Motivating pregnant women to eat healthily and engage in physical activity for weight management: An exploration of routine midwife Instruction

Mary Jane Brown, Marlene Sinclair, Sarah Dianne Liddle, Alyson J Hill, Doreen J Stockdale, Elaine Madden

Research output: Contribution to journalArticle

Abstract

Background: The importance of antenatal education for supporting and advising women about diet and physical activity for weight management has been highlighted in recent guidelines. However, little is known about how midwives (through routine instruction) aim to influence maternal motivation for healthy behaviours.
Aim: To explore the motivational content of routine antenatal instruction provided by midwives relating to diet, physical activity and weight management as a means of identifying any strengths, weaknesses and deficits.
Method: A non-participant, semi-structured observation approach was undertaken. All written and verbal instruction relating to diet, physical activity and weight management was collected through a semi-structured observation schedule. Barron and Harackiewicz (2000) conceptualisation of goals was chosen as a framework for analysis. Content and thematic analysis was undertaken to identify key patterns or themes that emerged from the data.
Key Findings: The type and frequency of the goals communicated to women about diet and physical activity during pregnancy varied considerably, depending on the individual midwife with no apparent standardised procedure being followed. Three key motivational deficits were identified: Lack of purpose goals within verbal instruction; lack of performance feedback indicators; and target goals often lacked specificity and relevance.
Conclusions: Findings suggest that the motivational potential of routine antenatal instruction is yet to be fulfilled. Although a purpose goal and target goal structure was evident, several motivational problems have been identified. Lack of purpose goals in verbal instruction, irrelevant target goals and almost non-existent feedback prevent antenatal education from fulfilling its potential to motivate women.
Implications: Now that these critical gaps have been identified, they can be addressed in order to create an optimally motivated environment that supports women in making healthy lifestyle choices. Midwives and other healthcare professionals would benefit from training and sufficient resources in order to empower them with the knowledge and skills that they need to effectively communicate and support women in their care.
LanguageEnglish
Pages120-127
JournalEvidence Based Midwifery
Volume11
Issue number4
Publication statusPublished - Dec 2013

Fingerprint

Midwifery
Pregnant Women
Exercise
Weights and Measures
Prenatal Education
Diet
Observation
Motivation
Appointments and Schedules
Mothers
Guidelines
Delivery of Health Care
Pregnancy

Keywords

  • Antenatal education
  • goals
  • motivation
  • diet
  • exercise
  • obesity
  • weight management
  • evidence-based midwifery

