Background
Method
Study design
Sampling and recruitment
Interview process
Questions | Prompts/Probes | |
---|---|---|
Intro | Tell me a little about your home life? | • First pregnancy? • Married, single? • Other Children – how many? • Employed – how many hours you work? |
Tell me a bit about your lifestyle at the moment? | • Diet – cravings, nausea • PA – active before pregnancy, frequency, duration • Have diet/PA patterns changed since pregnancy? • In what way and why? | |
Health | Has a HCP made you aware of the risks surrounding your pregnancy | • Excessive weight gain • GDM • Potential difficulties during delivery • How does that make you feel? |
PA and Diet | What PA do you/would you like doing? | • Walking, running, exercises tailored for pregnancy, sports, gym? |
How important do you feel exercise and PA is during pregnancy? | • Fitness level • Mobility • Give you more energy • Help sleep | |
Tell me what you think would be the best way to encourage women to be watchful of diet and PA during pregnancy? | • Through friends, other pregnant women, GP, nurses, information sessions, individual or group, exercise and diet programmes | |
Behaviour Change | Have you been given advice about dietary habits and PA since you became pregnant? | • HCP, family, friend, book, internet? • When was this? • How did you feel about the advice? |
What to do think are the main challenges to PA and diet changes during pregnancy? | • Lack of information/ support/ time/ resources | |
Would you be interested in using technology to help you track and improve you PA and diet | • Mobile phone apps, text message/phone, web based information forums, pedometer? • Would these support mechanisms be useful? • If it provided you with information as well • If it provided you HCP with your information | |
How would you feel about participating in a study where technology would be used as encouragement to increase PA? | • Mobile phone apps, text message/phone, web based information forums, pedometer • Access to internet, mobile phone | |
Is there anything I haven’t asked you today you would like to mention? |
Data analysis
Results
Participants’ characteristics
Nationality | |
Chinese | 2 |
French | 1 |
Hungarian | 1 |
Lithuanian | 1 |
Irish | 16 |
Nigerian | 5 |
Sudanese | 2 |
Congolese (Democratic Republic of Congo) | 1 |
Ghanaian | 1 |
Age | |
20–29 | 6 |
30–39 | 14 |
40+ | 1 |
Unknowna | 9 |
Gestation | |
First Trimester (0 to 13 Weeks) | 1 |
Second Trimester (14 to 26 Weeks) | 8 |
Third Trimester (27 to 40 Weeks) | 20 |
Not stated | 1 |
BMI (kg/m2\)b | |
Overweight 25–29 | 12 |
Obese ≥30 | 12 |
Unknownc | 6 |
Pregnancy | |
Singleton | 29 |
Twins | 1 |
Employment | |
Working full time | 10 |
Working part time | 2 |
Out sick from work | 2 |
Not working | 6 |
Not stated | 10 |
Gestational Diabetes Mellitusd | |
GDM | 5 |
Not stated | 25 |
Miscarriagese | |
Miscarriages | 8 |
Not stated | 22 |
Physical activity clusters identified in pregnancy
Summary of the TDF and COM-B model: Barriers and enablers to physical activity
Themes | TDF | COM-B |
---|---|---|
- Fitness level prior to pregnancy - House work as a form of PA - Medical conditions and pregnancy symptoms (pain/energy/tiredness) | Knowledge (awareness of the existence of something: knowledge of condition) | Psychology capability Knowledge or psychological skills, strength or stamina to engage in the necessary mental process |
- Limited knowledge surrounding PA benefits, types of PA in pregnancy and PA resources - Pregnant women discussed concerns around having that ‘conversation’ | Knowledge (awareness of the existence of something: knowledge of condition) | Psychology capability Knowledge or psychological skills, strength or stamina to engage in the necessary mental process |
- Self- monitoring, use of pedometer/step count/phone apps | Behavioural regulation (managing or changes action – self monitoring) | |
- Women expressed interest in goal setting | Goalsa (mental representations of outcome or end states, that an individual wants to achieve) | |
- Pregnant woman’s situation (family life/children/work/pets) - Financial situation - Weather/ built environment and resources within the community | Environmental context and resources (persons situation or environment) | Physical Opportunity Opportunity afforded by the environment involving time, resources, location, cues physical affordance |
- Acknowledged support from family members, partner and friends - Interaction with other pregnant women [PA classes] was mentioned | Social influences (Process that can change thoughts feelings or behaviours – social pressure) | Social opportunity Opportunity afforded by interpersonal influences, social cues and cultural norms that influence the way we think |
- ‘Every pregnant women is different’ - Differences in pregnancies | Social role and identity (set of behaviours and displayed personal qualities in a social or work setting) | Reflective Motivation Reflective process involving plans (self-conscious intentions) and evaluations (beliefs about what is good and bad) |
- Using pregnancy as an ‘excuse’ - Concern for health of the baby - Feeling responsible - Difficulty breaking habits/mind-set | Beliefs about capability (acceptance of the truth, reality or validity about an ability, perceived behavioural control,, self-esteem, confidence) | |
- Post-partum intentions (planning weight loss/healthy lifestyle) | Intentions (A conscious decision to perform a behaviour) | Reflective Motivation Reflective process involving plans (self-conscious intentions) and evaluations (beliefs about what is good and bad) |
