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Objective: 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.Design: A four-arm randomised controlled trial to explore potential mechanisms of action. Main outcome measures: 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).Results: 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 self-reporting '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.Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objectives: Psychosis can present parents with complex parenting challenges and significant adverse outcomes for parents and their children have been reported. However, remarkably little is known about how parenting is experienced by these parents. Therefore, this qualitative study aimed to understand the lived experiences of parents with psychosis, including how parenting support was experienced. Design and Methods: Using interpretative phenomenological analysis (IPA), eight biological parents (five mothers and three fathers) with psychosis were recruited and interviewed from early intervention in psychosis services in the Northwest of England. Results: Three superordinate themes and seven subordinate themes were identified. Theme 1 'Living with the Struggle: Painfully Disconnected' captured a persistent parenting struggle that distanced parents from their children and support due to all‐consuming experiences of psychosis, fear and risk‐focused service support. Theme 2 'Desired and Vulnerable Position: Comfortably Connected' captured parental experiences of symptom relief through connection with their children, alongside parental need to be integrated with the systems around them. Theme 3 'Exposed: Parenting Under a Spotlight' represented parental experiences of inescapable observation and judgement from the systems around them. Conclusions: Novel insights into the role of misaligned parent and service priorities in parental perceptions of powerlessness, shame and disconnection from their children, valued parenting identities, and system supports are presented. Systemic interventions that target stigma, provide system‐wide psychoeducation and promote person‐centred, compassionate and meaningful connections between parents and the systems they live within are needed to promote better parenting outcomes. [ABSTRACT FROM AUTHOR]

Background: 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. Methods: 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. Results: 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'. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Aim: Pregnancy after the death of a baby is associated with numerous, varied psychological challenges for pregnant women. This study aimed to explore women's experiences of pregnancy whilst attending a specialist antenatal service for pregnancies after a perinatal death.Methods: Semi-structured interviews with twenty women in a subsequent pregnancy after a perinatal death were conducted and analyzed taking an inductive thematic analysis approach.Results: All women expressed a heightened "awareness of risk". Two subthemes demonstrated how increased awareness of risk affected their experience and their desire regarding antenatal and postnatal support. Women talked about stillbirth being a "quiet, unspoken subject" causing them internal conflict as they had an awareness of pregnancy complications that other people did not. Navigating subsequent pregnancies relied on them "expecting the worst and hoping for the best" in terms of pregnancy outcomes. Women viewed specialist antenatal care in pregnancy after perinatal loss favorably, as it enabled them to receive tailored care that met their needs stemming from their increased awareness of and personal expectations of risk.Conclusion: Women's experiences can be used to develop models of care but further studies are required to determine to identify which components are most valued. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Mental simulation of future scenarios is hypothesized to affect future behavior, but a large and inconsistent literature means it is unclear whether, and under what conditions, mental simulation can change people's behavior. A meta-analysis was conducted to synthesize the effects of mental simulation on behavior and examine under what conditions mental simulation works best. An inclusive systematic database search identified 123 (N = 5,685) effect sizes comparing mental simulation to a control group. After applying a multilevel random effects model, a statistically-reliable positive effect of Hedges' g = 0.49, 95% CI [0.37; 0.62] was found, which was significantly different than zero. Using a taxonomy to identify different subtypes of mental simulation (along two dimensions, class [process, performance, outcome] and purpose [whether an inferior, standard, superior version of that behavior is simulated]), it was found that superior simulations garnered more reliable beneficial effects than inferior simulations. These findings have implications for integrating theories of how mental simulations change behavior, how mental simulations are classified, and may help guide professionals seeking evidence-based and cost-effective methods of changing behavior. [ABSTRACT FROM AUTHOR]

