively. A higher score on these components was associated with a lower risk of excessive GWG. The mean percentage of energy intake from ultra-processed foods (PEI-UPF) was 51.2%. There was no statistically significant difference in the PEI-UPF across GWG groups (inadequate, adequate, or excessive) and the PEI-UPF was not associated with odds of excessive GWG. However, the adequate GWG group had the lowest intake of PEI-UPF (49.2%) and the excessive GWG group had the highest intake of PEI-UPF (52.1%). Social determinants of health were not associated with the mean PEI-UPF, but results suggested a positive relationship between social support and total HEI scores (p = .08). Deeper analysis of the social support measure revealed a statistically significant relationship between the appraisal subscale of social support and HEI scores, Β = 0.13, F(1, 102) = 7.11 (p = 0.009). Overall, dietary intake during pregnancy may influence the adequacy of gestational weight gain. Achieving recommended intake of greens and beans, as well as seafood and plant proteins, may play a particularly important role in reducing the risk for excessive gestational weight gain. In addition, greater levels of social support, particularly access to another person who can offer advice and guidance with personal problems, may enhance diet quality during pregnancy.