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Pregnancy is an opportune time for women to make healthy changes to their lifestyle, however, many women struggle to do so. Multiple reasons have been posited as to why this may be. This review aimed to synthesise this literature by identifying factors that influence women's health behaviour during pregnancy, specifically in relation to dietary behaviour, physical activity, smoking, and alcohol use. Bibliographic databases (MEDLINE, PsycINFO, CINAHL-P, MIDIRS) were systematically searched to retrieve studies reporting qualitative data regarding women's experiences or perceptions of pregnancy-related behaviour change relating to the four key behaviours. Based on the eligibility criteria, 30,852 records were identified and 92 studies were included. Study quality was assessed using the CASP tool and data were thematically synthesised. Three overarching themes were generated from the data. These were (1) A time to think about 'me', (2) Adopting the 'good mother' role, and (3) Beyond mother and baby. These findings provide an improved understanding of the various internal and external factors influencing women's health behaviour during the antenatal period. This knowledge provides the foundations from which future pregnancy-specific theories of behaviour change can be developed and highlights the importance of taking a holistic approach to maternal behaviour change in clinical practice.

Breastfeeding has many known benefits, but rates vary globally. We propose two main reasons why psychological theory and interventions have not been successful to date in explaining breastfeeding behaviours. Specifically, prior research underestimates the importance of (1) specific emotions and (2) wider injunctive influences (i.e., societal and moral norms about what women feel they ought to be doing) in the breastfeeding experience. Therefore, we conducted a systematic review of quantitative, qualitative, and mixed-methods studies that explored whether injunctive norms and/ or specific emotions are associated with breastfeeding behaviours (i.e., intentions, initiation and duration). Seventy-two papers were included in this review; data were extracted and quality appraisals conducted for all included studies. A meta-analysis of effect sizes was performed with the quantitative data. A convergent qualitative synthesis of the data was conducted, resulting in the following line of argument: Breastfeeding is a social behaviour and not a personal/individual behaviour. From this line of argument, three themes with associated sub-themes were developed, highlighting the importance of both specific emotions and injunctive norms on breastfeeding behaviours. These influences are discussed in relation to both theoretical and practical implications, as well as future research.

Objective: \ud Mental imagery interventions are a cost-effective way of promoting health behaviour change. We tested a mental imagery intervention designed to promote adherence to wearing face coverings during the COVID-19 pandemic. \ud \ud Design: \ud A four-arm randomized controlled trial to explore potential mechanisms of action. \ud \ud Main outcome measures: \ud Measures of behaviour (frequency of self-reported face covering adherence), theory of planned behaviour constructs (i.e., intention, attitudes, subjective norms, and perceived behavioural control), personality traits, imagery ability and barrier self-efficacy were measured at baseline (T1). Behaviour was also assessed at four-week follow up (T2). \ud \ud Results: \ud Of 297 participants, a majority always wore face coverings (N = 216, 73% overall sample). Logistic regression analyses revealed no intervention effects on changes in adherence to wearing face coverings, though T1 wearing of face coverings and being male predicted T2 behaviour. Subgroup analysis of participants with ‘suboptimal T1 adherence’, revealed that T2 non-adherence was predicted by being a non-student and by subjective norms and lower T1 intention to wear face coverings. \ud \ud Conclusion: \ud Imagery-based interventions to increase face covering wearing adherence may exert significant public health effects but only when conducted on a very large scale. Our findings suggest that interventions should target men and disrupt habitual past behaviour.

Pregnancy is often conceptualised as a 'teachable moment' for health behaviour change. However, it is likely that different stages of pregnancy, and individual antenatal events, provide multiple distinct teachable moments to prompt behaviour change. Whilst previous quantitative research supports this argument, it is unable to provide a full understanding of the nuanced factors influencing eating behaviour. The aim of this study was to explore influences on women's eating behaviour throughout pregnancy.In-depth interviews were conducted online with 25 women who were less than six-months postpartum. Interviews were audio-recorded and transcribed verbatim. Data were analysed thematically.Five themes were generated from the data that capture influences on women's eating behaviour throughout pregnancy: 'The preconceptual self', 'A desire for good health', 'Retaining control', 'Relaxing into pregnancy', and 'The lived environment'.Mid-pregnancy may provide a more salient opportunity for eating behaviour change than other stages of pregnancy. Individual antenatal events, such as the glucose test, can also prompt change. In clinical practice, it will be important to consider the changing barriers and facilitators operating throughout pregnancy, and to match health advice to stages of pregnancy, where possible. Existing models of teachable moments may be improved by considering the dynamic nature of pregnancy, along with the influence of the lived environment, pregnancy symptoms, and past behaviour. These findings provide an enhanced understanding of the diverse influences on women's eating behaviour throughout pregnancy and provide a direction for how to adapt existing theories to the context of pregnancy.

Women with a BMI ≥ 30 kg/mA secondary analysis of eighteen semi-structured interviews with women with a BMI ≥ 30 kg/mDeductive thematic analysis was used to apply a framework of psychological factors to the data, and investigate the extent to which they feature within the women's breastfeeding experiences.All psychological factors were reported as part of women's experiences. Planning to breastfeed, planning short durations and having high confidence, factual and social knowledge positively influenced initiation and maintenance. Believing in their ability to produce nutritionally adequate and sufficient milk, that breastfeeding would assist weight loss, and that others around them approved of breastfeeding also had a positive impact. Novel relationships between psychological factors were found.Psychological factors influence women's breastfeeding experiences. A model of breastfeeding in women with a BMI ≥ 30 kg/m

