Starting the conversation: Patient initiation of weight-related behavioral counseling during pregnancy

•55% of prenatal visits included weight-related behavioral counseling.•Patients initiated weight-related discussions in 45% of these prenatal visits.•Prenatal visits with patient initiation were more participatory overall.•Patient-initiated counseling episodes included more socioemotional content.•Patient who initiated discussions received more counseling.

ObjectiveTo examine the relationship between patient initiation and weight-related behavioral counseling during pregnancy.MethodsWe examined audio recordings of prenatal visits between 22 obstetricians and 120 patients for behavioral counseling using the Roter Interaction Analysis System and the 5A’s behavioral counseling framework. We used multivariate regression models to examine the relationship between patient initiation and communication outcomes.ResultsOverall, 55% of prenatal visits included any behavioral counseling. Patients initiated counseling episodes 45.5% of these visits. Patients were less verbally dominated by their clinicians in prenatal visits with patient-initiated behavioral counseling episodes (difference in clinician verbal dominance ratio = 0.73, 95% CI = 0.16–1.30). Patient-initiated counseling episodes included more socioemotional communication relative to those initiated by clinicians (p = 0.02). The total duration of counseling was 28 s longer (95% CI 0.27–56.0 s) and clinicians were more likely to use two or more 5A’s strategies (OR = 3.61, 95% CI = 1.01–12.88) when patients initiated discussions.ConclusionsPatient initiation may lead to behavioral counseling that is longer in duration and includes more 5A’s strategies, possibly mediated by socioemotional communication.Practice implicationsParticipatory prenatal care communication may lead to more effective counseling that is responsive to women’s concerns.