Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy

OBJECTIVES: Pregnancy may provide a 'teachable moment' for positive health behaviour change, as a time when women are both motivated towards health and in regular contact with health care professionals. This study aimed to investigate whether women's experiences of pregnancy indicate that they would be receptive to behaviour change during this period. DESIGN: Qualitative interview study. METHODS: Using interpretative phenomenological analysis, this study details how seven women made decisions about their physical activity and dietary behaviour during their first pregnancy. RESULTS: Two women had required fertility treatment to conceive. Their behaviour was driven by anxiety and a drive to minimize potential risks to the pregnancy. This included detailed information seeking and strict adherence to diet and physical activity recommendations. However, the majority of women described behaviour change as 'automatic', adopting a new lifestyle immediately upon discovering their pregnancy. Diet and physical activity were influenced by what these women perceived to be normal or acceptable during pregnancy (largely based on observations of others) and internal drivers, including bodily signals and a desire to retain some of their pre-pregnancy self-identity. More reasoned assessments regarding benefits for them and their baby were less prevalent and influential. CONCLUSIONS: Findings suggest that for women who conceived relatively easily, diet and physical activity behaviour during pregnancy is primarily based upon a combination of automatic judgements, physical sensations, and perceptions of what pregnant women are supposed to do. Health professionals and other credible sources appear to exert less influence. As such, pregnancy alone may not create a 'teachable moment'. Statement of contribution What is already known on this subject? Significant life events can be cues to action with relation to health behaviour change. However, much of the empirical research in this area has focused on negative health experiences such as receiving a false-positive screening result and hospitalization, and in relation to unequivocally negative behaviours such as smoking. It is often suggested that pregnancy, as a major life event, is a 'teachable moment' (TM) for lifestyle behaviour change due to an increase in motivation towards health and regular contact with health professionals. However, there is limited evidence for the utility of the TM model in predicting or promoting behaviour change. What does this study add? Two groups of women emerged from our study: the women who had experienced difficulties in conceiving and had received fertility treatment, and those who had conceived without intervention. The former group's experience of pregnancy was characterized by a sense of vulnerability and anxiety over sustaining the pregnancy which influenced every choice they made about their diet and physical activity. For the latter group, decisions about diet and physical activity were made immediately upon discovering their pregnancy, based upon a combination of automatic judgements, physical sensations, and perceptions of what is normal or 'good' for pregnancy. Among women with relatively trouble-free conception and pregnancy experiences, the necessary conditions may not be present to create a 'teachable moment'. This is due to a combination of a reliance on non-reflective decision-making, perception of low risk, and little change in affective response or self-concept.

Self-affirmation promotes physical activity

The present study tests whether a self-affirmation intervention (i.e., requiring an individual to focus on a valued aspect of their self-concept, such as honesty) can increase physical activity and change theory of planned behavior (TPB) variables linked to physical activity. Eighty young people completed a longitudinal intervention study. Baseline physical activity was assessed using the Godin Leisure-Time Physical Activity Questionnaire (LTPAQ). Next, participants were randomly allocated to either a self-affirmation or a nonaffirmation condition. Participants then read information about physical activity and health, and completed measures of TPB variables. One week later, participants again completed LTPAQ and TPB items. At follow up, self-affirmed participants reported significantly more physical activity, more positive attitudes toward physical activity, and higher intentions to be physically active compared with nonaffirmed participants. Neither attitudes nor intentions mediated the effects of self-affirmation on physical activity. Self-affirmation can increase levels of physical activity and TPB variables. Self-affirmation interventions have the potential to become relatively simple methods for increasing physical activity levels. © 2014 Human Kinetics, Inc.

Does self-affirmation promote physical activity regardless of threat level?

Background: Self-affirmation (i.e., focusing on a valued aspect of the self-concept) can promote health behaviour change. This study aimed to see if self-affirmation increased physical activity (PA) regardless of threat level presented in health messages. Methods: Sixty-eight participants were randomly allocated to condition in a 2 (self-affirmation, no affirmation) x 2 (high threat, low threat) between-participants design. Participants completed the Godin Leisure-Time Exercise Questionnaire at baseline and one week later to assess PA. Findings: A two-way ANCOVA with affirmation condition and threat level as predictor variables, controlling for baseline PA, was performed on follow up PA. Baseline PA was a significant predictor (F(1,63) = 399.63, p<0.001) and the main effect of affirmation condition approached significance (F(1,63) = 3.55, p=0.06). There were no other significant effects. Discussion: This study provides further evidence that self-affirmation can increase PA, but found no interaction between self-affirmation and threat level presented in health messages.

Enhancing delivery of health behaviour change interventions in primary care: a meta-synthesis of views and experiences of primary care nurses

Objective To systematically find and synthesise qualitative studies that elicited views and experiences of nurses involved in the delivery of health behaviour change (HBC) interventions in primary care, with a focus on how this can inform enhanced delivery and adherence to a structured approach for HBC interventions. Methods Systematic search of five electronic databases and additional strategies to maximise identification of studies, appraisal of studies and use of meta-synthesis to develop an inductive and interpretative form of knowledge synthesis. Results Nine studies met the inclusion criteria. Synthesis resulted in the development of four inter-linking themes; (a) actively engaging nurses in the process of delivering HBC interventions, (b) clarifying roles and responsibilities of those involved, (c) engaging practice colleagues, (d) communication of aims and potential outcomes of the intervention. Conclusion The synthesis of qualitative evidence resulted in the development of a conceptual framework that remained true to the findings of primary studies. This framework describes factors that should be actively promoted to enhance delivery of and adherence to HBC interventions by nurses working in primary care. Practice implications The findings can be used to inform strategies for researchers, policymakers and healthcare providers to enhance fidelity and support delivery of HBC interventions.

Evaluating authentic behaviour change in leadership development programmes

The global economic crisis that hit the western countries strongly has emphasised the need to abandon the economic-performance significance of leadership and return to a meaning-making significance. While a lot of research has been done in the field of leadership and management disciplines, little has been done on how to develop leadership. This study evaluated the degree in which leadership training in the market-place today was effective at developing authentic leadership and, therefore, at changing individual behaviour. Since none of the leadership theories address how behavioural change is actually achieved, theories of change were integrated in the current study. A conceptual model combining Authentic Leadership Development (ALD) theory and the Theory of Planned Behaviour (TPB) was proposed. Furthermore, this study explored the relationship between a positive contemplation of change and the actual change observed in individuals after the leadership intervention. In order to test this conceptualisation, a longitudinal quasi-experimental study was conducted. Leaders were surveyed in this study one month before and one month after the programme. Three complementary questionnaires were distributed to participants in one of four leadership development programmes (two corporate initiatives and two business-school programmes). Analyses showed that leaders who attended a leadership intervention (as compared to a control group) developed higher levels of authentic leadership, as rated by them-selves and others in their working environment and controlling for baseline scores. The results also indicated that intentions were developed through the interventions and that the development of such intentions translated into changes in authentic behaviour. Intentions mediated the relationship between attitude and authentic leader-ship. In addition, when contemplation of change was high and attitudes towards authentic leadership were positive, the development of intentions was stronger. The implications of these findings for the theory and practice of leadership development programmes and the impact on organisational performance are discussed.