Cite this

@article{73bd4dbec0eb498a8b22a01ec4261f40,
title = "Motivating pregnant women to eat healthily and engage in physical activity for weight management: An exploration of routine midwife Instruction",
abstract = "Background: The importance of antenatal education for supporting and advising women about diet and physical activity for weight management has been highlighted in recent guidelines. However, little is known about how midwives (through routine instruction) aim to influence maternal motivation for healthy behaviours.Aim: To explore the motivational content of routine antenatal instruction provided by midwives relating to diet, physical activity and weight management as a means of identifying any strengths, weaknesses and deficits.Method: A non-participant, semi-structured observation approach was undertaken. All written and verbal instruction relating to diet, physical activity and weight management was collected through a semi-structured observation schedule. Barron and Harackiewicz (2000) conceptualisation of goals was chosen as a framework for analysis. Content and thematic analysis was undertaken to identify key patterns or themes that emerged from the data.Key Findings: The type and frequency of the goals communicated to women about diet and physical activity during pregnancy varied considerably, depending on the individual midwife with no apparent standardised procedure being followed. Three key motivational deficits were identified: Lack of purpose goals within verbal instruction; lack of performance feedback indicators; and target goals often lacked specificity and relevance.Conclusions: Findings suggest that the motivational potential of routine antenatal instruction is yet to be fulfilled. Although a purpose goal and target goal structure was evident, several motivational problems have been identified. Lack of purpose goals in verbal instruction, irrelevant target goals and almost non-existent feedback prevent antenatal education from fulfilling its potential to motivate women.Implications: Now that these critical gaps have been identified, they can be addressed in order to create an optimally motivated environment that supports women in making healthy lifestyle choices. Midwives and other healthcare professionals would benefit from training and sufficient resources in order to empower them with the knowledge and skills that they need to effectively communicate and support women in their care.",
keywords = "Antenatal education, goals, motivation, diet, exercise, obesity, weight management, evidence-based midwifery",
author = "Brown, {Mary Jane} and Marlene Sinclair and Liddle, {Sarah Dianne} and Hill, {Alyson J} and Stockdale, {Doreen J} and Elaine Madden",
note = "Reference text: Barron, K. E. and Harackiewicz, J. M. 2000. Achievement Goals and Optimal Motivation: A Multiple Goals Approach In: Sansone C. and Harackiewicz, J. M. eds. Intrinsic and extrinsic motivation: the search for optimal motivation and performance. San Diego: Academic Press. 233-235. Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative research in psychology, 3 (2), 77-101. Brown, M.J., Sinclair, M., Liddle, D., Hill, A.J., Madden, E. and Stockdale, J. 2012. A Systematic Review Investigating Healthy Lifestyle Interventions Incorporating Goal Setting Strategies for Preventing Excess Gestational Weight Gain. PloS one, [online]. Available at: <http://www.plosone.org/ article/authors/info{\%}3Adoi{\%}2F10.1371{\%}2Fjournal.pone.0039503> [Accessed 5th July 2012]. Centre for Maternal and Child Enquiries. 2010. Maternal obesity in the UK: Findings from a national project. London: CMACE. Available at: <http:// www.publichealth.hscni.net/sites/default/files/Maternal{\%}20Obesity{\%}20 in{\%}20the{\%}20UK.pdf> [Accessed 6th December 2010]. Cramp, A.G. and Bray, S.R. 2009b. A prospective examination of exercise and barrier self-efficacy to engage in leisure-time physical activity during pregnancy. Annals of Behavioral Medicine, 37 (3), 325-334. Cullen, K.W., Baranowski, T. and Smith, S.P. 2001. Using goal setting as a strategy for dietary behavior change. Journal of the American Dietetic Association, 101 (5), 562-566. Fowles, E.R., Bryant, M., Kim, S.H., Walker, L.O., Ruiz, R.J., Timmerman, G.M. and Brown, A. 2011. Predictors of dietary quality in low-income pregnant women: A path analysis. Nursing research, 60 (5), 286. Fowles, E.R. and Fowles, S.L. 2008. Healthy eating during pregnancy: determinants and supportive strategies. Journal of community health nursing, 25 (3), 138-152. Fraser, A., Tilling, K., Macdonald-Wallis, C., Hughes, R., Sattar, N., Nelson, S.M. and Lawlor, D.A. 2011. Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC). The American Journal of Clinical Nutrition, 93 (6), 1285. Gardner, B., Wardle, J., Poston, L. and Croker, H. 2011. Changing diet and physical activity to reduce gestational weight gain: a meta‐analysis. Obesity Reviews, 12 (7), 602-20. Halloran, D., Cheng, Y., Wall, T., Macones, G. and Caughey, A. 2011. Effect of maternal weight on postterm delivery. Journal of Perinatology, 32(2):85-90. Heslehurst, N., Lang, R., Rankin, J., Wilkinson, J.R. and Summerbell, C.D. 2007. Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services. BJOG: An International Journal of Obstetrics & Gynaecology, 114 (3), 334-342. Jackson, C. 1995. The association between childbirth education, infant birth weight, and health promotion behaviors. The Journal of Perinatal Education, 4 (1), 27-33. Keenan, J. and Stapleton, H. 2010. Bonny babies? Motherhood and nurturing in the age of obesity. Health, Risk & Society, 12 (4), 369-383. Keller, J.M. 2010. Motivational design for learning and performance: The ARCS model approach. New York: Springer Verlag. Koehn, M.L. 2002. Childbirth education outcomes: an integrative review of the literature. The Journal of Perinatal Education, 11 (3), 10. National Institute for Health and Clinical Excellence (NICE). 2010. Weight management before, during and after pregnancy: guidance [pdf] London: NICE. Available at: < http://www.nice.org.uk/nicemedia/ live/13056/49926/49926.pdf> [Accessed 15th January 2010]. Olander, E.K., Atkinson, L., Edmunds, J.K. and French, D.P. 2010. The views of pre-and post-natal women and health professionals regarding gestational weight gain: An exploratory study. Sexual & Reproductive Healthcare, 2(1):43-8. Olson, C.M., Strawderman, M.S. and Dennison, B.A. 2009. Maternal weight gain during pregnancy and child weight at age 3 years. Maternal and child health journal, 13 (6), 839-846. Pearson, E.S. 2011. Goal setting as a health behavior change strategy in overweight and obese adults: A systematic literature review examining intervention components. Patient Education and Counselling, 87(1):32-42. Sansone, C.E. and Harackiewicz, J.M. eds. 2000. Intrinsic and extrinsic motivation: The search for optimal motivation and performance. San Diego: Academic Press. Seale, C. 2012. Researching society and culture. London: Sage Publications. Shilts, M.K., Horowitz, M. and Townsend, M.S. 2004. Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature. American Journal of Health Promotion, 19, 81-93. Sims-Jones, N., Graham, S., Crowe, K., Nigro, S. and McLean, B. 1998. Prenatal class evaluation. International Journal of Childbirth Education, 13 28-32. Tuffery, O. and Scriven, A. 2005. Factors influencing antenatal and postnatal diets of primigravid women. The Journal of the Royal Society for the Promotion of Health, 125 (5), 227-231. Vonderheid, S.C., Norr, K.F. and Handler, A.S. 2007. Prenatal health promotion content and health behaviors. Western Journal of Nursing Research, 29 (3), 258-276. Young, T.K., Woodmansee, B. and PARISI, V.M. 2002. Factors that are associated with cesarean delivery in a large private practice: The importance of prepregnancy body mass index and weight gain. Discussion. Author’s reply. American Journal of Obstetrics and Gynecology, 187 (2), 312-320. Wickstr{\"o}m, G. and Bendix, T. 2000. The “Hawthorne effect”- what did the original Hawthorne studies actually show? Scandinavian Journal of Work, Environment & Health, 26(4):363-7.",
year = "2013",
month = "12",
language = "English",
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Motivating pregnant women to eat healthily and engage in physical activity for weight management: An exploration of routine midwife Instruction. / Brown, Mary Jane; Sinclair, Marlene; Liddle, Sarah Dianne; Hill, Alyson J; Stockdale, Doreen J; Madden, Elaine.