Background Pregnancy after the death of a baby is associated with a series of emotional and psychological challenges for pregnant women and their families. Specialist antenatal services have been proposed to address the increased biomedical and psychological risks in pregnancies after perinatal death. This study aimed to explore the pregnancy and postnatal experiences of women in a pregnancy after a perinatal death who were attending a specialist antenatal service and to evaluate the economic impact of the service.Methods To explore women’s views and experiences of care during their pregnancy this study used face-to-face semi-structured interviews following a topic guide comprising of four sections (history leading to care pathway, their experience of coping with new pregnancy after loss, support and advice for others). Following inductive thematic analysis, a deductive approach was taken to map themes to Stroebe and Schutt’s Dual Process Model of Grief.A Social Return on Investment (SROI) analysis informed by contributions from a subgroup of women and staff participants. Information was obtained from focus groups discussions, questionnaires and interviews. The SROI was reported as the ratio of the value generated by the clinic and the costs of providing the service.Results Thematic analysis of interviews (n=20) described how perinatal death was a quiet, unspoken subject and that navigating subsequent pregnancies relied on expecting the worst and hoping for the best. Mapping these themes onto the Dual Process Model of Grief found being pregnant complicated the grieving process, as increased awareness of the risk of stillbirth drew parents’ focus back to loss. Attendance at a specialist service was valued; SROI analysis found that for £1 invested, £6.10 of value was generated, mostly relating to the birth of a live baby, reduced negative psychological symptoms and fewer focussed contacts with health professionals.Conclusions Specialist antenatal care in pregnancies after perinatal death was viewed favourably by parents. Women’s experiences can be used to synthesise and develop models of care that aim to meet their needs but comparative studies are required to determine whether these models are superior to routine high-risk care and to identify which components are most valued.

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To identify measurement tools which screen for the presence of fear of birth (FOB) and to determine the most effective tool/s for use in clinical practice. Fear or birth (FOB) is internationally recognised as a cause for increasing concern, despite a lack of consensus on a definition or optimal measure of assessment. There is a wide array of FOB measurement tools, however little clarity on which tool should be used to screen for FOB in clinical practice. This review explores the use of tools that are used to screen for FOB and discusses the perceived effectiveness of such tools. A structured literature review was undertaken. Electronic databases were searched in July 2017 and manuscripts reviewed for quality. The review included 46 papers. The majority of studies were undertaken in Scandinavia (n = 29) and a range of tools were used to measure FOB. The most widely used tool was the Wijma Delivery Expectancy Experience Questionnaire’ (W-DEQ). Inconsistencies were found in the way this tool was used, including variations in assessment cut-off points, implementation and use across a range of cultural settings and women of varying gestations. Moreover, the tool may be too lengthy to use in clinical practice. The Fear of Birth Scale (FOBS) has been shown to be as effective as W-DEQ but has the advantage of being short and easy to administer. The inconsistencies in tools reflect the difficulties in defining FOB. A clear consensus definition of FOB would aid comparisons across practice and research. The W-DEQ is not used in clinical practice; this may be due to its length and complexity. The FOBS is likely to be a more versatile tool that can be used in clinical practice.

BackgroundPregnancy is widely recognised as a ‘teachable moment’ for healthy behaviour change and the postnatal period has been identified as the opportune time to initiate this change. In the UK, all women are offered a routine health check at 6–8 weeks postpartum with their GP. This provides a potential opportunity to facilitate long-term behaviour change discussions.AimTo explore GPs’ views and experiences of using the postnatal check as a health-related behaviour change opportunity.Design and settingA qualitative, inductive study in general practice.MethodSemi-structured telephone interviews were conducted with 18 GPs. Audiorecorded interviews were transcribed verbatim and analysed using thematic analysis.ResultsOne theme emerged from the data: the postnatal check is an unrealised opportunity to facilitate health-related behaviour change. This theme was organised into three subthemes: opportunity for health-related behaviour change; role responsibility; and patient-led versus GP-led behaviour change.ConclusionAlthough GPs recognise the postnatal check as a potential opportunity for health-related behaviour change, it is underutilised as they do not perceive this to be the purpose of the check and are uncertain as to their role in facilitating lifestyle changes. To enable this long-term lifestyle behaviour change opportunity to be utilised more fully, further research is needed to understand women’s expectations of the postnatal checks and the scope for further recommendations, guidance, and communication training around behaviour change.

Encouraging people to self-incentivize (i.e., to reward themselves in the future if they are successful in changing their behavior) or self-reward (i.e., prompt people to reward themselves once they have successfully changed their behavior) are techniques that are frequently embedded within complex behavior change interventions. However, it is not clear whether self-incentives or self-rewards per se are effective at bringing about behavior change. Nine databases were searched alongside manual searching of systematic reviews and online research registers. One thousand four hundred papers were retrieved, spanning a range of behaviors, though the majority of included papers were in the domain of "health psychology". Ten studies matched the inclusion criteria for self-incentive but no studies were retrieved for self-reward. The present systematic review and meta-analysis is therefore the first to evaluate the unique effect of self-incentives on behavior change. Effect sizes were retrieved from 7 of the 10 studies. Analysis of the 7 studies produced a very small pooled effect size for self-incentives (k = 7, N = 1,161), which was statistically significant, d+ = 0.17, CI [0.06, 0.29]. The weak effect size and dearth of studies raises the question of why self-incentivizing is such a widely employed component of behavior change interventions. The present research opens up a new field of inquiry to establish: (a) whether or not self-incentivizing and self-rewarding are effective behavior change techniques, (b) whether self-incentives and self-rewards need to be deployed alongside other behavior change techniques, and, (c) when and for whom self-incentives and self-rewards could support effective behavior change.

Background Physical activity (PA) tends to decline during pregnancy, and remains low in the early postpartum period, despite the known physical and psychological benefits. This study aimed to explore: (1) women’s experiences of PA during pregnancy and following birth; and (2) decision-making processes related to PA during this time. Methods Semi-structured telephone interviews were conducted with 16 women who were either pregnant or had recently given birth. Interviews were transcribed verbatim and analysed using thematic analysis. Results There were two over-arching themes: (1) ownership of body, which consisted of the sub-themes: others try to take ownership, important to maintain fitness into pregnancy and motherhood, expectations of PA, and pressure to conform; and (2) unknown territory, which consisted of the sub-themes: engaging in PA with caution, and unclear advice. Decision-making about PA during pregnancy was influenced by: pressure from others who felt responsible to protect the woman from coming to harm; pressure from social media to lose weight postpartum; participant’s beliefs about the benefits of maintaining fitness and participants expectations of how active they thought they would be able to be during pregnancy. Participants felt that pregnancy was an ‘unknown territory’ in terms of the unfamiliar feelings in their body and the inability to continually monitor their baby for reassurance of baby’s health. Advice received from midwives was often lacking, or not tailored to the individual. Advice from friends and family was often regarded as incorrect, but still caused doubt and fear of PA during pregnancy. Conclusions These findings contribute to the understanding of women’s experiences of PA during pregnancy and post-partum, and their decision-making processes about PA during pregnancy. Developing accurate and tailored advice as part of midwifery care, that considers the physical and psychological aspects of engaging in PA during pregnancy, will help to ensure that women are supported to make informed decisions about their PA behaviour.

