A multi-perspective examination of women's engagement with weight management behaviours and services during pregnancy

  • L. Atkinson

    Student thesis: Doctoral ThesisPhD by Publication


    This portfolio presents a unique and significant body of research which together provides a substantial, original description and analysis of women’s engagement with weight management behaviours and services during pregnancy. This body of research examines this topic from multiple perspectives, concluding with a detailed interpretative study which sheds light on the deep-rooted determinants of women’s weight-related behaviours during pregnancy. All outputs are articles published in peer-reviewed scientific journals: Article one describes an evaluation of the acceptability of an individual, home-based perinatal weight management service, based on a qualitative examination of the experiences of obese women who used the service during pregnancy. The findings showed that women valued the support they received from the service, and highlighted home visits, personalised advice and regular weight monitoring as beneficial, while suggesting that more frequent appointments and practical support with target behaviours would enhance the service. Article two describes a qualitative study of the views and experiences of obese women who had declined or disengaged from the service evaluated in article one. The study identified the referral experience as key to women’s decisions to decline participation, highlighting the need for midwives and other health professionals to have detailed knowledge of the service and training on how to sensitively offer this additional support. Findings also demonstrated that some obese women lacked the confidence or capability to successfully change weight-related behaviours, even with support, leading them to disengage from the service. Article three compares and combines qualitative data obtained from two sets of midwives, each referring women to either a one to one, home-based weight management service, or a group, community-based weight management service, to explore how midwives approach the referral with obese and overweight women, and their views of women’s responses to being offered a referral. Findings highlighted the important role midwives play as gatekeepers to weight management services and raised questions regarding how midwives approach the referral process within the wider context of the maternal obesity issue. The findings also suggest that services might improve uptake through addressing pragmatic and motivational barriers, and through better communication with their referral agents. Article four describes analysis of qualitative data collected from women who declined a referral to a group, community-based weight management service during their pregnancy, specifically exploring their views on being referred to the service by their midwife. In contrast to the findings described in article two, women in this study reported finding the referral acceptable, and that they expected to receive information about such services from their midwife. The more positive response of these women could be attributed to a number of potential factors, including; an increase in women’s awareness of the risks of maternal obesity, an increase in midwives’ confidence and skill to raise the issue of weight in the time elapsed between the two studies, or a different approach to making the referral between the two services. Article five reports the findings of a qualitative study using Interpretive Phenomenological Analysis (IPA) which sought to explore in detail the lived experience of a first pregnancy and the process of making decisions about diet and physical activity during this time. The article aimed to further illuminate the multiple and significant barriers to adopting positive dietary and physical activity behaviours during pregnancy, and to challenge the commonly cited belief that ‘pregnancy is a good time for behaviour change’ by examining women’s experiences with specific reference to the model of ‘Teachable Moments’ (McBride, Emmons, & Lipkus 2003). While partially supporting the model, the results also indicated that women with healthy, uncomplicated conception and pregnancy experiences base their diet and physical activity choices primarily on automatic judgements, physical sensations and perceptions of what pregnant women are supposed to do, which in turn suggests limited opportunity for antenatal health professionals to intervene and subsequently influence behaviour. These accumulated findings suggest that there is much that can be done to increase obese women’s engagement with maternal weight management behaviours and services. Service providers and commissioners could draw on these findings to design services which better meet the needs of many obese women, such as receiving personalised support, at a time and location convenient for them, and providing regular weight monitoring. There are also implications for health professionals’ education and clinical practice, with findings indicating that midwives would benefit from further training and better information about the weight management services they are asked to refer to, in order to make referrals more evidence-based and increase their confidence to advocate for the service to women who might benefit. Finally, the work presented in this portfolio further informs our understanding of the psychosocial determinants of women’s weight-related behaviour during pregnancy. It suggests that researchers and practitioners should consider how to tackle the largely socially learned, sub-optimal behaviour patterns that are often established in early pregnancy and how to activate more reflective decision-making in relation to diet, physical activity and weight management. The portfolio also includes critical reflection on each of the outputs and the contribution of each unique study to the development of the author into an independent and expert researcher, and concludes with suggestions for future research.
    Date of Award2016
    Original languageEnglish
    Awarding Institution
    • Coventry University
    SupervisorDavid French (Supervisor) & Wendy Clyne (Supervisor)

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