A total of ten pregnant women with a pre-pregnancy BMI ≥ 25 kg/m2 and aged between 23 and 41 years participated in this study. All were first-time mothers in gestation week 20 or more. Participant characteristics are presented in Table 2.
Table 2
Participant characteristics
Identifier
|
Ethnicity
|
Age
|
Employment/education
|
ID1
|
Turkish
|
33
|
Medical laboratory technologist
|
ID2
|
Danish
|
23
|
Nurse student
|
ID3
|
Danish
|
41
|
Doctor
|
ID4
|
Danish
|
30
|
Kindergarten teacher
|
ID5
|
Danish
|
28
|
Media and communications student
|
ID6
|
Danish
|
26
|
Social worker
|
ID7
|
Danish
|
28
|
Unemployed
|
ID8
|
Danish
|
33
|
Teacher
|
ID9
|
Romanian
|
34
|
Health professional
|
ID10
|
Danish
|
24
|
Nurse student
|
We identified three main themes from the interviews: (i) a need for clear and specific action-oriented knowledge, (ii) difficulties navigating a complex health system, and (iii) difficulties reconciling conflicting information and options.
The need for clear and specific action-oriented knowledge
Pregnant women are motivated to search and consult multiple sources of information. They understand the general health information provided by health professionals and feel well-informed about general health recommendations.
“I am a bit of a tech nerd. I frequently use apps, the internet and social media. For example, I use Emento a lot.” ID5
“I think they’ve done a good job informing me. Initially, they said do you know Emento (app)? I think the amount of information I received has been sufficient. Not overwhelming. “ ID1
Although participants reported receiving sufficient advice from health professionals, feeling well informed, and utilising multiple sources of information, they struggled to translate general health information into healthy everyday-life behaviours.
“I missed receiving a few proper recommendations about things. I don’t know if I should just rely on my commonsense or what. I didn’t receive more specific information. I had to search all kinds of blogs, web pages, etc. But it could be something directly from the health authorities or the health professionals, e.g. the physician or midwife.” ID7
“I think that recommendations have been very general – including recommendations for daily exercise. You then have to find out which kind of exercise you need, and that’s not very specific.” ID6
Hence, participants’ knowledge was not necessarily reflected in their behaviour, and they expressed a need for more specific action-oriented knowledge. For example, ID2 explains that, despite knowing that physical activity is recommended during pregnancy, her husband’s daily use of their only car limits her options for accessing physical activity classes, courses or locations. We also identified a need for specific information about which types of physical activity are suitable during pregnancy and how best to undertake them.
“When I cannot go for a walk or bike ride due to back pain, what should I do then? “ ID4
“I feel left alone with this part. I have to find out on my own what works for me. Especially during pregnancy. What exercise am I supposed to do? “ ID8
The receipt of test results is another example of the gap between the information provided by health professionals and pregnant women’s ability to receive, understand and apply it. Participants receive information from health professionals about their BMI status and glucose tolerance but are unsure how to understand and respond to these details. Aware that these results might negatively influence both their own and their child’s health but unsure how to positively change their behaviour, they require more support and guidance from health professionals.
“When they told me that my BMI was already too high at the beginning of my pregnancy, I was surprised they didn’t offer any recommendations for improving it. Should I be more careful about what I eat? I know that some women gain a lot of weight [...] – should I have eaten in a different way? Should I have been more careful? Should I have exercised more?” ID9
“Mostly related to my result on the glucose tolerance test. They didn’t clarify its meaning. They didn’t explain the result, but wrote that I should be attentive to diet and physical activity. I thought that it would be nice to receive some explanation. Is it because I’m at risk of diabetes during my pregnancy? It would be nice to receive some more information.” ID8
ID8 expresses a need for further explanation with a personalised “how-to” focus, illustrating a desire for a more precise explanation of what such results mean for pregnancy and everyday life and whether or not there is a need to change behaviour accordingly.
In summary, there is a gap between pregnant women’s knowledge and their ability to change their behaviour accordingly, despite their motivation.
Difficulties navigating a complex health system
Participants described positive experiences using the Emento app, which guides and supports pregnant women in navigating health services during pregnancy. However, participants also described difficulties navigating booking systems and understanding when and how to book particular types of appointments, which they experienced as barriers to fully utilising antenatal services.
“I think that it could be easier to navigate the booking system, or perhaps we could be given better instructions for using it.“ ID4
“It’s been unclear sometimes whether I should book appointments myself or wait to be invited. An example is my glucose tolerance test; I had to figure out whether it would happen at my doctor’s surgery or the hospital. I asked if I should book the appointment myself, as I hadn’t received any information about it.” ID9
“A guide or timeline that explained what I was supposed to do in which week would have been beneficial for me. I’m sure that such a guide exists. I just didn’t receive one.” ID10
These examples suggest that the organisation of antenatal appointments is not always adequately managed by the clinic or other health professionals. Such ambiguity presents a challenge for pregnant women, who feel responsible for booking appointments and utilising available services at the right time via a navigation process that is not transparent for them.
In summary, participants described difficulties successfully navigating antenatal booking systems and services. Therefore, not all pregnant women can meet navigation requirements, leading to uncertainty and disorientation. Participants expressed a need for health professionals to accommodate their navigation barriers and help them manage their pregnancy course.
Difficulties reconciling conflicting information and options
There is a wealth of conflicting advice about how to behave “correctly” during pregnancy. Participants reported receiving numerous different opinions from their social network, family, health professionals and via social media.
“There are many different opinions about how you should behave when pregnant. You should do this and that.“ ID6
Pregnant women’s ability to critically navigate conflicting advice and recommendations is therefore essential. However, even pregnant women with a health professional background might find such conflicting information challenging.
“Even as a health professional myself, I find it hard to navigate.” ID3
Pregnant women encounter many different health professionals during their pregnancy. Participants described challenges in knowing whom to seek clarification from about conflicting information.
“They say that you should just ask your midwife, and I think to myself, ‘who is that?’” ID5
Uncertainty about whom to ask for advice about conflicting information presents a challenge for pregnant women. The above example suggests that ID5 encountered numerous midwives during her pregnancy but did not feel she had a relationship with any particular midwife. Confusion about which midwife to ask may impact a woman’s ability to interact with health professionals when necessary.
Some participants’ experiences suggest that the various antenatal health professionals they interact with are not adequately collaborating and communicating with one another.
“I explained to my physician about the test my midwife performed, but I don’t think she had any understanding of it. It was as if she didn’t know about the test.“ ID2
The Covid vaccination is an example of a topic that participants felt particularly conflicted over. Even though their health professionals recommended the vaccination, they reported strong and conflicting opinions from their family and social network.
“I have many family members who are against vaccination. I cannot decide what is right or wrong.” ID6
“Then a family member sends you 10,000 posts and pictures about the side-effects of vaccination.” ID1
These accounts suggest that family members’ opinions may significantly influence pregnant women; they are unsure whether to trust information received from health professionals if it conflicts with the opinion of one or more family members.
However, others report that they reconcile such contradictions by trusting information received from their health professionals. Hence, not all participants experienced the same level of struggle in response to conflicting advice. This difference may suggest different levels of health literacy among pregnant women.
“I think you should distinguish between the information you receive from a health professional and, for example, the information you receive from your friend about her opinion on something.” ID3
“When it is from my social network, I am friendly and say that it was nice of them to share, but I don’t immediately believe it as others might do. I consider it critically before I make any decisions.” ID2
Contradictions between the advice offered by health professionals versus that offered by family, friends or social media present a clear challenge for pregnant women.