This study explored what support male partners of women admitted to Mother and Baby Units (MBUs) wanted. Although research has highlighted the need to support male partners of women admitted to specialist MBUs, little is known about the type of support men want and how they wish support to be delivered Ten men whose partner was admitted to a MBU in the United Kingdom or Australia participated in semi-structured interviews. Data were analysed using Thematic Analysis. Five themes were identified: (1) A smoother journey to and from the MBU, (2) Feeling included, (3) Uncertainty about 'what is going on', (4) Barriers to support and (5) Facilitators of support. This is the first qualitative study to specifically explore the type of support male partners of MBU patients would like in terms of content, delivery and timing. Participants expressed the need to be involved in care decisions regarding their spouse and infant and to be offered advice from professionals. They highlighted barriers to accessing support and offered solutions to minimise those. In terms of clinical implications, we recommend a support package, which could be developed for MBUs to improve outcomes for male partners and their family. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: This systematic review thematically synthesised qualitative research exploring men's experiences of their partner's postnatal mental health problems and their impact on men's emotional wellbeing, relationships and support needs. Maternal postnatal mental health problems impact women and their infants. Recognition of the role that men play in supporting women's' recovery and infants' development is growing. However, less is known about how maternal postnatal mental health problems affect men and how they wish to be supported. Methods: A systematic review of the literature was conducted in January 2018 by searching five electronic databases (PsycINFO, EMBASE, MEDLINE, PubMed and Web of Science). Qualitative research studies published in English exploring men's experiences of having a partner with postnatal mental health problems were included. Twenty papers met the inclusion criteria and were appraised for methodological quality. Data were thematically synthesised. Results: In addition to nineteen subthemes, 5 main themes were identified: (1) Being a father, (2) Being a partner, (3) Experiencing negative emotions, (4) The ways in which men cope and (5) Where support is needed. Conclusions: Maternal postnatal mental health problems impacted men's roles of being a father and a partner and gave rise to negative emotions. Men coped with these experiences in a number of ways, which were both helped and hindered by personal, social and professional factors. Participants' coping methods were understood in relation to Coping Theory. Recommendations for perinatal mental health professionals included the need for increased public awareness of postnatal mental health. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Congenital heart defects (CHD) can be detected at ultrasound but are sometimes not diagnosed until birth, which can cause stress and heightened emotion within the family. Parents face challenges including dealing with surgical procedures for their child and integrating healthcare management into family life. The aim of this review was to understand parental coping with their child's CHD. Methods: Six databases were systematically searched to identify qualitative studies relating to parental coping in the context of having a child with CHD and which met inclusion criteria. Studies were subject to quality appraisal using Walsh and Downe's checklist, and synthesised using Noblit and Hare's meta-ethnographic approach. Results: The synthesis of 22 studies reporting on 704 parents' accounts showed that parent coping fell within four overarching themes: Emotional Responses, Support Systems, Parental Management and Avoidance. These four themes contained 13 subordinate themes. Conclusions: Parental psychosocial coping varies over time from diagnosis, through surgery to childhood. Common themes were evident, but individuals employed their own styles and strategies based on prior experience, availability of social support, personal characteristics and beliefs. Parents tried to maintain a sense of normality, integrating CHD into their lives without it having a major impact except at times of transition and hospitalisation when they had to call on additional strategies or support to manage this stress. This review offers clear guidance to clinical services on how best to support parents and families. [ABSTRACT FROM AUTHOR]