Background: Information on the factors influencing parents’ decision-making process following a lethal, life-limiting or severely debilitating prenatal diagnosis remains deficient. A comprehensive systematic review and meta-synthesis was conducted to explore the influencing factors for parents considering termination or continuation of pregnancy following identification of lethal, life-limiting or severely debilitating fetal abnormalities.Methods: Electronic searches of 13 databases were conducted. These searches were supplemented by hand-searching Google Scholar and bibliographies and citation tracing. Thomas and Harden’s (2008) thematic synthesis method was used to synthesise data from identified studies.Results: Twenty-four papers were identified and reviewed, but two papers were removed following quality assessment. Three main themes were identified through systematic synthesis. Theme 1, entitled ‘all life is precious’, described parents’ perception of the importance of the fetus’ life, a fatalistic view of their situation alongside moral implications as well as the implications decisions would have on their own life, in consideration of previous life experiences. Theme 2 (‘hope for a positive outcome’) contained two sub-themes which considered the parent’s own imagined future and the influence of other people’s experiences. Finally, Theme 3 (‘a life worth living’) presented three sub-themes which may influence their parental decision-making: These described parental consideration of the quality of life for their unborn child, the possibility of waiting to try for another pregnancy, and their own responsibilities and commitments. Conclusion: The first review to fully explore parental decision-making process following lethal, life-limiting, or severely debilitating prenatal diagnosis provided novel findings and insight into which factors influenced parents’ decision-making process. This comprehensive and systematic review provides greater understanding of the factors influential on decision-making, such as hope, morality and potential implications on their own and other’s quality of life, will enable professionals to facilitate supported decision-making, including greater knowledge of the variables likely to influence parental choices

Objectives\ud \ud Weight-related stereotypes may have a detrimental impact on interactions between midwives and pregnant women with a body mass index (BMI) outside the recommended range of 18–30 kg/m2. This paper explores the reciprocal construal of midwives and pregnant women with a raised BMI and considers the clinical implications of these constructs.\ud Participants\ud \ud Ten pregnant women with a BMI≥30 kg/m2 and 11 midwives and from an inner city maternity service were recruited.\ud Intervention\ud \ud Participants provided information that allowed for the creation of a repertory grid; generating psychological constructs (perceptions or attitudes) identifying similarities and differences between pregnant women and midwives across a BMI range.\ud Findings\ud \ud Midwives were extremely conscious of being perceived as judgemental. They construed all pregnant women as anxious and vulnerable, but attributed characteristics such as “less health-conscious” and “complacent” to those with a raised BMI. The ideal pregnant woman and ideal midwife were typically construed as more likely to have a BMI of 18–30 kg/m2. Pregnant women with a BMI≤18 kg/m2 were construed as lacking warmth. While midwives differentiated between the elements based on role, the pregnant women construed the elements according to their BMI. Similarly, they construed those with a BMI≤18 kg/m2 as having an undesirable personality, and acknowledged weight-related stereotypes for those with a raised BMI.\ud Clinical Implications\ud \ud It is possible these constructs impact on the way midwives care for and interact with women. Midwives may be supported through reflective clinical supervision and communication skills training to reduce the perceptions of stigma experienced by women with a raised BMI. It may be beneficial to involve pregnant women with a raised BMI in service development to ensure services meet their needs.

Although structured taught aquatic baby programmes (STABPs) are one of the earliest forms of physical activity, the possible impacts of structured taught aquatic baby programmes are unknown. This study aims to understand the perceived impact that attending STABPs has on parents/carers, their baby/child and their family. An online survey was completed by 2854 parents/carers. It was advertised via numerous online advertisements. Of the respondents, 89% had attended STABPs. ‘Attendees’ were significantly older and were less likely to live in a more deprived area compared to ‘non-attendees’. STABPs are perceived to be beneficial in terms of water safety, confidence, benefits to parent-child relationships and interaction with other children but cost affects attendance. The evidence-base regarding the benefits of STABPs should be established to further understand their impact on parents/carers and babies. Further research should focus on understanding barriers to attendance and ways to facilitate attendance. The need to understand the ‘key ingredients’ of structured taught aquatic baby programmes was highlighted.

BackgroundMidwives are increasingly expected to promote healthy behaviour to women and pregnancy is often regarded as a ‘teachable moment’ for health behaviour change. This view focuses on motivational aspects, when a richer analysis of behaviour change may be achieved by viewing the perinatal period through the lens of the Capability-Opportunity-Motivation Behaviour framework. This framework proposes that behaviour has three necessary determinants: capability, opportunity, and motivation.Aim To outline a broader analysis of perinatal behaviour change than is afforded by the existing conceptualisation of the ‘teachable moment’ by using the Capability-Opportunity-Motivation Behaviour framework. Findings Research suggests that the perinatal period can be viewed as a time in which capability, opportunity or motivation naturally change such that unhealthy behaviours are disrupted, and healthy behaviours may be adopted. Moving away from a sole focus on motivation, an analysis utilising the Capability-Opportunity-Motivation Behaviour framework suggests that changes in capability and opportunity may also offer opportune points for intervention, and that lack of capability or opportunity may act as barriers to behaviour change that might be expected based solely on changes in motivation. Moreover, the period spanning pregnancy and the postpartum could be seen as a series of opportune intervention moments, that is, personally meaningful episodes initiated by changes in capability, opportunity or motivation.DiscussionThis analysis offers new avenues for research and practice, including identifying discrete events that may trigger shifts in capability, opportunity or motivation, and whether and how interventions might promote initiation and maintenance of perinatal health behaviours.

