Developing a behavior change intervention for physical activity during pregnancy
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Background: Although the benefits of physical activity during pregnancy are well documented in the literature, women’s activity levels often reduce or cease during pregnancy. Moreover, adherence to physical activity guidelines is particularly low for pregnant women with a Body Mass Index (BMI) ≥25kg/m². Aim: The aim of this PhD is to enhance our understanding of physical activity during pregnancy with the view to inform the development of a theoretically based behaviour change intervention to improve physical activity levels for pregnant women with overweight and obesity. Methods: Following the guidelines of the UK Medical Research Council Framework for developing complex interventions, four studies were conducted to address the three steps in the development phase of this framework. In the first study a cross-sectional analysis using the Screening for Pregnancy Endpoints (SCOPE) data was conducted. This study examined the impact of other health behaviours (fruit and veg consumption, fish consumption, smoking and alcohol) and psychological well-being (perceived stress scale, behavioural responses to pregnancy, state trait anxiety inventory, depression scale, and postnatal depression score) on physical activity levels during early pregnancy. Two qualitative studies were conducted, the first with pregnant women with overweight and obesity to identify enablers and barriers to physical activity using the theoretical domains framework and COM-B model (capability, opportunity, motivation and behaviour). And secondly with health care professional to understand how obstetricians, GPs and midwives engage with women with overweight and obesity during pregnancy. In the final study a systematic review and meta-analysis was conducted to identify and summarise the effectiveness of existing physical activity interventions for pregnant women with overweight and obesity with a specific emphasis on the behaviour change techniques employed. Findings: Results from the cross-sectional analysis found that having more than 12 years of schooling and a higher socioeconomic status was related to moderate physical activity compared to low physical activity. From the qualitative interviews with pregnant women with overweight and obesity, knowledge was identified as a barrier to physical activity, as women lacked information on safe activities during pregnancy and described the information they received from their midwife as ‘limited’. Social support was identified as a key enabler to physical activity; women are more likely to be physically activity if they received support from their family and friends. Health care professionals, described using a “softly-softly approach” to weight management in order to strike a balance between being woman-centred and empathetic and medicalising the conversation. Findings from the systematic review and meta-analysis, suggest that physical activity interventions are to some extent effective at increasing physical activity levels for pregnant women with overweight and obesity. The behaviour change technique ‘social support’ was identified for pregnant women with overweight and obesity within the included interventions. Additionally, ‘self-monitoring of behaviour’ (using items such as diaries, workbooks and pedometers to monitor physical activity) emerged as one of the most frequently used BCTs within the included interventions. Conclusion: The findings of this research contribute to a clearer understanding of physical activity, providing an in-depth exploration of the barriers, enablers and determinants of physical activity for pregnant women, providing important insights into this high-risk population and a thorough foundation for intervention development. Following the MRC framework and utilising frameworks from behavioural science, this research revealed factors such as ‘social support’, ‘goal setting’ and ‘self-monitoring of behaviour’ as important behavioural components that may have a positive impact on improving physical activity in future interventions. Future interventions should include women’s ‘social support’ networks and provide some form of ‘self-monitoring’ such as pedometers so that women can set goals and monitor their progress.