Background: Self-incentives offer a plausible alternative to paying smokers to quit but have not yet been tested in a randomized controlled trial.Purpose: The present study tested whether, compared with a control group, prompting smokers explicitly to self-incentivize if they abstain from smoking for a week or a month encouraged sustained abstinence.Method: One hundred and fifty-nine smokers were recruited from stop smoking clinics and randomized to an active control condition (asked to form a plan to quit, n = 65) or one of two intervention conditions in which they were asked to form implementation intentions designed to ensure that they incentivized themselves if they had not smoked at all by the end of (a) the week (n = 44) or (b) the month (n = 50). The main outcome measure was self-reported abstinence at 3- and 6-month follow-ups, which was biochemically verified at baseline and in a subsample at 3-month follow-up.Results: At 3-month follow-up, 34% (15/44; p < .05, d = 0.45) and 36% (18/50; p < .05, d = 0.49) of smokers abstained in the weekly and monthly self-incentivizing conditions respectively, compared with 15% (10/65) in the control. The same pattern of findings was observed at 6-month follow-up: 30% (13/44; p < .05, d = 0.35), 34% (17/50; p < .05, d = 0.45) and 15% (10/65) of smokers remained abstinent in the two intervention groups and control group, respectively.Conclusions: Ensuring that smokers self-incentivized boosted significantly the effectiveness of the stop smoking program. Self-incentivizing implementation intentions could be implemented at low cost with high public health "reach" to change many health behaviors beyond smoking.Trial Registration: ISRCTN11610200. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 < 30 kg/m2 was considered to be most similar to the ideal midwife, while the midwife with a BMI ≤ 18 kg/m2 was construed as having an undesirable interpersonal style. The midwife with a BMI ≥ 40 kg/m2 was often construed as sharing similar experiences to the pregnant women with a BMI ≥ 30 kg/m2, such as struggling with the psychological consequences of a raised BMI. Some women construed the midwife with a BMI 30 < 40 kg/m2 in a positive way, whereas others viewed it as sharing similar feelings about weight as the midwife with a BMI ≥ 40 kg/m2. Conclusions The pregnant women with a BMI ≥ 30 kg/m2 in this study described perceptions of themselves and the midwives responsible for their care, which may affect their engagement and satisfaction with services. Pregnant women with a BMI ≥ 30 kg/m2 should be involved in service development activities to ensure the structure of services and the language used by midwives are acceptable and do not confirm weight-related stereotypes. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Pregnant women with a BMI ≥ 30 kg/m2 construe themselves as vulnerable and self-conscious and perceive themselves responsible for their weight., Pregnant women with a BMI ≥ 30 kg/m2 construe midwives with a low BMI as having an undesirable, cold, interpersonal style., Midwives with a raised BMI are construed as similar to the women, because they share the uncomfortable psychological consequences of a raised BMI., The nature of pregnant women's construal may affect their engagement and satisfaction with maternity services and midwifery care. [ABSTRACT FROM AUTHOR]

Background: Maternal obesity [body mass index (BMI) ≥ 30 kg/m2] 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/m2, 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/m2. 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/m2 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. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusess topics within the issue including behavior change related to pregnancy; health of pregnant women; and health behavior change before, during and after pregnancy.

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Although the association between young pregnancy and the socio-economic environment is globally recognised, little is understood about either the processes behind it or how young parents construe this relationship. Twenty-one semi-structured interviews were conducted in four London areas; two ‘less deprived’ and two ‘more deprived’ in order to solicit young parent''s views. Thematic analysis uncovered three factors indicative of how young parents understand the social gradient in young pregnancy; the parental relationship status (openness and parental control); access to education and career; and acceptance of young pregnancy. It is suggested that differing representations of young parenthood across socio-economic subgroups correspond to differing representations, values and beliefs concerning sexual and reproductive behaviour, education and the social acceptability of young pregnancy. Further work is needed to build up a holistic picture of the influence place has on young people''s sexual and reproductive health. [Copyright &y& Elsevier]