Objectives Congenital heart defects (CHD) can be detected during routine antenatal scans or go undiagnosed until birth. Parents of children with Single Ventricle CHD (SVCHD) have a complex experience. This study aimed to explore the lived experiences of parents of children with SVCHD from diagnosis through to adolescence. Design Interviews were conducted with 12 parents whose children had completed the Fontan procedure. Interpretative Phenomenological Analysis (IPA) identified themes across parents' accounts. Results Data were analysed into three superordinate themes of super parents, striving for normality and accepting SVCHD and their role. Through accepting SVCHD, becoming experts, and taking responsibility for the management of their child's physical healthcare, parents developed their own sense of normality. Following distress at the point of diagnosis, parents found their own way of accepting and integrating SVCHD into family life and regained a sense of control and normality within the family. Conclusions Transition points such as starting nursery, final surgery, puberty, and reaching adulthood are key time points when parents may struggle with their changing roles and the gradual shift of responsibility and independence onto their children. There are implications for supporting parents to educate their children in terms of the management and long-term prognosis of their condition, especially when the child with SVCHD enters puberty or moves into adult services where they gain agency of their condition and its management. The role of healthcare professionals promoting emotional wellbeing and providing support to families during significant periods is discussed.

Objectives Women with a BMI ≥ 30 kg/m

Background Self-efficacy is an important determinant of physical activity but it is unclear how best to increase self-efficacy for physical activity and to maintain these changes. Purpose This systematic review aimed to identify which specific behavior change techniques (BCTs), BCT clusters, and number of BCTs were associated with changes in postintervention and maintained changes in self-efficacy for physical activity across all adult populations. Methods A systematic search yielded 180 randomized trials (204 comparisons) which reported changes in self-efficacy. BCTs were coded using the BCT Taxonomy v1. Hierarchical cluster analysis explored the clustering of BCTs. Meta-analyses and moderator analyses examined whether the presence and absence of individual BCTs in interventions were associated with effect-size changes for self-efficacy. Results Small intervention effects were found for postintervention self-efficacy for physical activity (d = 0.26; 95% CI: [0.21, 0.31]; I2 = 75.8 per cent). “Information about social, environmental, and emotional consequences” was associated with higher effect sizes, whereas “social support (practical)” was associated with lower effect sizes. Small and nonsignificant effects were found for maintained changes in self-efficacy for physical activity (d = 0.08; CI: [−0.05, 0.21]; I2 = 83.8 per cent). Lack of meaningful clustering of BCTs was found. A significant positive relationship was found between number of BCTs and effect sizes for maintained changes in self-efficacy for physical activity. Conclusions There does not appear to be a single effective approach to change self-efficacy for physical activity in all adults: different approaches are required for different populations. Interventions with more BCTs seem more effective at maintaining changes in self-efficacy for physical activity.

ObjectivesThe research team aimed to understand women’s lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV), with a view to also explore women’s decisions around pregnancy management.MethodsQualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis. FindingsThree superordinate themes alongside thirteen subthemes were identified. Theme 1 described ‘a fine line between supportive and unhelpful’ care experiences. A second theme of ‘understanding the situation and decision to be made’ described how women faced many uncertainties. The final theme of ‘parental responsibility’ reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child. Key Conclusions and Implications for PracticeWomen highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations.

There is compelling evidence that regular physical activity (PA) during pregnancy benefits both mother and baby.1 2 Notably, physical and psychological benefits are evident in the literature, such as marked reductions in the development of gestational diabetes and hypertensive disorders, alongside improvements in depressive symptoms and cardiorespiratory fitness.1 2 The evidence base has been reflected by recent policy initiatives, for example, in 2017 (relaunched in 2019), the UK‘s chief medical officers (CMOs) published PA guidelines for pregnant women, which made substantial strides in unifying and translating the evidence into recommendations.1 The CMO guidelines are aimed at supporting health professionals to provide consistent, evidence-based PA messages to women throughout pregnancy.1 Recently, the Chartered Institute for the Management of Sport and Physical Activity have updated their professional standards for working with antenatal and postnatal clients to align with these CMO guidelines.3 However, not all women have access to professionals with this level of expertise and training, potentially limiting the impact of the CMO guidelines. Antenatal healthcare professionals, primarily midwives, are the key sources of information for pregnant women in the UK. Although the CMO guidelines are aimed at healthcare professionals, it is unlikely that the guidelines will be integrated into routine practice unless they are …

Objective To explore the construal of midwives by pregnant women with a body mass index greater than 30 kg/m2 (BMI ≥ 30 kg/m2). Method Ten pregnant women with a BMI ≥ 30 kg/m2 were recruited from antenatal clinics at a maternity hospital in the North West of England. Each participant completed a repertory grid. The participants chose people to match roles including themselves, pregnant women, midwives of different BMIs and hypothetical elements. They also generated psychological constructs to describe them. Results Pregnant women with a BMI ≥ 30 kg/m2 construed themselves as vulnerable and self-conscious. Some women endorsed obesity-related stereotypes for themselves and felt responsible for their weight. The midwife with a BMI 18

