(MRC DTP) Development of a theoretical model of ‘teachable moments’ to support lifestyle behaviour change during pregnancy

Pregnancy (and the period shortly afterwards) has been viewed as a ‘teachable moment’. That is, a time when women are particularly motivated to make lifestyle changes e.g. eat more healthily, take up physical activity, stop cigarette smoking, reduce alcohol intake. Additional healthy behaviours are pregnancy-specific (e.g. breast-feeding). The psychological mechanisms involved in making these changes at this time are poorly understood. Emerging evidence reveals healthcare professionals find it challenging to support women to make behaviour changes this time and opportunities to facilitate changes are frequently missed. There is also a lack of theoretical understanding of pregnancy as a teachable moment. Understanding health behaviour change during pregnancy is particularly important for some women as pregnancy may be the only time they engage with health services (e.g. black and minority ethnic groups, those with a low socio-economic status). For these women pregnancy provides a unique opportunity to encourage behaviours that can potentially impact, not only on the health of the mother, but also her family and future pregnancies.
The overall aim of this PhD is to identify mechanisms involved in health behaviour change during pregnancy and produce a clearer theoretical understanding of pregnancy as a teachable moment. During the first year the student will conduct a systematic review to consolidate the existing literature on health behaviour changes in pregnancy and identify psychological components of teachable moments. Informed by this, a longitudinal study will measure social cognition and health behaviours in a large sample of pregnant women and into the postpartum period. A qualitative interview study with women (including different BME and socioeconomic groups) and their healthcare professionals will investigate communication barriers and facilitators to behaviour change in these groups. From the outset a stakeholder group (pregnant women & midwives) will be set up to help develop and refine the research questions and methodologies. Findings will be disseminated to academic and public audiences.
The skills which will be developed include quantitative and qualitative techniques. The project will also provide opportunities for the candidate to engage in inter-disciplinary research (health psychology and obstetrics). The first study will be a systematic review, and depending on the nature and homogeneity of the data will provide training in meta-regression and meta-synthesis. The longitudinal study will provide training in participant recruitment, quantitative methods and advanced statistical techniques (Structure Equation modelling). The final two qualitative studies provide opportunity for the student to develop advanced interviewing and qualitative analytical skills.

In addition, the proposed project will implement patient and public involvement (PPI) and address wider social responsibility issues, such as, the need to engage culturally diverse stakeholders, conduct impactful research and to disseminate findings accessibly and broadly.

Finally, this programme of work will involve developing collaborative skills involving our NHS colleagues which will involve a rigorous understanding of the operation of NHS trusts, and of NHS (DH) priorities from service provision and public health perspectives. In conclusion, the proposed project provides an excellent opportunity for training in the MRC categories of quantitative skills and inter-disciplinary skills.