Ellinor K. Olander

What are the most effective techniques in changing obese individuals’ physical activity self-efficacy and behaviour: a systematic review and meta-analysis

Increasing self-efficacy is generally considered to be an important mediator of the effects of physical activity interventions. A previous review identified which behaviour change techniques (BCTs) were associated with increases in self-efficacy and physical activity for healthy non-obese adults. The aim of the current review was to identify which BCTs increase the self-efficacy and physical activity behaviour of obese adults. A systematic search identified 61 comparisons with obese adults reporting changes in self-efficacy towards engaging in physical activity following interventions. Of those comparisons, 42 also reported changes in physical activity behaviour. All intervention descriptions were coded using Michie et al’s (2011) 40 item CALO-RE taxonomy of BCTs. Meta-analysis was conducted with moderator analyses to examine the association between whether or not each BCT was included in interventions, and size of changes in both self-efficacy and physical activity behaviour. Overall, a small effect of the interventions was found on self-efficacy (d = 0.23, 95% confidence interval (CI): 0.16-0.29, p < 0.001) and a medium sized effect on physical activity behaviour (d = 0.50, 95% CI 0.38-0.63, p < 0.001). Four BCTs were significantly associated with positive changes in self-efficacy; ‘action planning’, ‘time management’, ‘prompt self-monitoring of behavioural outcome’ and ‘plan social support/social change’. These latter two BCTs were also associated with positive changes in physical activity. An additional 19 BCTs were associated with positive changes in physical activity. The largest effects for physical activity were found where interventions contained ‘teach to use prompts/cues’, ‘prompt practice’ or ‘prompt rewards contingent on effort or progress towards behaviour’. Overall, a non-significant relationship was found between change in self-efficacy and change in physical activity (Spearman’s Rho = −0.18 p = 0.72). In summary, the majority of techniques increased physical activity behaviour, without having discernible effects on self-efficacy. Only two BCTs were associated with positive changes in both physical activity self-efficacy and behaviour. This is in contrast to the earlier review which found a strong relationship between changes in physical activity self-efficacy and behaviour. Mechanisms other than self-efficacy may be more important for increasing the physical activity of obese individuals compared with non-obese individuals.

Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews

Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full‐text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre‐eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large‐for‐gestational‐age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy.

Computer- or web-based interventions for perinatal mental health: A systematic review

BACKGROUND Treating prenatal mental health issues is of great importance, but access to treatment is often poor. One way of accessing treatment is through computer- or web-based interventions. Reviews have shown that these interventions can be effective for a variety of mental health disorder across different populations. However, their effectiveness for women in the perinatal period has not been reviewed. This review therefore aimed to provide a first overview of computer- or web-based interventions for womens perinatal mental health issues by systematically identifying and reviewing their characteristics and efficacy. METHODS Twelve electronic databases were searched for published and unpublished literature using keywords, supplemented by hand searches. Data were extracted for characteristics of the intervention and the study, study findings and the methodological quality was assessed. RESULTS The majority of the eleven eligible studies were randomized controlled trials. Interventions were targeted at depression, stress, and complicated grief during the antenatal or postpartum period or the time after pregnancy loss. Findings suggest that computer- or web-based interventions targeted at improving mental health, especially depression and complicated grief, may be effective. LIMITATIONS Findings and their generalizability is limited by the heterogeneity of reviewed interventions and study designs, as well as methodological limitations. CONCLUSIONS This systematic review constitutes the first synthesis of research on computer- or web-based interventions for perinatal mental health issues and provides preliminary support that this could be a promising form of treatment during this period. However, there are significant gaps in the current evidence-base so further research is needed.

Obese women's reasons for not attending a weight management service during pregnancy

Evaluations of services targeting obese womens gestational weight gain often report low uptake. Thus it is important to elicit the reasons why obese pregnant women decline to participate in these services and to identify their barriers to participation. Sixteen obese pregnant and postnatal women were interviewed regarding their reasons for declining a group‐based service targeting their gestational weight gain. All interviews were recorded, transcribed verbatim and analyzed thematically. Both pragmatic and motivational barriers were identified. The most common practical reasons for not attending the service were its inconvenient location and time, and feeling unable to attend due to work commitments. Pregnancy‐specific barriers included decreased mobility and feeling unwell. Motivational barriers included lack of interest and not wanting to focus on ones weight in pregnancy. These findings highlight issues that need to be taken into consideration when designing group‐based weight management services for this population.