- Feelings of worry, concern and guilt during pregnancy - Fear based on previous pregnancy outcome/miscarriage | Emotion (complex reactions - fear, anxiety, affect, stress, depression, positive and negative effect, burn out) | Automatic Motivation Automatic processes involving emotional reactions, desires(wants and needs) impulses inhibitions drive states and reflex responses |
Capability
Physical skills
Furthermore, women who knew their pregnancy was high risk, decided themselves, that it was best not to engage in physical activity.‘The problems I had just stopped me [PA]. Like I got a polyp…which was heavy bleeding and the more I strained the body, even just a swim it was just like there was more pressure on it so I just said it was better to cut everything’ (Participant 15; 32 weeks pregnant)
Another barrier was that of feeling too tired to engage in physical activity; finding it hard to move, lack of energy and being physically drained.‘I’m a high risk pregnancy so I couldn’t do any of the exercise then on this pregnancy. And then I have factor 5 blood so really clotting and all that, I have to take it easy’ (Participant 05; 28 weeks pregnant)
However, some women felt that physical activity during pregnancy did benefit them (e.g. helped them wake up, gave them energy and made them feel good). Likewise, being physically fit before pregnancy was identified as an enabler; if a woman was active before pregnancy she was more likely to keep it up.‘It’s harder to move faster now that I am pregnant. Like sometimes I have energy and some days I don’t… It’s difficult, like you feel like you want to do stuff but you can’t, your body is just tired and drained physically’ (Participant 20; 28 weeks pregnant)
House work emerged as an enabler particularly for women who did not like exercise. These women considered household activities as part of their daily activity.‘I don’t know I think it depends on everyone’s circumstances. Like a lot of women would be fit before they got pregnant and they would keep up their walking or running’ (Participant 01; gestation unknown)
‘No I wouldn’t get out and walk or anything like that…housework would be my activity during the day’ (Participant 04; 28 weeks pregnant)‘Not really, there’s nothing really, I’m not a big fan of exercise. I will do the house work, the cleaning and the cooking’ (Participant 17; 36 weeks pregnant)
Knowledge
These doubts were partly due to the limited information they reported receiving from their midwife or health care professional. This information was described as a ‘limited’, ‘quick’, ‘automatic’, ‘like a checklist’ and women felt the benefits of physical activity was rarely discussed.‘To be honest, I’m not good in what physical activities a pregnant woman should do because nobody really has told me about the kind of exercise you should be doing’ (Participant 28; 32 weeks pregnant).‘I mean I don’t know can you do certain exercises so I would be worried that I could pull a muscle so I would be extra cautious I suppose at the gym cause I’m afraid and I wouldn’t really know’ (Participant 13; 32 weeks pregnant)
Furthermore when discussing ‘the conversation’ women felt more emphasis was placed on the clinical aspect of the visit rather than information and advice.‘It’s very limited really, very limited. It’s a quick one minute conversation really in relation to it [PA/Diet]….I suppose nobody really sits you down to go through the implications of that or the benefits and stuff like that’ (Participant 21; 26 weeks pregnant)
Some women felt that midwives assumed because they had other children they already had knowledge and information around being physically active in pregnancy.‘They don’t tend to offer any advice good or bad in terms of weight management and activity and stuff like that. It’s more the blood pressure, checking the baby and stuff like that’ (Participant 21; 26 weeks pregnant)
Women actually felt less confident in terms of what they knew about physical activity and would have preferred more advice from their midwife.‘…what I found different was when they know that you have children already they kind of thinking that you know everything which is not true…you may forget, years apart, like between now and the last time I had a baby there is a three year gap so I can’t remember everything but they seem to assume because you have had other children you know already what to do’ (Participant 28; 32 weeks pregnant)
Some women were active when they had “knowledge” of the health benefits (e.g. keeping muscles strong for labour). Furthermore, women expressed interest in attending pregnancy exercise classes; if they were provided with information on these classes in their area they would be more likely to attend.‘there’s no such thing as really showing you or describing it you know, or making sure that you are doing it [PA], I think that could be discussed or checked a little bit more’ (Participant 14: 30 weeks pregnant)
‘I think that would be a good idea [PA information & resources], like if you were given like numbers and sort of classes around that area at your clinic appointments for like types of yoga and stuff like that’ (Participant 04; 28 weeks pregnant)
Behavioural regulation and goals
Some women suggested setting “goals” as an enabler to physical activity, providing them with targets to accomplish.‘If there was definitely some sort of measurement like a pedometer or something like that, just something that would flag where you are at and what your targets should be’ (Participant 21; 26 weeks pregnant)
