Background
Method
Study design
Participants
Interview process
General health in pregnancy | |
What does it mean to you to have a healthy pregnancy? What factors are important? | |
When you were pregnant, how did your health behaviours change? | |
How important do you think it is to eat a healthy diet during pregnancy? | |
How important do you think it is to exercise when you are pregnant? | |
Experience with behaviour change support during pregnancy | |
What kinds of things did you talk to the research nurses about during your appointments? | |
What goals did you set with them? | |
What were your reasons for setting those goals? | |
How important was it to reach the goals you set? | |
What factors in your life supported you to reach your goals? What made it difficult? | |
How did your conversations with the nurses affect your health behaviours? | |
What else do you think could have helped you reach your goals or have a healthier pregnancy? |
Thematic analysis
Results
Participants
Description | Number (%) |
---|---|
Age at interview (y) | |
21–25 | 1 (6%) |
26–30 | 4 (24%) |
31–35 | 5 (29%) |
36–40 | 7 (41%) |
Highest level of education | |
A-level | 4 (24%) |
Higher national diploma | 1 (6%) |
Degree level or above | 12 (71%) |
Home index of multiple deprivation quintile | |
1 – most deprived | 1 (6%) |
2 | 3 (18%) |
3 | 4 (24%) |
4 | 3 (18%) |
5 – least deprived | 6 (35%) |
Number of children | |
1 | 8 (47%) |
2 | 8 (47%) |
3 | 1 (6%) |
Ethnicity | |
White British | 16 (94%) |
East Asian | 1 (6%) |
Key themes
Theme | Description |
---|---|
1) What keeps me from improving my health? | Barriers to improving health or reaching goals |
1a. The way pregnancy makes me feel | Pregnancy-specific experiences |
1b. I’m still recovering from labour | Physical changes/impairments made it difficult to exercise post-birth |
1c. My focus has changed since giving birth | Barriers related to having a new baby |
1d. My health is not a priority | Lack of interest in own health |
2) What things in my life help me to be healthy? | Facilitators to improving health or reaching goals |
2a. I have always had a healthy lifestyle | Being healthy comes naturally |
2b. People around me are healthy too | Social support for improving health behaviours |
2c. My environment encourages healthy behaviours | Environmental factors such as food availability or exercise facilities |
3) How did I use pregnancy-specific resources? | Use of available sources of information or support such as apps, books and classes |
3a. Baby’s development | Reading about how the baby is growing and developing |
3b. Specific concerns | Looking up specific symptoms or guidelines |
3c. To help me improve my health | Advice or information related to improving diet or increasing physical activity |
4) How much did I engage with the research nurses’ support? | Experiences and engagement with the HCS intervention |
4a. I realised that they were trying to support me to set and reach health behaviour goals | Participants describe the HC skills that the nurses used |
4b. The support I had helped me to be healthier | How the HCS intervention encouraged behaviour change |
4c. I set goals and tried to meet them (or not) | Engagement with goal-setting and effort made to reach those goals |
5) Why do I want to be healthy? | Motivators for wanting to improve diet or increase physical activity |
5a. I want to do the best I can for my children | Focus on the baby’s health and development |
5b. I want to stay healthy or get healthier | Focus on improvement or maintenance of own health |
5c. I don’t want to be fat | Concerns about body weight |
What keeps me from improving my health?
I hit six weeks and I just felt like absolute rubbish, and I pretty much lived on rice cakes and mashed potato for ages. It was just anything to settle my stomach, and that’s all I fancied. (26–30; 1 child; IMD 3)
Similarly, women found it difficult to remain physically active as they progressed through pregnancy.I get hyperemesis and I vomit and vomit until about six months. Both times, until almost six months. And so I didn’t really eat anything except crisps and bread and Coke […] really starchy things to keep it down. (36–40; 2 children; IMD 3)
Fewer pregnancy-related barriers were discussed with regard to physical activity than diet. In contrast, the post-natal period appeared to influence physical activity levels more than pregnancy as women described being tired and needing to recover from childbirth.As I got more pregnant, it got harder. And he’s a very strong dog. He pulls a lot as well, so I got to the point where I was like, ‘I’m just not doing this anymore.’ I had quite a sore lower back in pregnancy as well. (26–30; 2 children; IMD 5)
For those who had more than one child, there were additional barriers such as lack of time or energy. This appeared to be true both during pregnancy and after giving birth.I had some problems with my episiotomy and the stitches came out. That was quite painful and sore, so I actually found walking quite difficult […] For the first two months I really couldn’t walk very far at all. (36–40; 1 child; IMD 2)
The second time you just sort of have to continue as you are because you’ve got someone else to think about. So actually, I didn’t make nearly as many changes to my life as I did the first time I was pregnant, when it was just me and my partner. (36–40; 2 children; IMD 3)
Pregnancy-related barriers to improving diet and increasing physical activity were reported by most participants, regardless of their intention or desire to change these behaviours. However, one factor that was not necessarily related to pregnancy was a few women’s apparent lack of interest in their own health:We haven’t been on as many walks as I used to do with [first child] when she was little. We used to go for a walk after my husband got home from work […] ‘Course we can’t do that now when we’ve got a toddler as well. (36–40; 2 children; IMD 3)
Barriers to improving health behaviours were identified by most participants, and these were usually related to pregnancy or motherhood. On the other hand, some women were able to identify things in their lives that made it easier to be healthy.I’m sure there’s plenty of other women out there that are a lot more together than me, and probably are out and, you know, jogging around the block at 7 o’clock in the morning or whatever. And you know, that’s just not me. (36–40; 2 children; IMD 3)
What things in my life help me to be healthy?
