Improving pregnant women’s diet and physical activity behaviours: the emergent role of health identity – BMC Pregnancy and Childbirth

This qualitative study aimed to address two research questions to inform the exploitation of interventions for supporting fraught women to improve their health behaviours. first, we aimed to identify key factors that influenced diet and physical activity during pregnancy. second, we explored women ’ s betrothal with available life style defend in order to better understand why some women engage more than others. In reception to the first inquiry question, this study identified pregnancy-specific factors that influenced diet and forcible natural process. pregnancy can introduce raw barriers such as nausea, pain and fatigue, making it a particularly difficult prison term to adopt healthier behaviours. other qualitative studies have similarly found that forcible symptoms introduced a barrier to physical natural process and to engaging with a weight management interposition [ 34, 35 ]. There is, however, a dearth of experimental data on pregnancy-related barriers to healthy eat. The stream study besides found that concern in the health and development of the fetus can provide motivation to make positive life style changes, as can the desire to maintain a level of fitness and avoid gaining excessively much weight. This supports the theme that pregnancy can represent a ‘ docile here and now ’ for improving diet or increasing physical activity, which has been proposed by others [ 36 ]. The more novel find of this learn is in relation to the second base inquiry question. That is, women ’ s date with HCS and early sources of accompaniment appeared to be related to the priority they placed on their own health, and the extent to which they identified as healthy people. indeed, the function of identity and its sexual intercourse to health was an important component that emerged from these data, and is summarised in the concept of ‘ health identity ’. Those whose health identity was constantly to have been healthy, or the kind of person to stay active, more often reported maintaining healthier lifestyles than those who did not identify as being peculiarly healthy. Women ’ s health identities appeared to influence their engagement with available support and the theme of making a change. Women who did not prioritise their health were less likely to want to change their behaviours and did not very engage with the goal-setting component of the HCS treatment ; nor did they seek life style patronize through available services. At the other end of the spectrum, women who viewed themselves as healthy people and therefore already prioritised their health, were unlikely to feel that they needed to set goals or change their behaviours. Those who fell between these two extremes were more probably to show matter to in improving their health behaviours and to engage with available defend. These women much had more to say about their goals in the interview and had made an campaign to change their health behaviours.

The function of pregnancy in motivating women to change their health behaviours appeared besides to vary along the health identity spectrum. For the most health-disengaged, pregnancy did not seem to provide significant motivation to set goals or change demeanor. For others who were relatively health-disengaged, diet and physical action were not normally a major focus or precedence, but pregnancy and motherhood provided extra motivation to make a change for their children ’ second benefit. Women who were near the middle of the spectrum identified as slightly healthy people, and were not entirely motivated by pregnancy or baby-related factors, but rather they were besides concerned in maintaining or improving their own health. Theme 5 suggests that the desire to be healthy was sometimes explicitly linked to women ’ randomness identities. The most health-focused women normally did not report making any significant changes to their behaviours because they felt they were already doing what they needed to stay healthy and have a goodly baby. The kinship between health and identity has been described before [ 37, 38, 39, 40, 41, 42 ]. Often, this work has focused on people with particular health conditions or disabilities and examined the effects of these conditions on a person ’ second identity [ 37 ]. however, some research has examined behaviour-related constructs including exercise identity [ 41 ] and healthy-eater identity [ 40 ]. These studies found that identity, in combination with self-efficacy, was an important deciding of health behaviours amongst university students. similarly, a few studies have shown that exercise identity was associated with exercise attachment [ 41, 42 ]. While limited, the existing research on health behaviours and identity lends hold to the idea that a womanhood ’ s health identity, in junction with other psychological factors, may predict her diet quality or level of physical activity. The current study extends this work by focusing on pregnancy, and by describing the function of health identity in influencing both women ’ second behavior during this period and women ’ second date with health behaviour change interventions. former studies, though not explicitly referring to health identity, have shown that understanding the way women view themselves and their burden can help with personalising interventions to improve women ’ s employment [ 43, 44 ] .

Strengths and limitations

The methods employed in this study were appropriate and effective for addressing the research questions. Participants recruited to the interviews had all been recently pregnant and were exposed to HCS, making them ideally placed to discuss both the factors that influenced their diet and forcible activity in pregnancy and their engagement with a health behavior change interposition. The semi-structured interview steer approach allowed for the collection of a rich and unique dataset, from which the concept of health identity emerged, and the thematic analysis was conducted in accord with established guidelines [ 30 ], ensuring a rigorous and transparent march. While all participants represented the target population, there was limited diversity in the sample distribution with involve to demographic characteristics as all women lived in and around Southampton, most were educated to degree horizontal surface and about all were white british. furthermore, there were well fewer women who fell toward the ‘ health-disengaged ’ end of the spectrum than the ‘ health-focused ’ end, which may limit the transferability of findings. While the range of socio-economic condition by home IMD was represented, more than half of participants ( 9/17 ) lived in the two most affluent quintiles. A likely limitation in any qualitative study is bias introduced by the assumptions and beliefs of the research worker [ 30, 31, 45 ]. In club to ameliorate this effect, the epistemic put informing this survey was made clear from the beginning and regular contemplation on biases was part of the serve. All interviews were conducted with a second research worker who took the character of an perceiver and who could ask extra questions. This helped to reduce the bias that may arise if a individual person were conducting all of the interviews entirely. similarly, two members of the research team double-coded a choice of transcripts, and the tease frame was revisited and discussed to ensure consistency and accurate mirror image of arising themes. ultimately, in examining the different themes and synthesising the results of the sketch, five members of the inquiry team ( TM, SS, WL, CV and MB ) met to discuss the interpretation presented here.

