Understanding pregnancy as a teachable moment for behaviour change: a comparison of the COM-B and teachable moments models

Rockliffe, Lauren; Peters, Sarah; Heazell, Alexander E P; Smith, Debbie

doi:10.1080/21642850.2021.2014851

Cited by 17 publications

(19 citation statements)

References 42 publications

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“…These include the physical environment and aspects of the social environment, and the influence of pregnancy symptoms. This is consistent with what has previously been reported in the literature [ 31 ]. However, the findings from the current study build on this, by also identifying established eating behaviour as additional factor not otherwise reflected in the TM model, which is a facet of women’s preconceptual identity.…”

Section: Discussionsupporting

confidence: 94%

A qualitative exploration of influences on eating behaviour throughout pregnancy

Rockliffe

Smith

Heazell

et al. 2022

BMC Pregnancy Childbirth

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Background: Pregnancy is often conceptualised as a ‘teachable moment’ for health behaviour change. However, it is likely that different stages of pregnancy, and individual antenatal events, provide multiple distinct teachable moments to prompt behaviour change. Whilst previous quantitative research supports this argument, it is unable to provide a full understanding of the nuanced factors influencing eating behaviour. The aim of this study was to explore influences on women’s eating behaviour throughout pregnancy. Methods: In-depth interviews were conducted online with 25 women who were less than six-months postpartum. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically. Results: Five themes were generated from the data that capture influences on women’s eating behaviour throughout pregnancy: ‘The preconceptual self’, ‘A desire for good health’, ‘Retaining control’, ‘Relaxing into pregnancy’, and ‘The lived environment’. Conclusion: Mid-pregnancy may provide a more salient opportunity for eating behaviour change than other stages of pregnancy. Individual antenatal events, such as the glucose test, can also prompt change. In clinical practice, it will be important to consider the changing barriers and facilitators operating throughout pregnancy, and to match health advice to stages of pregnancy, where possible. Existing models of teachable moments may be improved by considering the dynamic nature of pregnancy, along with the influence of the lived environment, pregnancy symptoms, and past behaviour. These findings provide an enhanced understanding of the diverse influences on women’s eating behaviour throughout pregnancy and provide a direction for how to adapt existing theories to the context of pregnancy.

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Section: Discussionsupporting

confidence: 94%

A qualitative exploration of influences on eating behaviour throughout pregnancy

Rockliffe

Smith

Heazell

et al. 2022

BMC Pregnancy Childbirth

Self Cite

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show abstract

“…This is important as neither the COM‐B nor TM model consider that the salience of their respective constructs might change at different points in time. Consequently, previous research has suggested that these models may be limited when applied to the context of pregnancy, due to the changeable nature of the pregnancy experience and the static understanding of behaviour change that these models offer (Rockliffe, Peters, Heazell, & Smith, 2021a, 2021b). It will therefore be important to further explore nuances in the salience of the constructs over time, in future work.…”

Section: Discussionmentioning

confidence: 99%

“…Some of the variance unaccounted for by the COM‐B constructs may therefore still reflect capability, opportunity, and motivation, but require a more sensitive measure to effectively record these aspects. With regard to the TM model, previous research has suggested that when applied to pregnancy, the model fails to account for non‐psychological factors, such as practical and environmental factors, social influences, and physical pregnancy symptoms (Rockliffe, Peters, Heazell, & Smith, 2021b). These may therefore reflect some of the unmeasured factors contributing to eating behaviour that the TM model failed to include.…”

Section: Discussionmentioning

confidence: 99%

Investigating the utility of the COM‐B and TM model to explain changes in eating behaviour during pregnancy: A longitudinal cohort study

Rockliffe

Peters

Smith

et al. 2022

British J Health Psychol

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Objectives. Pregnancy has been described as a 'teachable moment' for behaviour change, which presents an important opportunity for health promotion within antenatal care settings. However, no pregnancy-specific model has been developed or tested in the context of health behaviour change during pregnancy. This study aimed to investigate and compare the utility of the Capability-Opportunity-Motivation Behaviour (COM-B) and Teachable Moments (TM) models, to explain health behaviour change during pregnancy, within the context of eating behaviour.Design. Longitudinal cohort study.Methods. Five hundred and sixteen women completed a survey at between 12-16 weeks gestation (T1). Follow-up data were collected at 20-24 weeks (T2), 36-40 weeks (T3), and 6-12 weeks postnatally (T4). The primary outcome was eating behaviour. To assess the utility of the COM-B model, perceived capability, opportunity, and motivation to eat healthily were measured. To assess the utility of the TM model, risk perceptions, self-image, and affective response were measured.Results. Overall, the COM-B model explained 18.4% of the variance in eating behaviour, whilst the TM model explained 9%. Both models explained the most variance in eating behaviour at T1 and T3, compared with T2 and T4. Small changes were observed in eating behaviour and the model constructs over the time period studied, although these were not clinically meaningful.

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“… 28 Women who are less aware, or who held misconceptions about the consequences of their behaviours will be less likely to engage in behaviour change. 28 , 42 The women in our sample had limited knowledge about stillbirth and its associated risk factors; however, when prompted to speak about the advice received during their antenatal care, monitoring of fetal movements and the importance of sleep position was often mentioned. These findings are very similar to those obtained by Stacey et al 43 in a recently published study, where they explored migrant women's awareness of health messages to reduce stillbirth risk.…”

Section: Discussionmentioning

confidence: 99%

Exploring first‐time mothers' experiences and knowledge about behavioural risk factors for stillbirth

Sánchez

Matvienko‐Sikar

Meaney

et al. 2022

Health Expectations

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Background Modifiable factors such as substance use, lack of attendance at antenatal care, overweight or obesity and sleeping position are associated with a higher risk of stillbirth. This qualitative study aimed to explore women's experiences of modifiable factors during pregnancy and their awareness of stillbirth. Methods Purposive sampling was implemented by hospital staff in a large tertiary maternity hospital in Ireland between November 2020 and March 2021. Women were approached during their stay in the hospital and were invited to participate in a semistructured interview 3–5 months later. Eligible women were primiparous, >18 years of age and had an uncomplicated pregnancy and delivery. Eighteen women who consented to be followed up were interviewed at 3–5 months postpartum. Thematic analysis was used to analyse the data. Results Four themes were identified: attitudes towards behaviour change, awareness regarding stillbirth and risk factors, the silence around stillbirth and risks, and attitudes towards receiving information about stillbirth. Women spoke about behaviour change in terms of outcomes, and most changes (e.g., ceasing alcohol consumption) were perceived as easy to manage. Awareness of stillbirth was limited among the women interviewed, and the association between risk behaviours and stillbirth was not known by any woman. Results suggest that there is a silence around stillbirth, including in antenatal care, which hinders information provision. However, most women highlighted the value of receiving information and extra education about modifiable risk factors and stillbirth. Conclusion There is a general lack of understanding of the link between behavioural risk factors and potential pregnancy outcomes such as stillbirth. Providing further information to women about stillbirth and providing additional support with behaviour change might contribute to enhancing preventive efforts. Patient or Public Contribution Patients were involved in this study by providing their experiences of antenatal care which were used as primary data.

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Understanding pregnancy as a teachable moment for behaviour change: a comparison of the COM-B and teachable moments models

Cited by 17 publications

References 42 publications

A qualitative exploration of influences on eating behaviour throughout pregnancy

A qualitative exploration of influences on eating behaviour throughout pregnancy

Investigating the utility of the COM‐B and TM model to explain changes in eating behaviour during pregnancy: A longitudinal cohort study

Exploring first‐time mothers' experiences and knowledge about behavioural risk factors for stillbirth

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