Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers

Abstract

Summary A healthy postpartum lifestyle is vital for the promotion of optimal maternal health, return to pre‐pregnancy weight and prevention of postpartum weight retention, but barriers exist. We performed a systematic review that aimed to describe the barriers and facilitators to a healthy lifestyle in the first 2 years postpartum from the perspectives of women and healthcare providers. Databases were searched for eligible studies published up to 26 August 2019. Following thematic analysis, identified themes were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour model. We included 28 qualitative and quantitative studies after screening 15,643 citations and 246 full texts. We identified barriers and facilitators relating to capability (e.g., lack of knowledge regarding benefits of lifestyle behaviours; limitations in healthcare providers' skills in providing lifestyle support), opportunity (e.g., social support from partners, family, friends and healthcare providers; childcare needs) and motivation (e.g., identifying benefits of exercise and perception of personal health; enjoyment of the activity or food). We suggest intervention components to include in lifestyle interventions for postpartum women based on the identified themes. Our findings provide evidence to inform the development of interventions to support postpartum women in adopting and maintaining a healthy lifestyle.

Reducing Postpartum Weight Retention: A Review of the Implementation Challenges of Postpartum Lifestyle Interventions

“…Previous interventions successful in promoting weight loss, dietary and physical activity behaviours have used a range of settings, including home-based and/or hospital clinic based [ 82 , 93 ]. The choice of intervention setting is critical considering that postpartum women face challenges of childcare and time constraints which may impact on their participation and adherence to lifestyle interventions [ 90 , 94 ]. Home-based interventions using telephone, internet or mail may be more practical for postpartum women than clinic-based interventions unless when interventions are embedded into routine visits to child health clinics [ 90 , 95 ].…”

“…These barriers could hinder participation in lifestyle interventions and contribute to high attrition rates of up to 42% as reported in previous systematic reviews [ 16 , 78 , 90 , 109 ]. These barriers were summarized in a recent systematic review using the Capability, Opportunity, Motivation and Behaviour (COM-B) model, which is a behaviour change framework [ 94 ]. In terms of capability, barriers reported include limited knowledge on how to safely resume exercise after birth, fatigue, tiredness, sleep disturbances, stress and depression.…”

“…Lack of support from partners for healthy eating, exercising and childcare, from friends for exercise, and lack of lifestyle support from healthcare providers were also reported. In terms of motivation, the perception that great effort is required, lack of confidence in their ability to exercise, unwillingness to change eating habits, lack of enjoyment of exercise or healthy food and low self-worth were reported barriers to healthy lifestyle behaviours in postpartum women [ 94 ]. These barriers may explain poor attendance at interventions targeted at postpartum women as reported in previous studies [ 95 ].…”

“…Determinants that influence engagement with lifestyle interventions beyond the individual woman include family and friends, cultural influence, health professionals, the built environment and socio-economic impact [ 110 ]. The influence of the family on postpartum women’s willingness to engage in lifestyle modification has previously been reported [ 84 , 94 , 111 ]. The support and involvement of partners in postpartum lifestyle interventions is particularly crucial for lasting behaviour change especially in high-risk women who have experienced gestational diabetes or preeclampsia [ 108 , 111 , 112 , 113 , 114 ].…”

“…The support and involvement of partners in postpartum lifestyle interventions is particularly crucial for lasting behaviour change especially in high-risk women who have experienced gestational diabetes or preeclampsia [ 108 , 111 , 112 , 113 , 114 ]. Cultural values and norms can also impact on postpartum lifestyle choices [ 94 ].…”