Factors Related to Listeriosis Prevention in Pregnant Women: A Mixed Methods Exploratory Study

Abstract

This research examined factors related to listeriosis prevention in pregnant women, with the aim of improving messages designed for pregnant women. Pregnant women are twenty times more likely than other adults to become infected by <italic>Listeria monocytogenes</italic>. Listeriosis can lead to miscarriage, stillbirth, or illness in the newborn. Current FDA guidelines for pregnant women advise avoiding foods that pose high risk of <italic>L monocytogenes</italic> contamination: hot dogs or luncheon meats without reheating, soft cheeses made with unpasteurized milk, refrigerated pâtés, refrigerated smoked seafood, and unpasteurized milk. These were updated in 2003 as our understanding of <italic>L. monocytogenes</italic> contamination in foods has changed. Previous research found that pregnant women were unaware of the guidelines, defensive when made aware, and consuming high-risk foods. The impact of changing guidelines has not been examined. A sequential explanatory mixed methods study was conducted. First, data collected in the second Infant Feeding Practices Study was analyzed to determine whether demographic and health-related factors were related to awareness of <italic>L. monocytogenes</italic> and the consumption of high-risk foods. Next, six focus groups with pregnant women were used to triangulate secondary data analysis findings, examine underlying beliefs related to listeriosis, and explore the impact of changing listeriosis prevention messages. The Extended Parallel Process Model was used as a theoretical framework to guide the groups. The results showed that awareness has increased, with 37% of IFPS II participants aware of <italic>L. monocytogenes</italic>. However, almost 75% reported eating unheated cold cuts. Subgroup differences were identified and fell along income and educational lines. Those with less education and lower incomes were less aware and more likely to consume high-risk foods. Focus group findings suggest that risk and efficacy beliefs affected adoption of the guidelines, consistent with the EPPM. Participants felt that too much emphasis on the potential of advice to change weakens response efficacy. The findings suggest that listeriosis prevention messages should heighten risk perceptions, enhance efficacy perceptions, and suggest, but not belabor, the notion of changing messages.