Why don’t many obese pregnant and post-natal women engage with a weight management service?

Objective: This study investigated the views and experiences of obese pregnant and post-natal women who had declined or disengaged from an evidence-based weight management service, and their reasons for doing so. Background: Despite significant risks of maternal obesity to both mother and baby, the majority of obese women offered tailored weight management support during or after pregnancy declined to use it, and many women who accepted the service disengaged soon after. Methods: Semi-structured interviews regarding women’s views and experiences were conducted with obese pregnant and post-natal women who declined the service (N = 7) and women who disengaged from the service (N = 11) and analysed thematically. Results: Four main themes were identified. ‘First contact counts’ related to inadequate explanation of the service by the referrer, being offended by the referral, and negative expectations of the service. ‘Missed opportunities for support’ describes what support declining women identified as desirable, such as regular weight monitoring. ‘No need for help’, and ‘Service not meeting needs’ related to personal choices regarding weight management, including not wanting support and preferring group-based services. Conclusions: While some obese pregnant and post-natal women did not want any type of weight management support, many did but failed to engage with the service on offer due to a variety of barriers. A more sensitive and transparent referral process and further tailoring of the service to meet individual needs may increase uptake and continued use of this service. The inclusion of non-participants and non-completers formed a valuable element of service evaluation.

Person-centred care in interventions to limit weight gain in pregnant women with obesity - a systematic review

BackgroundPerson-centred care, asserting that individuals are partners in their care, has been associated with care satisfaction but the value of using it to support women with obesity during pregnancy is unknown. Excessive gestational weight gain is associated with increased risks for both mother and baby and weight gain therefore is an important intervention target. The aims of this review was to 1) explore to what extent and in what manner interventions assessing weight in pregnant women with obesity use person-centred care and 2) assess if interventions including aspects of person-centred care are more effective at limiting weight gain than interventions not employing person-centred care.MethodsTen databases were systematically searched in January 2014. Studies had to report an intervention offered to pregnant women with obesity and measure gestational weight gain to be included. All included studies were independently double coded to identify to what extent they included three defined aspects of person-centred care: 1) “initiate a partnership” including identifying the person’s circumstances and motivation; 2) “working the partnership” through sharing the decision-making regarding the planned action and 3) “safeguarding the partnership through documentation” of care preferences. Information on gestational weight gain, study quality and characteristics were also extracted.ResultsTen studies were included in the review, of which five were randomised controlled trials (RCT), and the remaining observational studies. Four interventions included aspects of person-centred care; two observational studies included both “initiating the partnership”, and “working the partnership”. One observational study included “initiating the partnership” and one RCT included “working the partnership”. No interventions included “safeguarding the partnership through documentation”. Whilst all studies with person-centred care aspects showed promising findings regarding limiting gestational weight gain, so did the interventions not including person-centred care aspects.ConclusionsThe use of an identified person-centred care approach is presently limited in interventions targeting gestational weight gain in pregnant women with obesity. Hence to what extent person-centred care may improve health outcomes and care satisfaction in this population is currently unknown and more research is needed. That said, our findings suggest that use of routines incorporating person-centredness are feasible to include within these interventions.

