A feasibility study of ‘Simple Steps' - a general practice based physical activity intervention in pregnancy.
Gestational weight gain is an important independent contributory factor to the global problem of obesity. Previous studies, mostly in secondary care, suggest that physical activity (PA) interventions in pregnancy can help women manage their weight gain but evidence regarding the most effective approach is unclear. However, the focus of obstetric care is increasingly being directed towards primary care. Thus, we aimed to determine the feasibility of delivering a novel PA intervention for pregnant women in general practice and of evaluating this in a randomised controlled trial.
We sought to recruit women less than 14 weeks pregnant, with a BMI of 18.5-39.5; 4 general practices, in different socio-cultural settings in Belfast, agreed to participate. With consent, each participant's baseline PA was assessed by a week's accelerometer data and a subsequent validated questionnaire before they were randomly allocated to intervention (usual antenatal care, brief PA advice, pedometer, step-count diary and 2-weekly contact for review) or control groups (usual antenatal care only). For both groups, PA was reassessed after 12 weeks, by accelerometer and questionnaire, and study feedback questionnaires were completed. Following this, semi-structured interviews were conducted with healthcare professionals involved in recruitment and other women attending primary care antenatal clinics, to explore their views regarding PA and research during pregnancy. The interviews were analysed using a thematic framework.
During 18 weeks' recruitment (21.7.14-31.10.14) women were only recruited from 2 practices, due to unpredicted organisational change in the other 2 practices. Of 68 women identified as being eligible to participate, 26 (38.2%) consented to contact by the researcher. Multiple reasons were given for 20 of these failing to participate; 6 were recruited. Reasons given for non-participation were reflected in the interviews and included time (work commitments, other children) and fear that PA was harmful in pregnancy. Both women and health professionals identified women's reluctance to engage in PA and in research during pregnancy, due to fear of causing harm baby, embarrassment (regarding weight, low levels of PA) and uncertainty of any potential value of PA; they identified a knowledge gap regarding appropriate relevant health advice.
:These findings reveal new information about how pregnant women and health professionals concur in their perceptions of lack of support for PA in pregnancy and that the delivery and evaluation of the intervention which we designed to help promote PA among pregnant women in general practice is not feasible. Major barriers include women's prioritisation of other demands of their lives and a lack of professional and lay knowledge regarding physical activity in pregnancy. Further research should explore alternative approaches to addressing the problem of gestational weight gain and encouraging PA, possibly focused on interventions implemented prior to pregnancy and involving education and peer support.
- Madeline Brennan
- Margaret Cupples
- Valerie Holmes
- Mark Tully
- Neil Heron