An Evaluation of the Implementation of Maternal Obesity Pathways of Care: A Mixed Methods Study with Data Integration

Abstract

ObjectivesMaternal obesity has multiple associated risks and requires substantial intervention. This research evaluated the implementation of maternal obesity care pathways from multiple stakeholder perspectives.Study DesignA simultaneous mixed methods model with data integration was used. Three component studies were given equal priority. 1: Semi-structured qualitative interviews explored obese pregnant women’s experiences of being on the pathways. 2: A quantitative and qualitative postal survey explored healthcare professionals’ experiences of delivering the pathways. 3: A case note audit quantitatively assessed pathway compliance. Data were integrated using following a thread and convergence coding matrix methods to search for agreement and disagreement between studies.ResultsStudy 1: Four themes were identified: women’s overall (positive and negative) views of the pathways; knowledge and understanding of the pathways; views on clinical and weight management advice and support; and views on the information leaflet. Key results included positive views of receiving additional clinical care, negative experiences of risk communication, and weight management support was considered a priority. Study 2: Healthcare professionals felt the pathways were worthwhile, facilitated good practice, and increased confidence. Training was consistently identified as being required. Healthcare professionals predominantly focussed on women’s response to sensitive obesity communication. Study 3: There was good compliance with antenatal clinical interventions. However, there was poor compliance with public health and postnatal interventions. There were some strong areas of agreement between component studies which can inform future development of the pathways. However, disagreement between studies included a lack of shared priorities between healthcare professionals and women, different perspectives on communication issues, and different perspectives on women’s prioritisation of weight management.ConclusionThe differences between healthcare professionals’ and women’s priorities and perspectives are important factors to consider when developing care pathways. Shared perspectives could help facilitate more effective implementation of the pathway interventions that have poor compliance.

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

“…Current health-care guidance suggests that health professionals should advise women who have had a baby in the previous 2 years to eat healthily and keep active to encourage postpartum weight reduction. 45,46 The postpartum period could be an ideal time to intervene to shape new health behaviours as women have shown motivation for weight loss during this time, 47,48 and they may have a heightened awareness of their own and their families' health, and so may be receptive to information about lifestyle. 13 It is also a time when many women start to prepare for the next pregnancy, so there is the potential to set women on a positive course for subsequent pregnancies.…”

Weight Management in Pregnancy

“…17 This is not surprising as weight can be a very sensitive topic for many women, in particular during pregnancy when weight gain is inevitable. It needs to be emphasised that pregnant women are happy to be weighed in pregnancy 17,18 and this may be a good time to raise the issue. NICE recommends that all women should be weighed at the start of pregnancy, but weighing should only continue throughout pregnancy if there is a clinical reason to do so.…”

“…8 Even though many women are aware of what healthy eating entails, they still appreciate this information from a healthcare professional. 17 …”

“As soon as you’ve had the baby that’s it…” a qualitative study of 24 postnatal women on their experience of maternal obesity care pathways

“…These pathways, based on published national guidelines and research evidence, and the expertise of a multi-disciplinary steering group, were as follows: pathway 1 for women with a booking BMI ≥30; pathway 2 for women with a booking BMI ≥35; and pathway 3 for women with a booking BMI ≥40. These pathways were set up with the aim of providing the appropriate level of antenatal intervention to manage risks associated with obesity in pregnancy, as well as reducing known barriers to healthcare professionals’ management of maternal obesity [ 31 ]. The pathways were provided alongside a written maternal obesity guideline, and acted as a tick list for healthcare professionals incorporating antenatal, intrapartum, and postnatal clinical requirements relevant to the booking BMI, as well as an opportunity for weight management intervention.…”

“…The early implementation of these pathways has been evaluated via a mixed methods study [ 31 ], in which. Pregnant women highlighted positivity about the pathways when they were not seen as a tick box process, although women with a BMI <40 that weight management support and advice was lacking.…”