Women's dietary changes before and during pregnancy: A systematic review

BACKGROUND dietary intake before and during pregnancy has significant health outcomes for both mother and child, including a healthy gestational weight gain. To ensure effective interventions are successfully developed to improve dietary intake during pregnancy, it is important to understand what dietary changes pregnant women make without intervention. AIMS to systematically identify and review studies examining womens dietary changes before and during pregnancy and to identify characteristics of the women making these changes. METHODS a systematic search strategy was employed using three databases (Web of Science, CINAHL and PubMed) in May 2016. Search terms included those relating to preconception, pregnancy and diet. All papers were quality assessed using the Scottish Intercollegiate Guidelines Network methodology checklist for cohort studies.The search revealed 898 articles narrowed to full-text review of 23 studies. In total, 11 research articles were included in the review, describing nine different studies. The findings were narratively summarised in line with the aims of the review. FINDINGS the included studies showed marked heterogeneity, which impacts on the findings. However, the majority report an increase in energy intake (kcal or kJ) during pregnancy. Of the studies that reported changes through food group comparisons, a majority reported a significant increase in fruit and vegetable consumption, a decrease in egg consumption, a decrease in fried and fast food consumption and a decrease in coffee and tea consumption from before to during pregnancy. The characteristics of the women participating in these studies, suggest that age, education and pregnancy intention are associated with healthier dietary changes; however these factors were only assessed in a small number of studies. KEY CONCLUSIONS the 11 included articles show varied results in dietary intake during pregnancy as compared to before. More research is needed regarding who makes these healthy changes, this includes consistency regarding measurement tools, outcomes and time points. IMPLICATIONS FOR PRACTICE Midwives as well as intervention developers need to be aware of the dietary changes women may spontaneously engage in when becoming pregnant, so that care and interventions can build on these.

Do Single and Multiple Behavior Change Interventions Contain Different Behavior Change Techniques? A Comparison of Interventions Targeting Physical Activity in Obese Populations

OBJECTIVE Interventions to increase physical activity (PA) can target this behavior alone or as part of multiple health behavior change (MHBC) interventions. To date, little is known about the content of MHBC interventions compared with single health behavior change (SHBC) interventions. This study sought to compare the number and type of behavior change techniques (BCTs) in SHBC and MHBC interventions using a secondary analysis of studies included in a systematic review of PA interventions in obese populations. METHODS BCTs used to increase PA (PA BCTs) in intervention descriptions of included studies were double coded using a standardized BCT taxonomy. Interventions were categorized as SHBC (targeting PA) or MHBC (targeting PA and diet) interventions. The mean number of PA BCTs for SHBC and MHBC interventions was compared using an independent-samples t test. Chi-square analyses for each BCT assessed differences in proportions of SHBC and MHBC interventions that contained that BCT. RESULTS The MHBC obesity interventions contained a greater number of PA BCTs (M = 11.68) than the SHBC obesity interventions (M = 8.71). Six PA BCTs were more common in MHBC interventions. Two PA BCTs were more common in the SHBC interventions. CONCLUSIONS SHBC and MHBC interventions may systematically differ not only in the number of behaviors targeted, but also in the numbers and type of BCTs used. This study demonstrates that intervention content should also be considered when assessing the relative effectiveness of SHBC and MHBC interventions.

What are we measuring and why? Using theory to guide perinatal research and measurement

Background: A theory is a set of ideas that attempt to explain phenomena and can provide guiding principles on which to base practice. Many theories from biological and social sciences are relevant to women’s health and well-being during pregnancy and after birth, yet theory is not commonly explicitly reported in perinatal research. Method: This paper outlines the importance of theory to perinatal research and provides a pragmatic overview of when and how to use theory in research. In particular, we consider (i) deciding when it is appropriate to use theory, (ii) choosing which theory to use and (iii) how to operationalise theory in research. We give examples that illustrate how four different theories have been used in perinatal research to increase understanding and inform the development of interventions. Conclusion: Even when it is not appropriate to use theory in our research, careful consideration of pertinent theories contributes to greater clarity of concepts and understanding of different explanations or perspectives on what we are studying. It also prompts us to consider where our research fits in terms of contribution to knowledge or the development and evaluation of treatments. However, it is important that a critical approach is taken so that theories continue to be developed. In this way we will systematically advance our understanding of general factors or processes that are relevant to perinatal health, as well as those factors that are unique to perinatal health.

An exploration of obese pregnant women’s views of being referred by their midwife to a weight management service

Midwives have previously reported concerns about discussing and referring obese pregnant women to weight management services, with some women stating that this referral can be upsetting. The current study interviewed obese women who had declined a weight management service during pregnancy to explore if it was the referral process that made them decline the service. Fifteen women participated and reported that being informed about and referred to a service by their midwife was acceptable to them. Participants also mentioned they would expect this information from their midwife. No participants reported being upset by this referral.