OBJECTIVE: To explore the experiences of postnatal women who are obese [body mass index (BMI) ? 30 kg/m(2) ] in relation to making behaviour changes and use of behaviour change techniques (BCTs). DESIGN: Qualitative interview study. SETTING: Greater Manchester, UK. POPULATION OR SAMPLE: Women who were 1 year postnatal aged ?18 years, who had an uncomplicated singleton pregnancy, and an antenatal booking BMI ? 30 kg/m(2) . METHODS: Eighteen semi-structured, audio-recorded interviews were conducted by a research midwife with women who volunteered to be interviewed 1 year after taking part in a pilot randomised controlled trial. The six stages of thematic analysis were followed to understand the qualitative data. The Behavior Change Technique Taxonomy (version 1) was used to label the behaviour change techniques (BCTs) reported by women. MAIN OUTCOME MEASURES: Themes derived from 1-year postnatal interview transcripts. RESULTS: Two themes were evident: 1. A focused approach to postnatal weight management: women reported making specific changes to their eating and physical activity behaviours, and 2. Need for support: six BCTs were reported as helping women make changes to their eating and physical activity behaviours; three were reported more frequently than others: Self-monitoring of behaviour (2.3), Prompts/cues (7.1) and Social support (unspecified; 3.1). All of the BCTs required support from others for their delivery; food diaries were the most popular delivery method. CONCLUSION: Behaviour change techniques are useful to postnatal women who are obese, and have the potential to improve their physical and mental wellbeing. Midwives and obstetricians should be aware of such techniques, to encourage positive changes. TWEETABLE ABSTRACT: BCTs are useful to postnatal women who are obese, and have the potential to improve their wellbeing.

The current study aimed to explore student midwives' awareness, knowledge, and experiences of supporting women with antenatal anxiety (ANA) within clinical practice.ANA is associated with negative outcomes for mother and baby. Midwives play a key role in the screening of antenatal mental health and care of women suffering from ANA.This study was conducted with student midwives at one UK university in the north-west of England. Twenty-five midwifery students completed a brief online survey informed by National Institute of Health and Care Excellence (NICE) guidelines. Of these, seven volunteered to participate in semi-structured interviews exploring the survey data. The interview topic guide was designed based on the findings of the survey.Thematic analysis of the seven interviews revealed four overarching themes: Perpetuating factors, Barriers to care, Skills required in role and Suggestions for future directions. Midwives had a varied knowledge and understanding of ANA and expressed a desire to learn more about their role in supporting women with ANA.Although a small study, the results highlight the need for education to be improved in order to best prepare student midwives for cases of ANA, with emphasis on integrating psychology and mental health information into teaching as well as time spent in clinical practice. Midwives are key in the screening of women for ANA and are in an ideal position to signpost for specialist care.

Objective: While many people with Type 1 diabetes find it difficult to achieve recommended blood glucose levels, a minority do achieve good control. Our study was conceived by patient and public (PP) partners and sought to learn about experiences of people living with well-controlled diabetes. Design: A collaboration between academic health psychologists and five PP partners with experience of diabetes, who were trained to conduct and analyse semi-structured interviews. Fifteen adults with well-controlled Type 1 diabetes were interviewed about the history of their diabetes and their current self-management practices. Interviews were subjected to inductive thematic analysis. Results: Eight sub-themes were arranged into two overarching themes, ‘facing up to diabetes’ and ‘balance leads to freedom’. Participants described a process of acceptance and mastery of diabetes, and talked about how they gained a deeper understanding of bodily processes through trial and error. Conclusion: Based on the experiences of people with well-controlled Type 1 diabetes, interventions for people with this condition should encourage acceptance of the diagnosis and increasing confidence to experiment with behaviours (trial and error) to encourage ‘mastery’ of self-management. The research collaboration described here is an example of best practice for future researchers wanting to actively engage PP partners.

Objective To assess the extent to which the title and font of participant information sheets (PISs) can influence pregnant women's and trainee midwives' perceptions of an antenatal intervention. Methods Pregnant women ( n =35) and trainee midwives ( n =36) were randomly presented with one of four PISs where the title and font of the PIS had been manipulated to create four experimental conditions (i.e., Double Fluent ; Double Awkward ; Fluent Title-Awkward Font ; Awkward Title-Fluent Font ). After reading the PIS, participants rated their perceptions of the intervention (i.e., Attractiveness, Complexity, Expected Risk, Required Effort) using five-point Likert scales. Results A 4×2 factorial multivariate analysis of variance revealed that pregnant women rated the Double Awkward condition as significantly more complex than the Double Fluent ( p =.024) and Awkward Title-Fluent Font ( p =.021) conditions. Conclusion Font influenced pregnant women's ratings of intervention complexity. Practice implications Results have implications for ethical recruitment, and in turn, the optimisation of corresponding interventions.

BACKGROUND: Maternal obesity [body mass index (BMI)�?�30�kg/m(2) ] is associated with numerous complications, but currently, little is known about the pregnancy experiences of these women. OBJECTIVE: To gain insight into the experience of pregnant women with BMI�?�30�kg/m(2) , when accessing maternity services and attending a community lifestyle programme. DESIGN: Qualitative methodology, utilizing focus groups and semi-structured interviews with post-natal women who had an antenatal BMI�?�30�kg/m(2) . The sample was obtained from a larger study. RESULTS: Thirty-four women participated. Three main themes were identified using thematic analysis. Women described disappointment with their pregnancy. In particular, their informational expectations were not met; some health professionals appeared uninterested, insensitive or unconfident. Women described readiness to make a lifestyle change, but this was not encouraged during routine care. Attending the programme began the process of behavioural change. Women's beliefs that small changes make a big difference led to them being spurred on by success; driven by a desire to improve the health of their family. DISCUSSION AND CONCLUSION: Pregnant women who are obese know this is the case and expect to be provided with information to assist them in making lifestyle changes. Health professionals should be aware of women's readiness for change and view pregnancy as an ideal time to communicate. Pregnant women with a BMI�?�30�kg/m(2) should contribute to health professional training, to highlight the reality of the maternity system journey; first-hand accounts may improve the way health professionals' approach these women. Lifestyle interventions should be developed with input from the intended target group.

Pregnancy can be both a time of change and increased stress for women. Through taking part in a research study and attending an antenatal lifestyle programme for women with a body mass index (BMI) ≥30kg/m2, a group of eight women formed a reference group and became a strong and effective source of social support for each other. This article discusses the role of social support from reference groups in engaging in postnatal healthy behaviours, such as physical activity (social learning theory) and protection against stressful situations (social support as a buffer for psychosocial stress), by presenting some observations and data from a number of women taking part in a larger research study and the literature base. Two conclusions are made in this discussion article and require further research attention in the opinion of the research team. First, health professionals should educate women about the different sources of social support that they may need during and after pregnancy; and second, they should provide antenatal opportunities for women to meet others with whom they can form a social support group (e.g. BMI can be the basis for a reference group).

