Enablers and barriers to physical activity in overweight and obese pregnant women: an analysis informed by the theoretical domains framework and COM-B model

Abstract

BackgroundObesity during pregnancy is associated with increased risk of gestational diabetes mellitus (GDM) and other complications. Physical activity is a modifiable lifestyle factor that may help to prevent these complications but many women reduce their physical activity levels during pregnancy. Interventions targeting physical activity in pregnancy are on-going but few identify the underlying behaviour change mechanisms by which the intervention is expected to work. To enhance intervention effectiveness, recent tools in behavioural science such as the Theoretical Domains Framework (TDF) and COM-B model (capability, opportunity, motivation and behaviour) have been employed to understand behaviours for intervention development. Using these behaviour change methods, this study aimed to identify the enablers and barriers to physical activity in overweight and obese pregnant women.MethodsSemi-structured interviews were conducted with a purposive sample of overweight and obese women at different stages of pregnancy attending a public antenatal clinic in a large academic maternity hospital in Cork, Ireland. Interviews were recorded and transcribed into NVivo V.10 software. Data analysis followed the framework approach, drawing on the TDF and the COM-B model.ResultsTwenty one themes were identified and these mapped directly on to the COM-B model of behaviour change and ten of the TDF domains. Having the social opportunity to engage in physical activity was identified as an enabler; pregnant women suggested being active was easier when supported by their partners. Knowledge was a commonly reported barrier with women lacking information on safe activities during pregnancy and describing the information received from their midwife as ‘limited’. Having the physical capability and physical opportunity to carry out physical activity were also identified as barriers; experiencing pain, a lack of time, having other children, and working prevented women from being active.ConclusionA wide range of barriers and enablers were identified which influenced women’s capability, motivation and opportunity to engage in physical activity with “knowledge” as the most commonly reported barrier. This study is a theoretical starting point in making a ‘behavioural diagnoses’ and the results will be used to inform the development of an intervention to increase physical activity levels among overweight and obese pregnant women.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1816-z) contains supplementary material, which is available to authorized users.

Influence of GDM Diagnosis and Treatment on Weight Gain, Dietary Intake and Physical Activity in Pregnant Women with Obesity: Secondary Analysis of the UPBEAT Study

“…This study identified no differences in physical activity levels between women with and without GDM in the interval following GDM screening. The lack of change in physical activity for both groups aligns with reported barriers to physical activity for such women including a lack of time, pain, fatigue, work and childcare commitments [27].…”

Improving case detection of tuberculosis in hospitalised Kenyan children– employing the Behaviour Change Wheel to aid intervention design and implementation

“…Behaviour Change Techniques are the active, observable and replicable components that make up an intervention. COM-B/BCW have been used successfully for behavioural analysis and to design interventions in both health and non-health-related elds [26,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55], but to our knowledge, has been used in only one study of TB on contact tracing in a low-resource setting, to identify barriers and facilitators and to tailor interventions to improve contact investigation in Kampala [26]. In the qualitative arm, to understand the challenges in recognising and testing for TB in admitted children we analysed data from: i) semi-structured interviews, small-group discussions and key informant interviews with front line health workers and mid-level managers; ii) observations of TB trainings, sensitisation meetings, policy meetings, and hospital practices, and iii) desk review of guidelines, job aides and policy documents, which have been reported elsewhere [31].…”

Cross cultural “behavioural diagnosis” examining the uptake of the MIND diet, using the COM-B model to inform an intervention.

“…The TDF [38], compromises 14 domains, each of which corresponds to a COM-B component and also representing a range of theory-based barriers and facilitators to behaviour [37]. The COM-B model and TDF have been used by several studies to explore barriers and facilitators to behaviour change in sexual health [42], physical activity in obese pregnant women [43] and reducing sugar [40]…”

“…To our knowledge, this is the first study investigating adherence to the MIND diet at midlife (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55) years old) in a Mediterranean and non-Mediterranean country. This study addresses this gap in the literature and highlights the perceived barriers and facilitators to adhering to a diet that may promote brain health at midlife and compares those barriers and facilitators to those living in Northern Ireland.…”