Background: Obesity is a global public health issue. Having a BMI of 30 kg/m2 or more (classifying a person as obese) at the start of pregnancy is a significant risk factor for maternal and fetal morbidity. There is a dearth of evidence to inform suitable interventions to support pregnant women with a BMI of 30 kg/m2 or more. Here we describe a study protocol to test the feasibility of a variety of potential healthy lifestyle interventions for pregnant women with a BMI of 30 kg/m2 or more in a community based programme.Methods/design: Four hundred women will be approached to attend a 10-week community lifestyle programme. The programme will be provided as a supplement to standard antenatal care. The programme is multi-faceted, aimed at equipping participants with the skills and knowledge needed to adopt healthy behaviours. The social (cognitive) learning theory will be used as a tool to encourage behaviour change, the behaviour change techniques are underpinned by five theoretical components; self-efficacy, outcome expectancies, goal setting, feedback and positive reinforcement.The main outcomes are pregnancy weight gain and caesarean section rate. Other important outcomes include clinical outcomes (e.g., birth weight) and psychological outcomes (e.g., well-being). Secondary outcomes include women's experience of pregnancy and health care services, amount of physical activity, food intake and the suitability of the intervention components.A prospective study using quantitative and qualitative methods will inform the feasibility of implementing the community lifestyle programme with pregnant women with a BMI of 30 kg/m2 or more. Mixed methods of data collection will be used, including diaries, focus groups/interviews, pedometers, validated and specifically designed questionnaires, a programme register, weight gain during pregnancy and perinatal outcome data.Discussion: Findings from this current feasibility study will inform future interventions and NHS services and add to the evidence-base by providing information about the experiences of pregnant women with a BMI of 30 kg/m2 or more undertaking a community lifestyle programme. The study will lead on to a randomised control trial of a suitable intervention to improve the pregnancy outcomes of this target group. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Pregnancy has been described as a 'teachable moment' for behaviour change, which presents an important opportunity for health promotion within antenatal care settings. However, no pregnancy‐specific model has been developed or tested in the context of health behaviour change during pregnancy. This study aimed to investigate and compare the utility of the Capability‐Opportunity‐Motivation Behaviour (COM‐B) and Teachable Moments (TM) models, to explain health behaviour change during pregnancy, within the context of eating behaviour. Design: Longitudinal cohort study. Methods: Five hundred and sixteen women completed a survey at between 12–16 weeks gestation (T1). Follow‐up data were collected at 20–24 weeks (T2), 36–40 weeks (T3), and 6–12 weeks postnatally (T4). The primary outcome was eating behaviour. To assess the utility of the COM‐B model, perceived capability, opportunity, and motivation to eat healthily were measured. To assess the utility of the TM model, risk perceptions, self‐image, and affective response were measured. Results: Overall, the COM‐B model explained 18.4% of the variance in eating behaviour, whilst the TM model explained 9%. Both models explained the most variance in eating behaviour at T1 and T3, compared with T2 and T4. Small changes were observed in eating behaviour and the model constructs over the time period studied, although these were not clinically meaningful. Conclusions: Neither the COM‐B nor TM model provide a satisfactory explanation of eating behaviour during pregnancy, however the findings suggest that certain stages of pregnancy may create more salient opportunities for behaviour change. The findings also support claims that motivation may not play a key role in directing eating behaviour during pregnancy. Further research is needed to explore the role of timing in antenatal behaviour change. The development of a pregnancy‐specific model is necessary to optimise understanding of pregnancy as a teachable moment for behaviour change. [ABSTRACT FROM AUTHOR]

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. Interviews were conducted with 12 parents whose children had completed the Fontan procedure. Interpretative Phenomenological Analysis (IPA) identified themes across parents' accounts. 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. 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. • We know little about the experiences of parents as parents of children with single ventricle congenital heart defects (SVCHD). • Numerous coping strategies are employed by these parents to manage their distress and family experiences. • Accepting SVCHD and its management enabled parents to gain control and normality. • Parents need extra support at transition points, such as starting nursery, final surgery, puberty and reaching adulthood. • Support for parents will enable them to educate their children on their condition. [ABSTRACT FROM AUTHOR]

Globally the rates of breastfeeding duration are extremely low and postnatal mental health issues are common. As a result, it is important to examine the emotions that underlie these matters. Across two studies (one correlational study N = 160 and one experimental study N = 118), we examined participants' experiences of shame and guilt when feeding their baby, and the relationship between these emotions with breastfeeding behaviors and internalized stigma. We also examined the psychosocial factors that predict internalized stigma, and whether shame and guilt mediate these relationships. We focused on three factors that have been shown to be associated with internalized stigma in other domains: self‐esteem and social support (Study 1), as well as self‐efficacy (Study 2). Multiple regression revealed that experienced guilt uniquely predicted a shorter duration of exclusive breastfeeding (Study 1). Higher self‐efficacy (Study 2), self‐esteem, and perceived social support (Study 1) predicted lower internalized stigma of feeding choice. We found that shame was a mediator for the self‐esteem and internalized stigma relationship (Study 1), while guilt was a mediator for the self‐efficacy and internalized stigma relationship (Study 2). Our findings highlight the importance of experienced shame and guilt in mothers' infant feeding experiences. The current results can inform future research and the design of interventions to improve breastfeeding rates and reduce feelings of stigma. [ABSTRACT FROM AUTHOR]