I know how to eat healthily – I’ve always done it. (26–30; 1 child; IMD 4)
For those who said they were healthy people, this focus on health often extended to their households or social circles. Social support further enabled them to maintain healthy lifestyles during and post-pregnancy.Oh, just that I have always been like, I really enjoy exercise. And then, you know… I didn’t want to not do anything and sort of stagnate when I was pregnant. I wanted to keep up doing something. So I think that was part of it too; the fact that I’m just naturally an active person. (31–35; 1 child; IMD 4)
I’m not panicking about any of it. As I said before, obviously with someone in the house who likes to cook, and he cycles a lot, so he wants to stay fit and healthy and the boys are always active so it’s quite easy. It’s not a household where everyone wants to eat you know, junk food. (31–35; 3 children; IMD 2)
In addition to their social networks, some women identified other factors in their environments that made it easier to maintain a healthy lifestyle. These included easy access to healthy food at home or work, and having responsibilities that kept them active.My neighbour next door’s got a baby as well, so we’re quite close…You know the Couch to 5k?[…]I did that with her. That’s how I started running, and I eventually ran two 10k races after I had [my first child]… so we’re going to start that in a couple of weeks. (26–30; 2 children; IMD 5)
I was very lucky ‘cause where I work we have our lunches included… So it was really easy for me to eat quite healthily. I always had melon for my dessert instead of having the… oh I would allow myself the odd crumble here and there […] but the majority of the time, I would have sort of melon or strawberries or something like that. (31–35; 3 children; IMD 2)
Those who were able to identify factors that helped them to stay healthy usually talked about long-term circumstances, which were not necessarily related to being pregnant, rather than available pregnancy-specific support.I was really active because of [my son] and I didn’t want [the pregnancy] to affect him at all. Having a dog really helped because it meant that I would always go out and walk the dog. (31–35; 2 children; IMD 5)
How did I use pregnancy-specific resources?
Tracking the development of the baby was mentioned frequently as an interesting feature, and was one of the primary uses for pregnancy apps.More interesting to see my baby’s the size of a honeydew melon this week rather than like, ‘you should be eating that honeydew melon.’ I guess I like to think I kind of know what it is to eat healthy. (31–35; 2 children; IMD 5)
Aside from the development of the baby, women were usually seeking information related to pregnancy-specific concerns or symptoms.I always remember the Baby Centre ones because it was like, ‘this week your baby is the size of a tomato’ and that really grabbed me because I was like, I’d text my friends going, ‘banana.’ You know like tell them what size. (31–35; 2 children; IMD 5)
I didn’t use anything as an ongoing thing, but if I had a query, you know, like, ‘oh, my hands have swollen,’ or whatever. So likeBabycentre.comor something. (36–40; 2 children; IMD 3)
Only a few women used the internet to find diet-specific guidance:Many questions. Mainly many concerns about the development of my bump. Because there was an episode where I felt like my bump was developing not very fast. (31–35; 1 child; IMD 5)
About half of participants identified a resource they used to help them be physically active, including antenatal fitness classes and a goal-setting app. More than a third of participants did not specifically identify any resources for diet or physical activity support. Use of these resources appeared to differ between women who had had previous pregnancies and those who had been pregnant for the first time. In their first pregnancies, women tended to have more worries, and were more engaged with the pregnancy-specific information and resources available. Women who had been pregnant before seemed more relaxed about their pregnancies and appeared to have less interest in accessing information:I did print a list of every food you’re supposed to eat, every vitamin you’re supposed to eat in pregnancy. So I tried to eat different things off that. (31–35; 2 children; IMD 5)
Although most of the women interviewed did not specifically seek sources of diet or physical activity support, all of these women had five healthy conversations as part of SPRING, which aimed to support them to improve their health behaviours.When you’ve not been pregnant before, you think, ‘I mustn’t eat this sort of cheese, and I mustn’t eat this sort of fish, and I mustn’t drink and I mustn’t smoke and everything,’ and blah blah. And I don’t smoke and I don’t drink a lot anyway, but I think when you’ve done it, you sort of think, ‘actually…’ It’s not that it’s scare-mongering. It’s all very good advice, but I think the second time, you just have to be a bit sensible in yourself. (36–40; 2 children; IMD 3)
How much did I engage with the research nurses’ support?