Vol. 11, No. 4, 12.2013, p. 120-127.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Motivating pregnant women to eat healthily and engage in physical activity for weight management: An exploration of routine midwife Instruction

AU - Brown, Mary Jane

AU - Sinclair, Marlene

AU - Liddle, Sarah Dianne

AU - Hill, Alyson J

AU - Stockdale, Doreen J

AU - Madden, Elaine

N1 - Reference text: Barron, K. E. and Harackiewicz, J. M. 2000. Achievement Goals and Optimal Motivation: A Multiple Goals Approach In: Sansone C. and Harackiewicz, J. M. eds. Intrinsic and extrinsic motivation: the search for optimal motivation and performance. San Diego: Academic Press. 233-235. Braun, V. and Clarke, V. 2006. Using thematic analysis in psychology. Qualitative research in psychology, 3 (2), 77-101. Brown, M.J., Sinclair, M., Liddle, D., Hill, A.J., Madden, E. and Stockdale, J. 2012. A Systematic Review Investigating Healthy Lifestyle Interventions Incorporating Goal Setting Strategies for Preventing Excess Gestational Weight Gain. PloS one, [online]. Available at: <http://www.plosone.org/ article/authors/info%3Adoi%2F10.1371%2Fjournal.pone.0039503> [Accessed 5th July 2012]. Centre for Maternal and Child Enquiries. 2010. Maternal obesity in the UK: Findings from a national project. London: CMACE. Available at: <http:// www.publichealth.hscni.net/sites/default/files/Maternal%20Obesity%20 in%20the%20UK.pdf> [Accessed 6th December 2010]. Cramp, A.G. and Bray, S.R. 2009b. A prospective examination of exercise and barrier self-efficacy to engage in leisure-time physical activity during pregnancy. Annals of Behavioral Medicine, 37 (3), 325-334. Cullen, K.W., Baranowski, T. and Smith, S.P. 2001. Using goal setting as a strategy for dietary behavior change. Journal of the American Dietetic Association, 101 (5), 562-566. Fowles, E.R., Bryant, M., Kim, S.H., Walker, L.O., Ruiz, R.J., Timmerman, G.M. and Brown, A. 2011. Predictors of dietary quality in low-income pregnant women: A path analysis. Nursing research, 60 (5), 286. Fowles, E.R. and Fowles, S.L. 2008. Healthy eating during pregnancy: determinants and supportive strategies. Journal of community health nursing, 25 (3), 138-152. Fraser, A., Tilling, K., Macdonald-Wallis, C., Hughes, R., Sattar, N., Nelson, S.M. and Lawlor, D.A. 2011. Associations of gestational weight gain with maternal body mass index, waist circumference, and blood pressure measured 16 y after pregnancy: the Avon Longitudinal Study of Parents and Children (ALSPAC). The American Journal of Clinical Nutrition, 93 (6), 1285. Gardner, B., Wardle, J., Poston, L. and Croker, H. 2011. Changing diet and physical activity to reduce gestational weight gain: a meta‐analysis. Obesity Reviews, 12 (7), 602-20. Halloran, D., Cheng, Y., Wall, T., Macones, G. and Caughey, A. 2011. Effect of maternal weight on postterm delivery. Journal of Perinatology, 32(2):85-90. Heslehurst, N., Lang, R., Rankin, J., Wilkinson, J.R. and Summerbell, C.D. 2007. Obesity in pregnancy: a study of the impact of maternal obesity on NHS maternity services. BJOG: An International Journal of Obstetrics & Gynaecology, 114 (3), 334-342. Jackson, C. 1995. The association between childbirth education, infant birth weight, and health promotion behaviors. The Journal of Perinatal Education, 4 (1), 27-33. Keenan, J. and Stapleton, H. 2010. Bonny babies? Motherhood and nurturing in the age of obesity. Health, Risk & Society, 12 (4), 369-383. Keller, J.M. 2010. Motivational design for learning and performance: The ARCS model approach. New York: Springer Verlag. Koehn, M.L. 2002. Childbirth education outcomes: an integrative review of the literature. The Journal of Perinatal Education, 11 (3), 10. National Institute for Health and Clinical Excellence (NICE). 2010. Weight management before, during and after pregnancy: guidance [pdf] London: NICE. Available at: < http://www.nice.org.uk/nicemedia/ live/13056/49926/49926.pdf> [Accessed 15th January 2010]. Olander, E.K., Atkinson, L., Edmunds, J.K. and French, D.P. 2010. The views of pre-and post-natal women and health professionals regarding gestational weight gain: An exploratory study. Sexual & Reproductive Healthcare, 2(1):43-8. Olson, C.M., Strawderman, M.S. and Dennison, B.A. 2009. Maternal weight gain during pregnancy and child weight at age 3 years. Maternal and child health journal, 13 (6), 839-846. Pearson, E.S. 2011. Goal setting as a health behavior change strategy in overweight and obese adults: A systematic literature review examining intervention components. Patient Education and Counselling, 87(1):32-42. Sansone, C.E. and Harackiewicz, J.M. eds. 2000. Intrinsic and extrinsic motivation: The search for optimal motivation and performance. San Diego: Academic Press. Seale, C. 2012. Researching society and culture. London: Sage Publications. Shilts, M.K., Horowitz, M. and Townsend, M.S. 2004. Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature. American Journal of Health Promotion, 19, 81-93. Sims-Jones, N., Graham, S., Crowe, K., Nigro, S. and McLean, B. 1998. Prenatal class evaluation. International Journal of Childbirth Education, 13 28-32. Tuffery, O. and Scriven, A. 2005. Factors influencing antenatal and postnatal diets of primigravid women. The Journal of the Royal Society for the Promotion of Health, 125 (5), 227-231. Vonderheid, S.C., Norr, K.F. and Handler, A.S. 2007. Prenatal health promotion content and health behaviors. Western Journal of Nursing Research, 29 (3), 258-276. Young, T.K., Woodmansee, B. and PARISI, V.M. 2002. Factors that are associated with cesarean delivery in a large private practice: The importance of prepregnancy body mass index and weight gain. Discussion. Author’s reply. American Journal of Obstetrics and Gynecology, 187 (2), 312-320. Wickström, G. and Bendix, T. 2000. The “Hawthorne effect”- what did the original Hawthorne studies actually show? Scandinavian Journal of Work, Environment & Health, 26(4):363-7.