Objectives Women with a BMI ≥ 30 kg/m2 are less likely to initiate and maintain breastfeeding compared to women with a BMI ≤ 30 kg/m2. Reasons for this disparity are not understood. Therefore, this qualitative interview study aimed to learn from women with a BMI ≥ 30 kg/m2 who have breastfed. Methods Eighteen women participated in a semi-structured telephone interview. Participants were required to have had a BMI ≥ 30 kg/m2 at the start of their pregnancy, and have breastfed and/or be currently breastfeeding. An inductive thematic analysis was used to analyze data. Results Two themes were identified: 'personal control over breastfeeding behavior' and 'realistic expectations of the breastfeeding journey'. To achieve their breastfeeding goals, women described the importance of feeling in control of their behaviors, and having realistic expectations, when facing social and practical barriers. They gained this control and formed realistic expectations by seeking support and information. In particular, gaining support from other breastfeeding women with a BMI ≥ 30 kg/m2, and information about alternative positioning, and compatible clothing and nutrition helped women to breastfeed. Conclusions for Practice Having adequate information and support in order to feel in control of breastfeeding behavior and form realistic expectations are vital contributors to breastfeeding behaviors in women with a BMI ≥ 30 kg/m2. Future work is necessary to develop suitable interventions and to investigate their feasibility. [ABSTRACT FROM AUTHOR]

Women with a BMI ≥ 30 kg/m2 are less likely to initiate and maintain breastfeeding compared to normal-weight women. Psychological factors have been linked with breastfeeding, but their influence on women with a BMI ≥ 30 kg/m2 experiences needs further exploration. The aim of this study was to investigate whether psychological factors are voiced by women with a BMI ≥ 30 kg/m2, and how these factors influence their breastfeeding. A secondary analysis of eighteen semi-structured interviews with women with a BMI ≥ 30 kg/m2 who had breastfed. Deductive 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/m2 has been developed, and can inform future intervention development. [ABSTRACT FROM AUTHOR]

Objective:The current study aimed to explore student midwives’ awareness, knowledge, and experiences of supporting women with antenatal anxiety (ANA) within clinical practice. Background: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. Methods: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. Results:Thematic analysis of the seven interviews revealed four overarching themes:Perpetuating factors,Barriers to care,Skills required in roleandSuggestions 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. Conclusion: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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Adolescent gambling can lead to significant harms, yet participation rates continue to rise. Interventions targeting gambling reduction have been implemented in this population. However, it is not clear which behavior change techniques (BCTs) and modes of delivery (MOD) are most effective at reducing gambling. Objective: The objective of the study was to identify 'promising' BCTs and MODs by systematically reviewing interventions targeting adolescent gambling behavior. 'Promising' was defined as those present in at least 25% of all interventions and in at least two effective interventions. Methods: Three databases were searched (PsycINFO, Medline, and Scopus) from database inception to May 2021. Interventions were eligible if they were randomized controlled trials; targeting adolescents (aged 10–25 years); and assessing gambling behavior post-intervention. BCTs were identified using the Behavior Change Technique Taxonomy v1. Results: From the initial 3,315 studies, the removal of duplicates and ineligible articles resulted in sixteen studies included in the review. Eleven of these reported successfully reducing gambling behavior. Eighteen BCTs and six MODs were used across the interventions. The BCTs identified as promising were '4.2. Information about antecedents', '4.4. Behavioral experiments', '5.3. Information about social and environmental consequences', and '5.6. Information about emotional consequences'. Promising MODs were 'face-to-face', 'computer', and 'playable electronic storage'. Conclusions: The study reviewed the content of interventions targeting adolescent gambling behavior. Four BCTs were identified as promising and should therefore be adopted in future interventions. To facilitate the delivery of these techniques, the study also identified three promising MODs. Interventions developed using these BCTs and MODs may successfully reduce adolescent gambling behavior. [ABSTRACT FROM AUTHOR]