There were two women who did not set any goals and one of these felt that the research nurse did not think she needed to make any changes.I think actually the nurses were brilliant ‘cause they were never like, ‘well, you should be doing this…’ they weren’t telling me what to do. They were kind of asking me what I would like to do and getting me to think about what I want[…] It got me thinking and a bit more focused on what I should be eating and doing. (36–40; 2 children; IMD 3)
The other woman who did not set any goals had a more negative attitude toward her experience and repeatedly stated that she was not the kind of person to set goals:I didn’t really set any goals with them actually. We did talk about doing swimming […] but when she took my measurements she wasn’t overly concerned that I was putting on excess weight. So for her I think she said, ‘whatever you are doing is working, so just continue to do that.’ (36–40; 2 children; IMD 5)
Women who set goals had a range of opinions about their helpfulness in supporting improved diet or increased physical activity. Some believed that they would have been just as healthy without the extra support, but most felt that having healthy conversations encouraged them to be healthier. Some women said that they appreciated the interest the research nurses showed in their health rather than only the development of the baby.I’m just not that sort of person […] My goal was to just get through the pregnancy relatively well, so I didn’t want to set myself a goal of saying ‘I’m going to do yoga twice a week’ or whatever. Or ‘I’m not going to eat any chocolate or anything.’ I just kind of wanted to get through it. (36–40; 2 children; IMD 3)
It does make you keep up everything you set because you almost feel when you’ve got someone ringing you in a few months’ time, you want to be able to say to them, ‘yes, yes! I’ve still done it.’ (31–35; 3 children; IMD 2)
I wouldn’t necessarily say those goals were really important to me, but the general being fairly healthy […] it wasn’t so much about the goals, it was just the [trial] that got me thinking generally about what you’re eating, what you’re putting in your body. (31–35; 2 children; IMD 5)
There was considerable variation in engagement with the HCS intervention as some women had set clear goals towards which they were still working, whereas others had not set specific goals or could not remember them after their participation in SPRING had ended.It was quite nice to have that, that time to actually really think about me pregnant and not just the baby whilst I was pregnant, if that makes sense. (36–40; 2 children; IMD 3)
I said to her that I was going to go back to Slimming World, which I have done. She asked me […] if I was still smoke-free. I said yeah. And basically, that was the major goal. (21–25; 2 children; IMD 1)
I don’t… I don’t know that I did, really. I found that quite hard. Yeah, they kept asking about things like that. I didn’t really set any goals. (36–40; 2 children; IMD 3)
Participants engaged to varying degrees with the support offered by the research nurses. This variation appeared to be closely related to the priority women placed on their own health as well as the extent to which they felt they could benefit from this support. In addition, women differed in their reasons for wanting to set goals to improve their diets or be more physically active.I: Do you think that talking about that with the nurses had any […] influence on your motivation to exercise, or to make sure you went and did it?P: Um… don’t think so. I mean they were lovely. Really lovely, really supportive, but I kind of knew I wanted to do that anyway. (26–30; 1 child; IMD 5)
Why do I want to be healthy?
The same woman was very focused on her children’s health, and stated that her children were her motivation for staying healthy.I do think that eating healthy is more important because that’s what they get, isn’t it, from you. (21–25; 2 children; IMD 1)
Most women, though, were also interested in their own health and how it would be affected by their pregnancies.I don’t want to teach my children that they’ve got to be skinny because they don’t have to be skinny. They just have to be healthy, and that’s what I want. So I can’t teach them not to smoke if I’m smoking. I can’t teach them not to drink if I’m an alcoholic. I can’t teach them to be healthy if I’m not healthy myself. (21–25; 2 children; IMD 1)
The focus was often related to weight gain and retention post-pregnancy.I think to be honest it was probably for me rather than for the baby […] Just before I got pregnant I had been quite healthy because I had been training to do the half marathon […] I guess I just didn’t want to completely go back to where I was before I started. (31–35; 1 child; IMD 2)
I just don’t want to be this fat mum waddling up to the school gates every day to pick up their children, you know? [...] But also, I’m worried about keeling over and having a heart attack because there’s been problems in my family – heart problems[…] I’m overweight and I don’t really look after myself and I’ve got two children. Something like that could happen to me, and I want to be healthy. (26–30; 2 children; IMD 5)
For some, the concern about health and weight was about not wanting to become an unhealthy person as this was not who they had been before having children. For others who had previously struggled to maintain a healthy weight or lifestyle, concerns about the effects of pregnancy reflected a general desire to be healthier. The extent to which women in this study viewed themselves as healthy can be conceptualised as ‘health identity’ where women’s perceptions of themselves fit on a spectrum that ranges from ‘health-disengaged’ to ‘health-focused’. Figure 1 is a visual representation of this concept and its relation to women’s openness to change. The statements that fall on different points in the figure are not quotes from the interviews, but were informed by this study and are intended to illustrate the range of responses.I think some people can slip into, ‘oh, I’m fat now.’ Then if you have another pregnancy… you know, I was quite scared about keeping my weight then having another baby and then just magnituding [sic]. I’ve seen a lot of people do that; they kind of put on four stone and they were healthy people, you know? (31–35; 2 children; IMD 5)