AimTo investigate GPs’ beliefs about complementary and alternative medicine (CAM) and its role in clinical practice.BackgroundDespite the prevalence of CAM in the United Kingdom, little is known about GPs beliefs regarding these alternative approaches to patient management and how they view it in relation to their clinical conduct and practice.MethodA qualitative study conducted on 19 GPs recruited from the North West of England. Semi-structured telephone interviews were analysed using an inductive thematic analysis.ResultsThree themes emerged from the data: limited evidence base, patient demand and concerns over regulation.ConclusionDespite recognising the limited evidence base of CAM, GPs continue to see a role for it within clinical practice. This is not necessarily led by patient demand that is highly related to affluence. However, GPs raised concerns over the regulation of CAM practitioners and CAM therapies.

Standardized systematic search strategies facilitate rigor in research. Current search tools focus on retrieval of quantitative research. In this article we address issues relating to using existing search strategy tools, most typically the PICO (Population, Intervention, Comparison, Outcome) formulation for defining key elements of a review question, when searching for qualitative and mixed methods research studies. An alternative search strategy tool for qualitative/mixed methods research is outlined: SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type). We used both the SPIDER and PICO search strategy tools with a qualitative research question. We have used the SPIDER tool to advance thinking beyond PICO in its suitable application to qualitative and mixed methods research. However, we have highlighted once more the need for improved indexing of qualitative articles in databases. To constitute a viable alternative to PICO, SPIDER needs to be refined and tested on a wider range of topics.

Objective: Maternal obesity (Body Mass Index [BMI] ≥ 30kg/m2) is associated with numerous maternal and fetal complications. Recent guidelines have called for advice to be given to women as pregnancy is a good time for intervention as due to women’s motivations for change being high and changes may impact on the wider family. Weight management guides can provide relevant lifestyle information for women but little is known about their use in pregnancy. This study examined whether weight management guides, designed for women with a BMI > 30kg/m2, are accessible and appropriate for pregnant women with a BMI ≥ 40kg/m2. Design: A cross-sectional qualitative study. Setting: Scotland, United Kingdom (UK). Method: Fourteen pregnant women attending a high-risk antenatal clinic for women with a BMI ≥ 40kg/m2 were interviewed. A semi-structured topic guide was used to explore the women’s views towards the content and layout of the two weight management guides. Results: Inductive thematic analysis highlighted four themes which summarized the women’s views towards the weight management guides: professionalism; personal; handy tool for behaviour change; and detail. The guides were well received and several features played an integral part in the women liking them: the goal grid; suitable pictures; appealing layout; relevant case stories; and alternative food choices/exercise tips. Conclusion: Limitations include the possible increased motivation of women who were recruited from a specialized antenatal clinic for very severely obese women. Weight management guides as an antenatal behaviour change intervention need researching in terms of impact on gestational weight gain and maternal and fetal outcomes.

This article addresses the theme of decision-making in clinical practice and is based on a teaching and learning session for third-year midwifery students. The focus of this article is on the processes of decision making. Scenarios are presented that can be used as problem-based learning exercises with student midwives and discussion questions are suggested.

Midwives are ideally placed to advise women about contraception during pregnancy and in the postnatal stage, and the National Institute for Health and Clinical Excellence (NICE) (2006) has outlined the ‘core care’ in relation to contraception that each woman and baby should receive. In some cases, midwives have the opportunity to counsel and advise women who have not accessed advice on contraception prior to their current pregnancy. It is important for midwives to be aware of the available methods of contraception and current advice as to the suitability and efficacy of the methods, as well as when they should be commenced. This article considers the guidelines regarding contraceptive advice in the postnatal period, and provides details of where midwives can access expert contraceptive services and the latest evidence supporting the use of various contraceptive methods.

Young pregnancy remains high on the UK’s public health agenda. This article reviews current literature and considers the role of school nurses in helping to reduce adverse outcomes of young pregnancy. Reviewing work from the author’s PhD research, attention will be directed to how school nurses can intervene and help improve pregnancy and parenthood experiences for young people.

Young pregnancy remains high on the UK public health agenda. This article reviews current literature and considers the role of midwives in helping to reduce adverse outcomes in young pregnancy. Reviewing work from the author's PhD work, attention will be directed to how midwives can intervene and help improve young parents' pregnancy experiences.

Increasing evidence points to student involvement in the sex industry. The current study comprised a cross-sectional sample of 315 undergraduates at a London university. Using a semi-structured questionnaire, data were gathered on students' financial and employment circumstances and their views on participation in sex work. Results suggested awareness of student sex work was widespread, and considered understandable by the majority. Students principally attributed participation in the sex industry to their financial situation. A relatively high proportion (16.5%) indicated that they would be willing to engage in sex work to pay for their education, with 11% indicating they would work as escorts. A model of willingness to undertake sex work was able to explain over one-quarter of the variance. These findings are explained in relation to the mainstreaming of sexual consumption, the supply routes of sexual labour from privileged socio-economic positions and the effects of student debt.

The teenage pregnancy strategy outlines the need for improved support to lower young parents' risk of long-term social exclusion by enabling 60% to return to employment, education or training. While current literature indicates that young parents need support during and after their pregnancy, little UK research has explored the influence of support on young parents' outcomes. This mixed-methods study provides insight into the antenatal and postnatal experiences of young parents in one London primary care trust. Four main barriers to receiving efficient antenatal and postnatal support were highlighted: a lack of male involvement; a poor and uncommunicative relationship between health professionals and young parents; the age restriction of services and a lack of knowledge about support availability. Age, gender and self-esteem were highlighted as influencing the needs and experiences of young parents and thus need to be considered when designing future antenatal and postnatal interventions.