Background: Around 1 in 150 babies are stillborn or die in the first month of life in the UK. Most women conceive again, and subsequent pregnancies are often characterised by feelings of stress and anxiety, persisting beyond the birth. Psychological distress increases the risk of poor pregnancy outcomes and longer-term parenting difficulties. Appropriate emotional support in subsequent pregnancies is key to ensure the wellbeing of women and families. Substantial variability in existing care has been reported, including fragmentation and poor communication. A new care package improving midwifery continuity and access to emotional support during subsequent pregnancy could improve outcomes. However, no study has assessed the feasibility of a full-scale trial to test effectiveness in improving outcomes and cost-effectiveness for the National Health Service (NHS).Methods: A prospective, mixed-methods pre-and post-cohort study, in two Northwest England Maternity Units. Thirty-eight women, (≤ 20 weeks' gestation, with a previous stillbirth, or neonatal death) were offered the study intervention (allocation of a named midwife care coordinator and access to group and online support). Sixteen women receiving usual care were recruited in the 6 months preceding implementation of the intervention. Outcome data were collected at 2 antenatal and 1 postnatal visit(s). Qualitative interviews captured experiences of care and research processes with women (n = 20), partners (n = 5), and midwives (n = 8).Results: Overall recruitment was 90% of target, and 77% of women completed the study. A diverse sample reflected the local population, but non-English speaking was a barrier to participation. Study processes and data collection methods were acceptable. Those who received increased midwifery continuity valued the relationship with the care coordinator and perceived positive impacts on pregnancy experiences. However, the anticipated increase in antenatal continuity for direct midwife contacts was not observed for the intervention group. Take-up of in-person support groups was also limited.Conclusions: Women and partners welcomed the opportunity to participate in research. Continuity of midwifery care was supported as a beneficial strategy to improve care and support in pregnancy after the death of a baby by both parents and professionals. Important barriers to implementation included changes in leadership, service pressures and competing priorities.Trial Registration: ISRCTN17447733 first registration 13/02/2018. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: The grief associated with the death of a baby is enduring, however most women embark on another pregnancy, many in less than a year following their loss. Symptoms of anxiety and depression are reported to be increased in pregnancies after perinatal death, although effect on maternal stress is less clear. Variation between individual studies may result from differences in gestation at sampling, the questionnaire used and the type of antecedent perinatal death. We aimed to describe quantitative measures of anxiety, depression, stress and quality of life at different timepoints in pregnancies after perinatal death and in the early postnatal period.Methods: Women recruited from three sites in the North-West of England. Women were asked to participate if a previous pregnancy had ended in a perinatal death. Participants completed validated measures of psychological state (Cambridge Worry Score, Edinburgh Postnatal Depression Score (EPDS), Generalized Anxiety Disorder 7-item score) and health status (EQ-5D-5L™ and EQ5D-Visual Analogue Scale) at three time points, approximately 15 weeks' and 32 weeks' gestation and 6 weeks postnatally. A sample of hair was taken at approximately 36 weeks' gestation for measurement of hair cortisol in a subgroup of women. The hair sample was divided into samples from each trimester and cortisol measured by ELISA.Results: In total 112 women participated in the study. Measures of anxiety and depressive symptoms decreased from the highest levels at 15 weeks' gestation to 6-weeks postnatal (for example mean GAD-7: 15 weeks 8.2 ± 5.5, 6 weeks postnatal 4.4 ± 5.0, p<0.001). Hair cortisol levels fell in a similar profile to anxiety and depression symptoms (p<0.05). In contrast, the median EQ-5D index, measuring health status was 0.768 at 15 weeks' gestation (Interquartile range (IQR) 0.684-0.879), 0.696 at 32 weeks' (IQR 0.637-0.768) and 0.89 (0.760-1.00) at 6 weeks postnatal. There was a negative relationship between EPDS and perceived health status.Conclusions: This study demonstrated heightened anxiety and depressive symptoms and elevated cortisol levels in women in pregnancies after a stillbirth or neonatal death which decrease as pregnancy progresses. Further studies are needed to determine optimal care for women to address these negative psychological consequences. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance among women with a body mass index (BMI) ≥ 30 kg m2 are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature that explored the perceptions and experiences of women with a BMI ≥ 30 kg m2 who breastfed. The search identified five eligible papers, and a meta‐ethnographic approach was taken to synthesise the findings. One theme was identified: "weight amplifies breastfeeding difficulties," revealing that women with a BMI ≥ 30 kg m2 experience common breastfeeding difficulties to a greater degree. In particular, women with a BMI ≥ 30 kg m2 struggle with the impact of medical intervention, doubt their ability to breastfeed, and need additional support. These findings can inform understanding of breastfeeding models, future research directions, intervention development, and antenatal and post‐natal care for women with a BMI ≥ 30 kg m2. [ABSTRACT FROM AUTHOR]