Preconception and pregnancy: opportunities to intervene
Engaging women through motivational conversations and via a digital platform.
Summary
A design of intervention is proposed that aims simultaneously to engage women through motivational conversations and offers access to a digital platform that provides structured support for diet and lifestyle change.
Background
Recent large scale trials of behavioural interventions have shown that lifestyle support improves maternal diet and physical activity during pregnancy and can reduce weight gain. The LIMIT and UPBEAT trials were each testing the efficacy of using contacts with healthcare professionals during pregnancy to deliver intervention programmes to improve diet and physical activity levels.
What was involved
The proposed intervention aims simultaneously to engage women through motivational conversations and to offer access to a digital platform that provides structured support for diet and lifestyle change.
A set of easily acquired theory-based skills has been developed for health care professionals called ‘Healthy Conversation Skills’. These skills have been designed to support diet and lifestyle change by engaging and motivating hard-to-reach patients and clients during routine brief consultations. Health care professionals such as GPs, practice nurses and health visitors could use the skills to maximise the value of any appointments they might have with women before they become pregnant.
Unlike information and advice-giving, Healthy Conversation Skills training promotes use of open discovery questions, listening, reflecting and goal-setting to enable a woman to reflect on her particular priorities for herself or for a planned pregnancy, and to support her in finding her own solutions to the challenges she faces.
One important advantage of delivering support for health behaviour change through routine health and social care contacts is its capacity to reach women and families living in disadvantaged circumstances, who may be less likely to become involved in interventions offered outside of routine care than more advantaged women.
Once engaged and motivated to change their diets and lifestyles, women are likely to need structured support for making those changes. Given the potential to maximise reach and therefore impact, behaviour change interventions using digital platforms of various types are becoming increasingly common, and recent reviews point to promising results.
Digital interventions, particularly those delivered by smartphone, have the advantage that they are portable, making them useable ‘in the moment’, cheap to deliver and may be less stigmatizing than conventionally delivered interventions.
‘Smarter Pregnancy’ is a digital platform designed specifically to support women prior to conception that generates a personal risk profile for each woman who registers.
It uses this to produce a personal 6 month coaching program which sends up to 3 suggestions per week using text messages which contain tips, recommendations, vouchers, and answers to frequently asked questions.
Every 6 weeks participants complete a short online survey to monitor nutrition and lifestyle changes, and to record pregnancy status, body mass index (BMI), quality of diet and use of the recipes they have received.
Results are fed back to participants throughout, and can be given to the woman’s healthcare professional so that additional preconception and antenatal care can be offered if the participant chooses.
Next steps
Using a digital intervention to support a process of diet and lifestyle change initiated through a ‘healthy conversation’ is mutually reinforcing, both intervention approaches emphasising empowerment and autonomy.
This combined approach may represent one way of providing the population-wide response to the Chief Medical Officer of England’s call for a focus on preconception health, ‘an important newly recognised opportunity for improving the health of the nation’(p.55).
Further information
Reference: Preconception and pregnancy: opportunities to intervene to improve women’s diets and lifestyles