Promotion and maintenance of physical activity during and after pregnancy among already active and inactive women from different socioeconomic backgrounds – A mixed-method exploratory study.

Abstract

BACKGROUND – Regular physical activity (PA) provides several health benefits to pregnant and postpartum women, which are widely acknowledged. Results from large scale studies and reviews demonstrate that pregnant and postpartum women do not meet these guidelines. This thesis aims to explore the effectiveness of PA interventions targeting both active and inactive pregnant and postpartum women living across varied socioeconomic groups and understand their beliefs, expectations and needs to maintain PA levels, thereby producing evidence and recommendations in the form of an infographic and a toolkit that will be used to design PA interventions specific to this population.
METHODS – Two systematic reviews and two qualitative studies were conducted to answer the research questions. The first systematic review assessed the effectiveness of PA interventions that aimed to maintain or increase PA in already active women during pregnancy and postpartum. The other review synthesised evidence from the wider literature on the effectiveness and implementation of physical activity interventions in pregnant and postpartum women from deprived communities. This was identified as an underrepresented group with unique barriers in the first systematic review. The first focus group study, with 19 women living in the Northeast of England, investigated the barriers and facilitators to PA in already active women. It explored their views on, and requirements for, the development of an intervention to maintain or increase PA levels. In the second qualitative study, a total of ten interviews were conducted among inactive pregnant and postpartum women living in deprived communities and explored their beliefs about barriers and enablers to PA. Transcribed data from the interview study among inactive women from low SES was coded in NVivo using thematic analysis and identified 28 sub-themes and seven broader themes, while analysis of the focus group study data with already active women from more affluent areas identified eight overarching themes.
RESULTS - A total of four studies were included in the first systematic review, which shows that largely PA interventions are successful in promoting activity and preventing a decline in activity, with simple techniques, such as supervised walking, providing DVDs with exercises to do at home, provision of pedometers and goal setting and periodic face-to-face sessions for monitoring are successful in increasing the activity levels. In the second systematic review, six studies were included. In addition to the components identified in the first systematic review, it was identified that face-to-face sessions and behaviour change techniques such as goal setting and self-motivation were particularly relevant for PA interventions among women from low socioeconomic status (SES). The focus group study with already active women for more affluent areas revealed that these women consider exercising during and after pregnancy as safe and beneficial. Changing body shape and childcare were significant barriers to PA. They expect an ideal PA intervention to be easily accessible, fun, and have a mix of old and new activities. The study identified that participants were aware of the health benefits of being active during and after pregnancy. They listed various factors such as fear from family, changing body stature, tiredness, lack of adequate resources and neglect from the government as barriers to being active.
DISCUSSION - The findings from this PhD suggest that different underlying factors affect women’s ability to engage in PA during pregnancy. Women living in deprived areas are disproportionally affected by socioecological factors that are recognised to an extent in the current literature. By applying a socioecological perspective, novel solutions to these more structural barriers for engaging women in PA were identified, focusing on social, financial, and broader environmental factors.
Firstly, engaging family and friends, especially their partners and the newborns were repeatedly emphasised by women in both the studies. Secondly, women from deprived communities, on the one hand, expected a programme that does not add any further financial burden to them and their families, while on the other hand, they doubt the quality of programmes offered for free. This finding highlights the importance of recognising pride and the stigmatising effect of using free PA vouchers. Instead, accessible community venues with participants belonging to a similar SES might help strike this balance better. Thirdly, safe and accessible venues to perform PA among such communities are important but lacking, and participants blame local authorities for not maintaining them. Key workers that understand the local community go some way in increasing the safety and accessibility of venues by building trust between providers and participants.
CONCLUSION - PA interventions targeting pregnant women need to consider socioecological determinants, such as engaging family and friends, financial and emotional (pride) incentives and perceived safety and accessibility of the venue and the staff that work there. The latter two determinants are particularly relevant for women living in more deprived communities, which is an under-researched area in the literature. Finding from this study contradict and expand findings from other studies. For example, peer pressure as a barrier to PA applies more to women from deprived areas and less to those already active and living in more affluent neighbourhoods. In contrast to previous studies suggesting that women in more deprived areas are less enthusiastic about engaging in PA during pregnancy, this study suggests that these women are equally aware and enthusiastic about the health benefits of PA during pregnancy; however, they experience an additional barrier in the form of lack of access to safe and non-stigmatising spaces and programmes. Therefore, the finding helped guide the infographic design intended to help health/fitness/lifestyle professionals design a PA intervention for both already active women living in more affluent areas and less active women living in more deprived communities by considering these social-ecological determinants and making practical suggestions for addressing these potential barriers.

Date of Award	6 May 2022
Original language	English
Awarding Institution	Teesside University
Supervisor	Louisa Ells (Supervisor), Liane Azevedo (Supervisor) & Peter Van Der Graaf (Supervisor)