Although women felt a pedometer or step count would help with motivation, other forms of technology did not have the same perceived benefit. Women disliked the idea of tracking physical activity (number of days, length of activity time) in a phone app if it was linked with the antenatal clinic. They felt like ‘big brother’ would be watching or that it was a chance for their health care professionals to ‘check up on me’ calling it an ‘invasion of privacy’. Furthermore some women felt that tracking physical activity would be a ‘burden’ or like ‘homework’ and that with their busy lifestyles they would just forget.‘I am very goal driven, I would love that, if someone said ' you need to walk three miles this week and you need to do four laps of the pool and something else, you know you would hit your targets and you know then that even if they say that was helping you, that you are going a good job. You’re doing something good anyway’ (Participant 18; 14 weeks pregnant)
‘I’m not actually that good of keeping track of anything really like that [PA] (laughs) I would try to write things down but I would just be so busy or I would forget and I wouldn’t do it, so I wouldn’t be a good user of those [pregnancy apps]’ (Participant 13; 32 weeks pregnant)
Opportunity
Environmental context and resources
Some women identified a lack of financial means as well as a lack of targeted services specifically tailored for pregnancy as barriers to physical activity. Women suggested subsidised services as a solution to financial difficulties. Making services ‘financially viable’ might encourage the use of a gym or exercise class’s thus enabling physical activity.‘I suppose prior to the first pregnancy I could go from work to exercise and then come home. Whereas, now if I do that I don’t see my son before he goes to bed. So I just can’t fit it into my day to be honest, it’s more challenging’ (Participant 21; 26 weeks pregnant)
‘I mean I’m not going just because I have two kids I have a massive big mortgage and I actually can’t afford the full membership to go swimming…….Free gym membership for pregnant woman for 9 months (laughs) that would be great, even I would go then (laughs)’ (Participant 16; 38 weeks pregnant)
Social influences
Women also expressed an interest in pregnancy physical activity classes giving mothers a chance to ‘talk’ comparing it to a ‘support group’.‘Put your feet up' that’s what I get especially over the last four weeks, from my mother in law’ (Participant 16; 38 weeks pregnant)
‘…it would be that extra motivation [PA classes]. Get out and make friends and talk more, and enjoy the activity more’ (Participant 04; 28 weeks pregnant)
Motivation
Social role and identity
‘I think it definitely depends on the individual, I think it depends on the pregnant mother whether they want to be healthy or not…’ (Participant 01; gestation unknown)
Belief about capability
Some women also described how they were changing behaviour to be healthy not only for the baby but for themselves.‘…every woman is different and every woman will take on board information differently [diet & PA]. I think it is very important when you’re pregnant, you need to just take responsibility like, and you do. (Participant 19; 27 weeks pregnant)
At the same time, pregnancy provided a reason to not make healthy changes (e.g. ‘…like sure I’m pregnant. I’m going to be big anyway’ (Participant 09; 39 weeks pregnant)). Woman felt that pregnancy could be used as an ‘excuse’ and that ‘mind-set’ played a big part in whether or not you would make any changes. Some women stated they would have to have been physically active at the start of pregnancy in order to keep it up and that breaking bad habits in pregnancy is difficult.‘..when I came out of my doctor I knew I was going to do something that was going to help me and the baby and that my actions would make us healthier together ya know. (Participant 18; 14 weeks pregnant)
‘No I would have to have been doing it from the start [PA]. I wouldn't have picked it up half way through. I definitely would have had to have started at the beginning. I mean I told myself at the start, I actually wouldn't mind doing that [PA] and keeping it up but I just didn't and then I just stopped and sat and eat….it’s hard to break that habit especially when you are pregnant as you do use it as an excuse’ (Participant 02; gestation unknown)
Intentions
‘I know I am not having any more and I tell myself afterwards I’ll get back into it’ (Participant 02; gestation unknown)‘So I said right when this baby now is done…after I have recovered I’m going back to my [PA] classes’ (Participant 05; 28 weeks pregnant)
Emotion
A fear based on previous pregnancy outcomes was highlighted with women afraid to do anything in pregnancy due to previous miscarriage experiences.‘if I could get away with it [no PA], if I could I would definitely but I know I would feel pure guilty. I know I would have them [health care professionals] looking at me and I would feel fierce guilty’ (Participant 18; 14 weeks pregnant)‘…the first time round I could go for walks, I was taking care of my health and ya know, you kind of that bit worried the first time round, you make sure you are doing the best for the baby and yourself’ (Participant 01; gestation unknown)
‘…from the moment I knew I was pregnant it has been terrifying for me. Because like I’m after having 3 miscarriages in 2 years it’s not a nice thing to experience, I mean you’re constantly waiting to see that heartbeat..’ (Participant 05; 28 weeks pregnant)