Development of a Lifestyle Intervention Program to Support Preconception, Pregnant and Postnatal Women Who are Overweight or Obese: A Qualitative Study

Abstract

Background: Poor lifestyle behaviors, including unhealthy diet and physical inactivity, contribute to the global obesity pandemic and result in long-term adverse health effects on mothers and their children. The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors. Since the success of a lifestyle intervention is heavily dependent on uptake and continued compliance, the intervention components should be acceptable, sustainable, and tailored to the concerns and needs of the target population. This study aims to identify enablers and barriers towards engagement with a lifestyle intervention for improving the metabolic health of prospective mothers and their offspring, among a sample of the target population.Methods: In-depth interviews were conducted with 15 overweight or obese women in the preconception, pregnancy or postpartum periods. Interviews were transcribed verbatim and thematic analysis was undertaken using NVivo. Factors influencing adoption of a novel lifestyle intervention were systematically charted using the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, that comprises Recipient, Context, Innovation and Facilitation constructs.Results: Ten enablers and barriers were identified. Barrier factors within the Recipient construct include time constraints as participants juggled multiple roles, and poor baseline knowledge about healthy behaviors and the impact of maternal obesity on maternal and offspring health. Within Context, a family culture of communal meals, convenient access to unhealthy foods in the environment, as well as lack of relevant data sources, were barriers to dietary change. Recipient motivation to be healthy for themselves and their offspring is an enabler, along with family and social support within the Context construct. In the Innovation construct, a holistic delivery platform providing desired information delivered at appropriate times increases engagement. Lastly, in Facilitation, regular feedback, goal setting and nudges would ensure continued engagement and sustainability of lifestyle changes.Conclusions: The features of a successful lifestyle intervention targeting overweight and obese women include (i) a holistic life-course approach to provide education and guidance, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits.