Knowledge, beliefs and experience of adopting healthy habits in pregnancy: a mixed methods study

BACKGROUND: Early life exposures affect a child's obesity risk. The EARLY START uses participatory action research to develop an intervention for reducing early life obesogenic exposures. The initial phase uses a mixed methods approach to investigate pregnant mothers’ knowledge, beliefs, and experience of adopting healthy dietary and physical activity (PA) habits. METHODS: Cypriot pregnant women in 2021 completed a web-based questionnaire on: a) Adherence to Mediterranean diet (MD) (MEDAS tool); b) knowledge, beliefs on diet and PA. A subgroup participated in a structured focus group discussion of their experience/needs in adopting healthy habits. Data were analyzed using Descriptive and Thematic Content methods. RESULTS: Ninety-seven women participated, 73% <35 y.o., 49% primigravida, 92% with tertiary education. Adherence to MD was moderate (median 6/14, IQR 2.5), 90% were eating <3 portions of fruit/vegetables daily, 50% believed their diet was healthy and did not change habits in pregnancy. Most had access to information (94%), internet was the commonest source (74%), and the doctor the most trusted (47%). Mild and moderate-intensity PA were considered appropriate by many (60%) for the first and second half of pregnancy, respectively. Most (90%) were aware of the risks of excessive weight gain in pregnancy. Qualitative analysis showed that women value diet as “the main driver to holistically achieving a healthy pregnancy”. The main barrier was the “struggle between the will and ability”. PA was considered a “therapy” but the challenge was “to achieve the right balance”. Internet was described as “accessible but unreliable information source”. Women believed that needs can be met by “early, holistic recommendation-based interventions run by professionals”. CONCLUSIONS: A huge gap exists between knowledge, beliefs, and practice of healthy behaviours in pregnancy. New interventions should meet gaps and needs using contextualized, timely, holistic, and reliable approaches. KEY MESSAGES: Exploring knowledge and experience of healthy habits in pregnancy as part of participatory action research in shaping an obesity prevention intervention revealed important gaps and unmet needs. Future interventions should holistically address knowledge gaps and behavioral change needs using contextualized, timely, holistic and reliable information and methods.