Implications for practice

This study has shown that pregnancy is indeed a unique menstruation where a number of factors influence women ’ s health behaviours. first, it is clear that pregnancy and the post-natal period introduce physical barriers such as nausea, annoyance and tire, which make it more unmanageable to eat a balanced diet or be physically active. While pregnancy is sometimes viewed as a ‘ docile here and now ’ where women are inclined to improve their health behaviours [ 36, 46, 47 ], it is necessity to acknowledge that it is besides a time when it can feel peculiarly unmanageable to change. Behaviour change interventions may be more effective if they help women to focus on changes they can make quite than changes that would be ideal. encouraging women to reflect on their individual circumstances and come up with their own ideas about what they can change, as is done through having ‘ healthy conversations ’, could be a brawny intervention part [ 26 ]. The main find of this study was the theme that women have unlike health identities and that this identity affects their tied of engagement with behavior change support. For health-disengaged women, goal-setting interventions may not be effective in supporting improvements in health behaviours, suggesting that alternate strategies are required for this group. In the present learn, merely a few women showed signs of health-disengagement, so promote research with unlike and more divers groups of pregnant women is needed to explore their priorities and to identify strategies that can encourage them to change. Those who were reasonably health-disengaged did not necessarily prioritise their own health, but were often motivated by their pregnancies, and engaged with health advice for their babies ’ benefit. For these women, pregnancy and the transition to motherhood provide a peculiarly valuable opportunity for health and social care practitioners to intervene and support improvements in health behavior. however, changes that are motivated by pregnancy may only be temp, as is often the event with smoking cessation [ 48 ]. Data presented in this paper suggest that there are two opportunities for more effective working with reasonably health-disengaged women : 1 ) there is electric potential to motivate women to improve their health behaviours by appealing to their desire to do the best they can for their baby and ensuring they are mindful of the electric potential consequences of ( not ) changing their health behaviours [ 47 ] ; and 2 ) improvements in health behaviours may be more permanent if they are linked to the womanhood ’ sulfur identity as a healthier person. Most of the participants in this study fell at the health-focused conclusion of the health identity spectrum. For these participants, pregnancy was an opportunity for extra awareness of their own health and consistency constitution, and the HCS defend and goal-setting provided by the spring inquiry nurses was acceptable and frequently supported women to strive for a healthier life style. Again, when these women make changes during pregnancy, this may encourage a switch in health identity, making the change a permanent part of how they view themselves and their lifestyles.

Women who were very health-focused believed that they did not need to change their behaviours because they had always been healthy. For these women, pregnancy may not require a major change in life style, so goal-setting interventions may not be necessary. however, having a baby introduced new barriers for some women, and while the most health-focused feel that they did not need to make a change during pregnancy, they may find it is more unmanageable to maintain their healthy life style after giving parturition. consequently, it could be beneficial to encourage women to think about how they will overcome newfangled barriers in the future and adjust to having a new pamper or a growing family. While the concept of health identity has not yet been incorporated into any diet or PA interventions, a recognizable exemplar of using identity to facilitate behavior change is in smoking cessation strategies. That is, a transfer in identity from ‘ smoker ’ to ‘ ex-smoker ’ or ‘ non-smoker ’ has been associated with successful discontinue attempts [ 49 ], while ‘ stag party identity ’ has been identified as a barrier to quitting [ 50 ]. It is possible that a exchangeable principle could be applied to diet or physical bodily process change. If it is feasible to support a change in identity from ‘ I am not person who jogs ’ to ‘ I am an active person, ’ or from health-disengaged to health-focused, such an treatment could lead to meaningful and suffer improvements in health behaviours. As noted above, these conclusions are based on a relatively little and homogeneous sample of women. Before developing raw interventions, the concept of health identity should be investigated in other groups, using both qualitative and quantitative methods. This should include far exploration of health identity as a reconstruct that influences health behaviours and openness to change, the potential shock of life events such as pregnancy on health identity, and development of a tool to assess health identity. far sour should then aim to develop and test methods of supporting women to move toward the health-focused end of the health identity spectrum, ampere well as identifying interposition components that are peculiarly effective for women with different health identities .

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