Background: Overweight and obese pregnancies are a growing health concern with long-term maternal and child health implications. Current interventions reflect few successful results in meeting or maintaining gestation weight gain guidelines in this population. Motivation represents a factor shown to impact health behavior modification in relationship to diet and exercise, resulting in improved weight management.
Aims: The goal of this study is to examine factors influencing motivation reported by overweight and obese pregnant women to embrace healthy behaviors during pregnancy. The specific aims include to: 1) Determine obese and overweight pregnant women’s perceived motivation 2) Examine the influence of perceived competence, autonomy support in the health care climate, relatedness, and attitude toward weight gain in pregnancy on motivation 3) Examine motivation in relationship to other factors, i.e. parity, age, marital status, employment status, ethnicity, planned or unplanned pregnancy and BMI 4) Ascertain an in-depth knowledge of obese and overweight pregnant women’s perceptions of motivation and healthy behaviors.
Methods: This research used an embedded mixed methods descriptive correlational comparative design. Five Likert scale instruments were used to measure the quantitative data including four instruments developed using the Self-Determination Theory including, the Basic Psychological Needs scale, the Health Care Climate scale, the Perceived Competence scale, and the Self Treatment Regulation scale; the Attitudes Toward Weight Gain in Pregnancy scale represents the fifth scale utilized. Recorded semi-structured interviews ensued over 20-40 minutes to acquire qualitative data using an approximate 20% subset of the overall sample.
Data Analysis: Quantitative analysis included descriptive statistics and correlations to look for significant relationships between the independent variables and the dependent variable motivation. Multivariate multiple regression was used to demonstrate the strongest predictors. Qualitative analysis included categorization and coding of the audio text, finding themes among the participants’ stories, and extracting direct quotes to support findings.
Results: The sample included overweight and obese (n=80)women with singleton pregnancies, 16 of which participated in semi-structured interviews. The sample consisted of 34% overweight and 66% obese, 45% primiparous and 55% multiparous, 35% white, 55% A.A., and 10% other ethnicity, 52% married, 49% had a college degree, 78% were employed, and 62% had a planned pregnancy. Findings indicatethe mean on a scale of 0-6 for the dependent variable Relative Autonomous Motivation Index related to diet was 3.092 and Relative Autonomous Motivation Index related to exercise was 3.335. These two dependent variables are significantly correlated with each other and with a number of independent variables. A significant (p =/< .05) positive correlation was found between autonomous motivation related to diet and autonomy, competence, perceived competence, and attitude toward weight gain. Moreover, a significant (p =/< .05) positive correlation was found between autonomous motivation related to exercise and autonomy, competence, relatedness, perceived competence, and attitude toward weight gain. No significant correlation was found between BMI and motivation, autonomy, competence, relatedness, perceived competence, and attitudes toward weight gain.
The healthcare climate related to exercise is significantly correlated to exercise motivation, however there is not a correlation between the healthcare climate and diet motivation. Content analysis from the interviews revealed four themes, support, time, need for accurate information, and doing what is best for the baby.
Discussion: Overweight pregnant women have indicated they are motivated toward healthy behaviors, perceive themselves as competent, and have positive views of their providers and weight gain during pregnancy, however this does not translate into healthy weight status during pregnancy. Further research needs to identify the disconnection in order to create effective and sustainable interventions to achieve healthy pregnancy weight.
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