One hundred and forty-seven psychology postgraduates from 60 UK universities completed an online survey. The survey aimed to examine the experiences of psychology postgraduates around teaching and to provide an initial benchmark against which future developments in their support could be measured. This report explores respondents' experiences of teaching, training and support they receive as well as how they balance the roles of teaching and research. Findings indicate that while generally the experiences of postgraduates in teaching are good, concerns are evident in relation to marking, preparation, time and dealing with difficult students. Problems with time were found often to be associated with marking and preparation. Remuneration for time spent on teaching was also an issue. Findings suggest that postgraduates could benefit from clearer and more realistic guidance. Significant differences were found between teaching tasks undertaken by respondents at pre and post 1992 institutions and postgraduates at post 1992 institutions more often exceed assigned teaching hours.

Background Pregnancy-related physical changes can have a significant impact on a woman’s body image. There is no synthesis of existing literature to describe the intricacies of women’s experiences of their body, and relevant clinical implications. Methods Four electronic databases were searched in February 2014 using predefined search terms. English-language, qualitative studies published between January 1992 and December 2013 exploring pregnancy and postpartum body image were included. Following quality appraisal, 17 papers were synthesised using the interpretive thematic synthesis approach within a social constructionist framework. Results Three themes were highlighted: “Public Event: ‘Fatness’ vs. Pregnancy”, “Control: Nature vs. Self”, and “Role: Woman vs. Mother”. Women perceived the pregnant body to be out of their control and as transgressing the socially constructed ideal, against which they tried to protect their body image satisfaction. Women perceived the physical manifestation of the mothering role as incongruent to their other roles as a wife or partner, or working woman. Body dissatisfaction dominated the postpartum period. Conclusions Women’s perception of their pregnancy body image is varied and depends on the strategies they use to protect against social constructions of female beauty. Women have unrealistic expectations for their postpartum body, highlighting this as an area where women need better support. Attending to women’s narratives about their pregnant body may identify at-risk women and provide an opportunity for health professionals to provide support to either address or accept body image dissatisfaction. Clinical communication training may enable health professionals to explore body image concerns with women and guide them in identifying ways of accepting or reducing any dissatisfaction.

Introduction maternal health inequalities exist across the world. In the United Kingdom, whilst there are variations within and between groups, Black and Minority Ethnic (BME) women tend to have worse maternal health outcomes than White British women. However, there is limited information about BME women׳s experience of maternity services. Midwives are central to the provision of safe maternity care but little is known about their perceptions of ethnically-based inequalities in maternal healthcare. Therefore, this study explored a cohort of midwives׳ experiences of providing care for BME women, focussing on their views on the relationship between maternal health inequalities and service delivery. Methods using a specifically-designed topic guide, 20 semi-structured interviews were conducted with qualified midwives in one National Health Service (NHS) Trust in the North West of England over a two-month period. Data were subsequently transcribed and thematically analysed. Results three main and seven sub-themes were identified. Firstly, ‘language' summarised difficulties midwives experienced in engaging with women whose English was limited. Secondly, ‘expectations of maternity care' outlined the mismatch between midwives and women׳s expectations of maternity care. Finally, ‘ complex needs extending beyond maternity care ' highlighted the necessity of inter-agency working to address women׳s care holistically when their needs transcend the scope of maternity services. Discussion Midwives׳ accounts indicated that they strive to provide equitable care but encountered numerous barriers in doing so. Paradoxically, this might contribute to inequalities in service delivery. In midwives׳ view, unrestricted access to interpretation and translation services is essential for provision of effective, holistic maternity care. Participants also advocated education for both women and midwives. For the former, this would improve BME women׳s understanding of health and care systems, potentially leading to more realistic expectations. Improving midwives׳ cultural competence would better equip them to respond to the needs of an ethnically diverse population. Finally, midwives highlighted that many minority women׳s complex care needs were identified during pregnancy. Hence, they regarded pregnancy as an ideal time for interventions to improve the health of women and their families and, as such, antenatal care cannot be treated as an isolated event. According to midwives in this study, delivering safe, effective maternity services in the 21st century requires greater collaboration with the women they care for and other health and care agencies (including independent sector providers).

Introduction maternal obesity [body mass index (BMI)≥30kg/m 2 ] is a cause for concern because of increasing rates and risk of associated complications. However, little is known about how to improve the health of women with a BMI≥30kg/m 2 . Objective and methods a 10-week antenatal lifestyle programme (The Lifestyle Course – TLC), underpinned by behaviour change theory, was developed in a programme of research which included a prospective, multicentred, feasibility phase ( n =227). Participants had a BMI≥30kg/m 2 at the start of their pregnancy, planned to deliver in two areas of Greater Manchester and were aged 18 or over. The objectives were to (1) assess the feasibility of the intervention and (2) to pilot the trial processes and outcome measures. Findings (1) Trial intervention : only 22% of women in the feasibility phase had received gestational weight advice prior to the study. One or more TLC sessions were attended by 79% of women and 97% said they would recommend TLC to a friend due to the content suitability, perceived personal gains and extra care received. Changes to the TLC were suggested and implemented in the pilot phase. (2) Trial processes: recruitment rates (36%), retention rates (100%) and questionnaire completion rates up to one year (33%) were found. Daily general ‘lifestyle' diaries and pedometers were not acceptable data collection tools (response rates of 32% and 16% respectively). However, specific food diaries were acceptable (response rates of 80–81%). The major challenge was the collection of maternal weight data at the follow-up points. Conclusions and implications the antenatal intervention (TLC) designed for this programme of work appears to suit the needs of women with a BMI≥30kg/m 2 . The need for an antenatal intervention is clear from this study and also highlights reflections on effective communication with pregnant women with a BMI≥30kg/m 2 . Lessons learnt for designing a future trial include effective ways to communicate with pregnant women with a BMI≥30kg/m 2 . Trial registration ISRCTN29860479.