PY - 2013/12

Y1 - 2013/12

N2 - Background: The importance of antenatal education for supporting and advising women about diet and physical activity for weight management has been highlighted in recent guidelines. However, little is known about how midwives (through routine instruction) aim to influence maternal motivation for healthy behaviours.Aim: To explore the motivational content of routine antenatal instruction provided by midwives relating to diet, physical activity and weight management as a means of identifying any strengths, weaknesses and deficits.Method: A non-participant, semi-structured observation approach was undertaken. All written and verbal instruction relating to diet, physical activity and weight management was collected through a semi-structured observation schedule. Barron and Harackiewicz (2000) conceptualisation of goals was chosen as a framework for analysis. Content and thematic analysis was undertaken to identify key patterns or themes that emerged from the data.Key Findings: The type and frequency of the goals communicated to women about diet and physical activity during pregnancy varied considerably, depending on the individual midwife with no apparent standardised procedure being followed. Three key motivational deficits were identified: Lack of purpose goals within verbal instruction; lack of performance feedback indicators; and target goals often lacked specificity and relevance.Conclusions: Findings suggest that the motivational potential of routine antenatal instruction is yet to be fulfilled. Although a purpose goal and target goal structure was evident, several motivational problems have been identified. Lack of purpose goals in verbal instruction, irrelevant target goals and almost non-existent feedback prevent antenatal education from fulfilling its potential to motivate women.Implications: Now that these critical gaps have been identified, they can be addressed in order to create an optimally motivated environment that supports women in making healthy lifestyle choices. Midwives and other healthcare professionals would benefit from training and sufficient resources in order to empower them with the knowledge and skills that they need to effectively communicate and support women in their care.

AB - Background: The importance of antenatal education for supporting and advising women about diet and physical activity for weight management has been highlighted in recent guidelines. However, little is known about how midwives (through routine instruction) aim to influence maternal motivation for healthy behaviours.Aim: To explore the motivational content of routine antenatal instruction provided by midwives relating to diet, physical activity and weight management as a means of identifying any strengths, weaknesses and deficits.Method: A non-participant, semi-structured observation approach was undertaken. All written and verbal instruction relating to diet, physical activity and weight management was collected through a semi-structured observation schedule. Barron and Harackiewicz (2000) conceptualisation of goals was chosen as a framework for analysis. Content and thematic analysis was undertaken to identify key patterns or themes that emerged from the data.Key Findings: The type and frequency of the goals communicated to women about diet and physical activity during pregnancy varied considerably, depending on the individual midwife with no apparent standardised procedure being followed. Three key motivational deficits were identified: Lack of purpose goals within verbal instruction; lack of performance feedback indicators; and target goals often lacked specificity and relevance.Conclusions: Findings suggest that the motivational potential of routine antenatal instruction is yet to be fulfilled. Although a purpose goal and target goal structure was evident, several motivational problems have been identified. Lack of purpose goals in verbal instruction, irrelevant target goals and almost non-existent feedback prevent antenatal education from fulfilling its potential to motivate women.Implications: Now that these critical gaps have been identified, they can be addressed in order to create an optimally motivated environment that supports women in making healthy lifestyle choices. Midwives and other healthcare professionals would benefit from training and sufficient resources in order to empower them with the knowledge and skills that they need to effectively communicate and support women in their care.

KW - Antenatal education

KW - goals

KW - motivation

KW - diet

KW - exercise

KW - obesity

KW - weight management

KW - evidence-based midwifery

M3 - Article

VL - 11

SP - 120

EP - 127

IS - 4

ER -