ABSTRACT
Maternal obesity is associated with health risks for women and their babies, exacerbated by excess gestational weight gain. We describe health professionals' perspectives in the provision of a Healthy Pregnancy service designed to optimise healthy lifestyle and support recommended gestational weight gain for women with obesity. Semi-structured interviews were conducted with health professionals. Questions were based on the Theoretical Domains Framework (TDF) and deductive thematic analysis was performed. A total of 14 multidisciplinary staff were interviewed. Six themes were identified: 1. health professionals view themselves as part of a team; 2. health professionals reported having necessary skills; 3. experience generated confidence in discussing gestational weight gain; 4. gestational weight gain is considered of variable importance; 5. health professionals want women to be comfortable; 6. the environmental context and resources presented some barriers. Staff were supportive of the Healthy Pregnancy service and valued developing teamwork with staff and rapport with women. Most felt relatively comfortable discussing weight gain with women. Barriers included ability to navigate sensitive topics with women, limited awareness of the intervention among new staff, communication between teams, and waiting time for women. Barriers and enablers to the delivery of an integrated model of maternity care were identified. These findings should inform and improve implementation of service models integrating healthy lifestyle in the antenatal care of women with obesity.
ABSTRACT
BACKGROUND: Maternal lifestyle in the months leading up to conception and throughout pregnancy has both immediate and transgenerational impacts on offspring health. AIM: To explore how women's lifestyles change when they become pregnant, and their perspectives of the lifestyle advice they receive throughout pregnancy. METHODS: A descriptive qualitative approach was used. Semi-structured interviews with 17 childbearing women (mean gestational age, 30.2 ± 2.0 weeks) recruited from a large hospital network in Victoria, Australia between July and October 2018 were transcribed and analysed using an inductive process of thematic analysis. FINDINGS: Three themes and six sub-themes were identified. Lifestyle change during pregnancy was highly influenced by participants' preconception lifestyle, the physiological demands of pregnancy and the pressures of daily life. While participants proactively sought lifestyle advice from a range of sources, including the Internet, they were generally less proactive in seeking advice during routine maternity care visits. Participants appreciated the lifestyle advice they received from health professionals, including midwives, as part of their maternity care despite acknowledging that they often received it only if they asked. Overall, it seemed that the lifestyle advice received from health professionals was much less influential on maternal lifestyle behaviour change than the broader socio-ecological environment. CONCLUSION: Childbearing women want lifestyle advice that supports positive lifestyle change during pregnancy and health professionals, including midwives, must be proactive as they provide it. Other factors that impact on childbearing women's capability and opportunity to make lifestyle change should be considered when providing advice that supports positive lifestyle behaviour change.