It is widely recognised that maternal and foetal risks are associated with maternal obesity (body mass index (BMI)≥30 kg/m 2 according to Obesity – Preventing and Managing the Global Epidemic – Report of a WHO Consultation on Obesity , 1999). To minimise risk and effectively manage possible complications associated with maternal obesity, individualised care pathways are essential for women with a BMI≥30 kg/m 2 . A holistic approach is vital as women with a BMI≥30 kg/m 2 have complex needs requiring multidisciplinary skills and knowledge. Midwives play a special role in this holistic individualised care pathway as they have contact with women at least once in their pregnancy and thus have the potential to make a difference to the health of the pregnant woman, her baby and the wider family. Pregnancy is an ideal opportunity to provide women with advice and support regarding their weight and how to have a healthy lifestyle and has potential for long-term impact. This chapter will focus on the role of the midwife when contributing to multidisciplinary individualised care to this target group. Current literature and examples from practice will be used to illustrate the main issues.

Background An increase in the number of women with maternal obesity (Body Mass Index [BMI] ≥30 kg/m2) has had a huge impact on the delivery of maternity services. As part of a programme of feasibility work to design an antenatal lifestyle programme for women with a BMI ≥30 kg/m2, the current study explored health professionals’ experiences of caring for women with a BMI ≥30 kg/m2 and their views of the proposed lifestyle programme. Method Semi-structured interviews with 30 health professionals (including midwives, sonographers, anaesthetists and obstetricians) were conducted and analysed using thematic analysis. Recruitment occurred in two areas in the North West of England in early 2011. Results Three themes were evident. Firstly, obesity was seen as a conversation stopper; obesity can be a challenge to discuss. Secondly, obesity was seen as a maternity issue; obesity has a direct impact on maternity care and therefore intervention is needed. Finally, the long-term impact of maternal obesity intervention; lifestyle advice in pregnancy has the potential to break the cyclic obesity relationship. The health professionals believed that antenatal lifestyle advice can play a key role in addressing the public health issue of obesity as pregnancy is a time of increased motivation for women with a BMI ≥30 kg/m2. Conclusions Maternal obesity is a challenge and details of the training content required for health professionals to feel confident to approach the issue of maternal obesity with women are presented. Support for the antenatal lifestyle programme for women with a BMI ≥30 kg/m2 highlights the need for further exploration of the impact of interventions on health promotion.

Information is needed about how the effects of socio-economic deprivation on teenage pregnancy are mediated by proximal risk factors, in order to target area-wide and family interventions more effectively. Using a 2x2 factorial design, we tested the separate and interacting effects of area deprivation and family deprivation on six specific proximal risk factors for teenage pregnancy: early sexual activity, life expectations, knowledge and beliefs about contraceptives, attitude to abortion, beliefs about love, and use of local sexual health services. Data were collected from 201 13-15-year-old girls in deprived and non-deprived families living in deprived and more affluent areas of the United Kingdom. Area deprivation significantly increased early sexual activity, and both area and family deprivation significantly reduced life expectations. Significant interactions between area and family deprivation showed that the impact of living in a deprived area depends to some extent on family circumstances, with implications for targeting different types of intervention. Living in a deprived area increased early sexual activity much more markedly among girls in deprived families, so interventions to reduce early sexual activity could target individually deprived girls living in deprived areas. Living in a more affluent area increased life expectations, but only among girls in non-deprived families, so both area-wide and individually targeted interventions would be needed to raise life expectations among girls most at risk of teenage pregnancy.

The goal of the Test Readiness Program is to transition to a 24 month test readiness posture and if approved move to an 18-month posture. One of the key components of the Test Readiness Program necessary to meet this goal is the reconstitution of the important diagnostics. Since the end of nuclear testing, the ability to field diagnostics on a nuclear test has deteriorated. Reconstitution of diagnostics before those who had experience in nuclear testing either retire or leave is essential to achieving a shorter test readiness posture. Also, the data recording systems have not been used since the end of testing. This report documents the reconstitution of one vital diagnostic: the low bandwidth reaction history diagnostic for FY04. Reaction history is one of the major diagnostics that has been used on all LLNL and LANL tests since the early days of nuclear testing. Reaction history refers to measuring the time history of the gamma and neutron output from a nuclear test. This gives direct information on the nuclear reactions taking place in the device. The reaction history measurements are one of the prime measurements the nuclear weapon scientists use to validate their models of device performance. All tests currentlymore » under consideration require the reaction history diagnostic. Thus moving to a shorter test readiness posture requires the reconstitution of the ability to make reaction history measurements. Reconstitution of reaction history was planned to be in two steps. Reaction history measurements that have been used in the past can be broadly placed into two categories. The most common type of reaction history and the one that has been performed on virtually all nuclear tests is termed low bandwidth reaction history. This measurement has a time response that is limited by the bandpass of kilometer length coaxial cables. When higher bandwidth has been required for specific measurements, fiber optic techniques have been used. This is referred to as high-bandwidth reaction history. The first step in the reconstitution of reaction history was thus naturally the reconstitution of the low-bandwidth capability in FY04. This will be followed in FY06 by the reconstitution of the high bandwidth capability. The reconstitution of the low-bandwidth reaction history measurement was done in several phases. First the status of legacy equipment has been ascertained. Existing detectors, cables, and recording systems have been inventoried, characterized and, for the most part, satisfied the specifications of the test program and are still useable. The ability to obtain replacement equipment is now available. Modern low-bandwidth fiber optic recording equipment which was similar to systems used on the old tests, has been evaluated. The ability to characterize and calibrate detectors and other components has been reestablished. New scientists and engineers have been working with designated mentors. These mentors participated on numerous shots during the old test program. Finally as a proof test, two hypothetical test scenarios were proposed: one each from LLNL and LANL. The LANL event was called ALPHA and the LLNL event was called POPOUT. The reaction history diagnostics for these two hypothetical underground tests were completely laid out and analyzed to make sure that the diagnostic could be successfully fielded within a 24 month time frame. In addition as part of a training exercise a reaction history trailer was reconstituted. This system was configured using a combination of new and experienced technical personnel and data analysts in collaboration with LLNL and LANL event physicists.« less