Barriers and enablers to initiating and maintaining positive dietary changes during and after pregnancy-A qualitative study of participants in the Healthy Gut Diet Study.

INTRODUCTION

The Healthy Gut Diet Study (HGD) was a pilot randomized controlled trial aiming to prevent gestational diabetes mellitus (GDM) through a gut-friendly diet from early to mid-pregnancy (11-18 weeks' gestation). The intervention was co-designed with women with a lived experience of GDM and incorporated behaviour change techniques to support adherence to gut-friendly dietary habits. This study aimed to investigate the enablers and barriers women faced in initiating and maintaining dietary behaviour changes during and after pregnancy.

METHODS

This qualitative study used semi-structured interviews with women 12 weeks postpartum who had been randomized to the intervention arm of the HGD study. Themes and subthemes were identified through an inductive reflexive thematic analysis. These were subsequently deductively mapped to the Theoretical Domains Framework, the COM-B model/the Behaviour Change Wheel and specific Behaviour Change Techniques.

RESULTS

Seventeen interviews were conducted with participants with a mean age of 33 (SD 4.9) years, and 30% of whom were first-time mothers. Five key themes were generated: (1) Empowering for Autonomy, (2) Building confidence and Competence, (3) Creating Capacity, (4) Navigating Physical Realities and (5) Sustaining Momentum. These themes each had their own descriptive sub-themes.

CONCLUSIONS

Pregnancy can serve as a "teachable moment" for dietary behaviour change, but sustainable behaviour change requires the use of person-centred care, access to credible education, early initiation, continuous reinforcement and shared social support.