Facilitators and barriers to behaviour change within a lifestyle program for women with obesity to prevent excess gestational weight gain: a mixed methods evaluation

Abstract

Background Maternal obesity is associated with health risks for women and their babies and is exacerbated by excess gestational weight gain. The aim of this study was to describe women’s experiences and perspectives in attending a Healthy Pregnancy Service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Methods An explanatory sequential mixed methods study design utilised two questionnaires (completed in early and late pregnancy) to quantify feelings, motivation and satisfaction with the service, followed by semi-structured interviews that explored barriers and enablers of behaviour change. Data were analysed separately and then interpreted together. Results Overall, 49 women attending the service completed either questionnaire 1, 2 or both and were included in the analysis. Fourteen women were interviewed. Prior to pregnancy, many women had gained weight and attempted to lose weight independently, and reported they were highly motivated to achieve a healthy lifestyle. During pregnancy, diet changes were reported as easier to make and sustain than exercise changes. Satisfaction with the service was high. Key factors identified in qualitative analysis were: service support enabled change; motivation to change behaviour, social support, barriers to making change (intrinsic, extrinsic and clinic-related), post-partum lifestyle and needs. On integration of data, qualitative and quantitative findings aligned. Conclusions The Healthy Pregnancy service was valued by women. Barriers and enablers to the delivery of an integrated model of maternity care that supported healthy lifestyle and recommended gestational weight gain were identified. These findings have informed and improved implementation and further scale up of this successful service model, integrating healthy lifestyle into routine antenatal care of women with obesity. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (no.12620000985987). Registration date 30/09/2020, retrospectively registered. http://www.anzctr.org.au/

“Scaling out” evidence-informed antenatal care to support healthy pregnancy weight gain: a context assessment using the Consolidated Framework for Implementation Research

“…Weighing women as a stand-alone intervention, does not appear to prevent excessive GWG in trial conditions, 29 demonstrating that behaviour change is a complex process requiring consistent, supportive advice and feedback in a nonjudgemental, woman-centered approach. 30 Excess gestational weight gain is not uncommon. Pooled international data puts the prevalence of GWG above recommendations at 47%, 5 a similar result to the present study.…”

“…Around 40% of women reported having discussed the amount of weight they should gain during pregnancy, yet less than 10% of women could correctly report their recommended weight gain. Weighing women as a stand-alone intervention, does not appear to prevent excessive GWG in trial conditions, 29 demonstrating that behaviour change is a complex process requiring consistent, supportive advice and feedback in a nonjudgemental, woman-centered approach 30 …”

Coaching Method For Pregnant Women To Prevent Stunting Risk In Banyumas

“…Sanitasi buruk dapat menimbulkan infeksi yang menyebabkan bayi atau balita mengalami stunting (30) . Ibu hamil merasa nyaman dengan bimbingan bidan karena membantu ibu dalam pengarahan bagaimana pola asuh yang tepat untuk mencegah stunting (31) . Kehamilan merupakan masa bagi wanita membutuhkan support dan dukungan sosialdari lingkungannya.…”

Impact Evaluation of the Get Healthy in Pregnancy Program: Evidence of Effectiveness

“…This may be due to the substantial variability in the stage of pregnancy at which women started (and finished) their involvement in the program. Qualitative research to explore the barriers and facilitators for program participation with both participants and health coaches could inform program improvements to enhance the effectiveness of GHiP as has been conducted by other lifestyle programs addressing GWG [28][29][30].…”