Preventing Disordered Eating and Body Dissatisfaction Among High-risk Pregnant Individuals

The investigators will consider the program feasible if the investigators meet recruitment targets (N=60).

The investigators will assess what percentage of enrolled participants complete 4 or more sessions. The benchmark will be > 50% of participants will complete 4 or more sessions.

The investigators will assess what percentage of enrolled participants complete post-test assessments. The benchmark will be > 50% of participants will complete the post-test surveys and interviews.

Assesses participants' satisfaction with the intervention. Scores range from 8 to 32 with higher scores indicating greater satisfaction. The benchmark will be that at least 70% of participants will have scores over and above the midpoint in both the PBP and PHE groups.

Assesses participants' perceptions that the treatment will work after learning about the study. The first three items measure credibility, and the latter three items measure expectancy. It is scored on a scale of 3-27 with higher scores indicating greater confidence in the treatment. The benchmark will be that at least 70% of participants will have scores over and above the midpoint in both the PBP and PHE groups.

E.g.: The investigators will assess the feasibility of quantitative measures with the benchmark of no questionnaires fully missing in >25% of participants

Assesses acceptability, appropriateness, and feasibility of the intervention and Facilitators and Barriers to Participating. Acceptability, appropriateness, and feasibility subscales each consist of 4 items ranging from 1-5. Scores can be calculated by averaging the 4 items and range from 1-5. Higher scores indicate greater acceptability, appropriateness, and feasibility. The benchmark will be that at least 70% of participants will have scores over and above the midpoint for these subscales in both the PBP and PHE groups. Facilitators and Barriers to participating are open-ended questions and will be assessed with qualitative analyses.

The investigators will assess the percentage of sessions with ≥75% adherence. The benchmark will be ≥70% of sessions will have ≥75% adherence (checklist and audio recordings); 20% of sessions rated.

The investigators will assess the percentage of participants that complete (i.e., upload/submit) ≥75% of the homework assignments. The benchmark will be ≥70% of participants will complete ≥75% of the homework assignments.

Measures the degree to which a person identifies with the notion that thinness is equivalent to attractiveness, with items ranging from 1-5. Scores are calculated by averaging the 8 items, and range from 1-5, with higher scores indicating greater internalization of the thin ideal.

Measures the frequency of dieting behaviors, with items ranging from 1-5. Scores are calculated by averaging the 10 items, and range from 1-5, with higher scores indicating increased levels of restrictive eating.

Measures body dissatisfaction, with items ranging from 1-5. Scores are calculated by averaging the 9 items, and range from 1-5, with higher scores indicating greater body dissatisfaction.

36 items that measure body image during pregnancy, with items ranging from 1-5. The measure is made up of seven subscales: 'preoccupation with physical appearance' (six items), 'dissatisfaction with facial features' (four items), 'sexual attractiveness' (six items), 'prioritizing appearance over body functioning' (five items), 'appearance-related behavioral avoidance' (three items), and 'dissatisfaction with body parts' (six items). Subscale scores are calculated by averaging items, and range from 1-5, with higher scores indicating greater body image disturbance. The investigators adapted wording to administer the questionnaire again during postpartum.

28-item questionnaire measuring ED psychopathology, with items ranging from 0-6. A global score is obtained by averaging all items except for 13-18, with higher scores indicating increased ED symptoms. The clinical cut-off score is 2.8, which indicates a probable ED. Items 13-18 assess frequency of ED behaviors and are not included in the global score.

Measures ED psychopathology during pregnancy, with items ranging from 1-5. Scores are calculated by summing the 12 items, and range from 12-60, with higher scores indicating greater ED symptomatology during pregnancy. Scores >39 indicate a current ED.

Measures intuitive eating, with items ranging from 1-5. A global score can be calculated by averaging the 12 items, and range from 1-5, with higher scores indicating greater levels of intuitive eating. Subscales (Unconditional Permission to Eat, Eating for Physical Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) can be calculated by averaging items specific to each subscale.

Provides tentative diagnoses of full threshold anorexia nervosa, full threshold bulimia nervosa, full threshold binge eating disorder, subthreshold anorexia nervosa, subthreshold bulimia nervosa, and subthreshold binge eating disorder. The EDDS also generates an overall ED symptom score based on the sum of all relevant items. Higher scores indicate increased disorder eating symptomology with a clinical cut-off score of 16.5 for the overall symptom composite score (Krabbenborg et al., 2011).

Krabbenborg, M. A., Danner, U. N., Larsen, J. K., van der Veer, N., van Elburg, A. A., de Ridder, D. T., Evers, C., Stice, E., & Engels, R. C. (2012). The Eating Disorder Diagnostic Scale: psychometric features within a clinical population and a cut-off point to differentiate clinical patients from healthy controls. European eating disorders review : the journal of the Eating Disorders Association, 20(4), 315-320. https://doi.org/10.1002/erv.1144

Measures depression in pregnancy and postpartum, with items ranging from 0-3. Scores are calculated by summing the 10 items, and range from 0-30, with higher scores indicating greater depressive symptoms.

Measures anxiety, with items ranging from 0-3. Scores are calculated by summing the 7 items, and range from 0-21, with higher scores indicating greater anxiety.

Measures perceived social support, with items ranging from 1-7. A global score is calculated by summing the 12 items, and ranges from 12-84, with higher scores indicating greater perceived social support. Subscales (Significant Other, Family, and Friends) can be calculated by averaging items specific to each subscale.

The investigators will conduct exit interviews with participants assigned to the PBP group. The investigators will use this to make further adaptations to the intervention. This is a qualitative assessment informed by the Consolidated Framework Implementation Research.

The investigators will conduct exit interviews with the PBP group facilitators. The investigators will use this to make further adaptations to the intervention. This is not a scale. It is a survey including open test qualitative questions.

Patient reported measures of infant health at birth (e.g., preterm birth, low birthweight), maternal and delivery complications (e.g., preeclampsia), provider interactions, pregnancy and postpartum experiences, and feeding experiences with their baby. Exploratory analyses and descriptive statistics will be conducted for these neonatal outcomes and pregnancy, postpartum and feeding experiences.