Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.

There are numerous biomedical and psychosocial challenges associated with obesity in pregnancy that impede communication between healthcare providers (HCPs) and patients. We conducted a narrative study informed by stigma theory to understand specific areas of communication breakdown in obesity-in-pr...

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Main Authors: Rachel Dadouch, Sarenna Lalani, Rory Windrim, Cynthia Maxwell, John Kingdom, Rohan D'Souza, Janet Parsons
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2025-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0318514
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author Rachel Dadouch
Sarenna Lalani
Rory Windrim
Cynthia Maxwell
John Kingdom
Rohan D'Souza
Janet Parsons
author_facet Rachel Dadouch
Sarenna Lalani
Rory Windrim
Cynthia Maxwell
John Kingdom
Rohan D'Souza
Janet Parsons
author_sort Rachel Dadouch
collection DOAJ
description There are numerous biomedical and psychosocial challenges associated with obesity in pregnancy that impede communication between healthcare providers (HCPs) and patients. We conducted a narrative study informed by stigma theory to understand specific areas of communication breakdown in obesity-in-pregnancy clinical encounters. Sixteen patients and 19 HCPs participated in in-depth, semi-structured interviews. We explored how participants positioned obesity-in-pregnancy clinical encounters within their broader narratives. Employing narrative analysis, we identified five narrative tensions contributing to communication challenges: 1) obesity as a detriment to health versus an acceptable biologic variation; 2) obesity as the result of personal choice versus the result of uncontrollable circumstances; 3) a regular pregnancy versus a high-risk diagnosis; 4) a typical and problem-free clinical encounter versus a tremendously difficult clinical encounter; and 5) talking openly about Body Mass Index (BMI) and related co-morbidities versus sidestepping the topic. How participants positioned themselves relative to prevailing societal discourses regarding obesity in general influenced these tensions. These narrative tensions revealed specific areas where communication is vulnerable to breaking down during the obesity-in-pregnancy clinical encounter. Participants' (both HCPs and patients) past experiences of clinical encounters-and the meanings they ascribe to them-shape subsequent encounters, and our analysis illuminates the complexities of this interactive space. This research has implications for improving clinical practice and education.
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spelling doaj-art-ed83fbe2d615448888652982abd5fc392025-08-20T02:16:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032025-01-01202e031851410.1371/journal.pone.0318514Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.Rachel DadouchSarenna LalaniRory WindrimCynthia MaxwellJohn KingdomRohan D'SouzaJanet ParsonsThere are numerous biomedical and psychosocial challenges associated with obesity in pregnancy that impede communication between healthcare providers (HCPs) and patients. We conducted a narrative study informed by stigma theory to understand specific areas of communication breakdown in obesity-in-pregnancy clinical encounters. Sixteen patients and 19 HCPs participated in in-depth, semi-structured interviews. We explored how participants positioned obesity-in-pregnancy clinical encounters within their broader narratives. Employing narrative analysis, we identified five narrative tensions contributing to communication challenges: 1) obesity as a detriment to health versus an acceptable biologic variation; 2) obesity as the result of personal choice versus the result of uncontrollable circumstances; 3) a regular pregnancy versus a high-risk diagnosis; 4) a typical and problem-free clinical encounter versus a tremendously difficult clinical encounter; and 5) talking openly about Body Mass Index (BMI) and related co-morbidities versus sidestepping the topic. How participants positioned themselves relative to prevailing societal discourses regarding obesity in general influenced these tensions. These narrative tensions revealed specific areas where communication is vulnerable to breaking down during the obesity-in-pregnancy clinical encounter. Participants' (both HCPs and patients) past experiences of clinical encounters-and the meanings they ascribe to them-shape subsequent encounters, and our analysis illuminates the complexities of this interactive space. This research has implications for improving clinical practice and education.https://doi.org/10.1371/journal.pone.0318514
spellingShingle Rachel Dadouch
Sarenna Lalani
Rory Windrim
Cynthia Maxwell
John Kingdom
Rohan D'Souza
Janet Parsons
Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.
PLoS ONE
title Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.
title_full Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.
title_fullStr Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.
title_full_unstemmed Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.
title_short Where is communication breaking down? Narrative tensions in obesity-in-pregnancy clinical encounters.
title_sort where is communication breaking down narrative tensions in obesity in pregnancy clinical encounters
url https://doi.org/10.1371/journal.pone.0318514
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