Table 1 Characteristics of included studies
Authors, year | Country | Article type | Context (i.e., service type/setting) | Healthcare providers included | Clinical population included | Study design, sample size (if applicable) | Data collection type | Major findings | |
|---|---|---|---|---|---|---|---|---|---|
Barriers | Enablers | ||||||||
Atkinson S & McNamara PM. 2017 | Republic of Ireland | Research paper | Hospital | N/A | Postnatal women | Qualitative, 15 consumers | Interviews | A lack of information & support received from healthcare providers; conflicting information; avoidance of communicating about obesity; language used in conversations | Â |
Davis DL, et al. 2012 | Australia | Research paper | Hospital | Midwives | Pregnant Women | Mixed Methods, 17 healthcare providers & 98 consumers | Data audit | Women - reasons for decline: service at unsuitable time/location; lack of childcare to attend service. Midwives: Issue of obesity can be distressing for women to hear during pregnancy; avoiding causing offence; difficulty raising the topic of obesity for midwives who themselves were overweight; lack of transport, childcare and time constraints for women; competing priorities in time-limited consultations; women not concerned about weight status; confidence in providing weight management advice dependant on midwife knowledge. | Midwives: Experience promotes confidence/skills; awareness of service by women; attractive and informative advertising of service promotes maternal request for service. |
Dinsdale S, et al. 2016 | UK | Research paper | Hospital | N/A | Postnatal Women | Qualitative, 24 consumers | Interviews | Inconsistent communication; not being offered weight management services; referral delays; women feeling judged by healthcare providers. | Â |
Fair, FJ et al. 2022 | UK | Research paper | Hospital | N/A | Pregnant women | Qualitative, 13 consumers | Interviews | Lack of specific advice or inundated with too much pregnancy advice; inconsistent advice; lack of understanding about healthy eating; pregnancy challenges (cravings, eating for two, tiredness, night hunger, difficulties exercises); practical considerations (unaware of community-based service, access issues, time pressures with young family); financial difficulties; lack of motivation; happy with current weight; discomfort with being weighed; social isolation; lack of confidence to attend group sessions; lack of respect and feeling dismissed by healthcare providers; too much attention on weight in pregnancy vs. healthcare providers avoiding the issue. | Motivation (self and for baby’s health); electronic information resources; supportive peer environment; supportive / attentive healthcare providers; healthcare providers who proactively addressed weight management; input from multidisciplinary teams. |
Fieldwick D, et al. 2014 | New Zealand | Research paper | Hospital | Midwives | N/A | Qualitative, 12 healthcare providers | Interviews, Focus groups | Lack of knowledge about gestational weight gain, lack of guidelines and consensus for practice and referral; lack of sensitivity around the topic of weight; communication difficulties; cultural difficulties; lack of weight management resources; judgemental attitudes about weight. | Knowledge of gestational weight gain; education; increased referral, and monitoring; continuity of care; maintaining a practical focus; multidisciplinary support; improve access specialists (e/g/. dieticians); clear guidelines. |
Flannery C, et al. 2018 | Combination of countries | Research paper | Hospital | N/A | Pregnant women | Qualitative, 22 consumers | Interviews | Lack of physical skills; lack of information; lack of opportunity to engage in physical activity in pregnancy / hindered by work and family commitments. | Action planning, goal setting and self-monitoring; family and friends’ support. |
Flannery C, et al. 2019 | Combination of countries | Research paper | GP, Hospital | Midwives, consultant obstetricians and general practitioners (GPs) | N/A | Qualitative, 17 Healthcare providers | Interviews | Normalisation of obesity; challenges broaching the subject of weight; shifting the focus to the management of obstetric complications; unclear roles and responsibilities for weight management advice; broader social determinants (e.g., obesogenic food environment). | Â |
Furness PJ, et al. 2011 | UK | Research paper | Hospital, community-based service | Midwives | Pregnant women | Qualitative, 7 Healthcare providers & 6 consumers | Focus groups | Healthcare providers: Lack of Information knowledge, and skills to support weight management. Women: negative self-talk; lack of motivation; lack of social support; stigma. | Continuity of care; supportive and non-judgemental attitudes; social support and interaction with healthcare providers and other pregnant women; opportunities for peer support online and in person. |
Goldstein RF, et al. 2021 | Australia | Research paper | Hospital | N/A | Pregnant women | Mixed Methods, 14 interviews & 49 surveys | Surveys, Interviews | Fatigue, lack of time, lack of motivation. | Developing rapport; receiving clear advice; resources to improve health literacy; family support. |
Hanley, SJ 2021 | UK- England | Thesis | Community (social media recruitment) | N/A | Postpartum Women | Mixed methods, 12 interviews, 27 Questionnaires 10 PPI, | Interviews, Questionnaires, Patient and Public Involvement (PPI) work | Fatigue; lack of advice and support; work commitments; physical constraints; lack of time and finances; concerns about safety of exercise in pregnancy; pregnancy cravings; nausea. | Â |
Heslehurst N, et al. 2011 | UK | Research paper | Hospital | Midwives, obstetricians, dietitians, physiotherapists, diabetes specialist and any other members of staff with a clinical interest in maternal obesity | N/A | Qualitative, 20 Healthcare providers | Interviews, Focus groups | Lack of knowledge about obesity services; information overload; negative perceptions about the feasibility of managing obesity; limited resources; lack of clear guidelines on monitoring weight in pregnancy; difficulties in discussing obesity and risks of complications with pregnant women. | Â |
Heslehurst N, et al. 2013 | UK | Research paper | Hospital, Community based service | Midwives | N/A | Qualitative, 46 Healthcare providers | Focus groups | Uncertainty about effective communication and management; concerns of a negative impact on the midwife-woman relationship; lack of confidence in weight measurement and monitoring; patient refusal to be weighed; lack of training in communication skills, empathy, and weight management support; lack of knowledge about local support services. | Â |
Heslehurst, N, et al. 2014 | UK- but included studies from UK, US, Aus, Japan, Canada, Finland | Systematic review/meta-analysis | Hospital and community-based services | Health care professionals involved in care of pregnant women | Pregnant women | Mixed methods, 25 included studies | N/A | Lack of formal training knowledge, guidelines, skills, and confidence; social influences; lack of resources for weight assessment; avoiding difficult and sensitive conversations; health professionals own weight status, personal experiences; normalisation of obesity; lack of referral/support services; lack of time and finances. | Peer learning to promote consistent practice; women prompting health care professionals for advice and providing feedback on services used. |
Heslehurst N, et al. 2017 | UK | Research paper | Hospital | N/A | Pregnant women | Qualitative, 15 consumers | Interviews | Advice not tailored to consumer’s specific needs | Treatment as individuals rather than the dietitian assuming the consumer’s diet was unhealthy because of their weight; personalized services; having choice and control over changes and setting realistic and achievable goals. |
Holton S, et al. 2017 | Australia | Research paper | Hospital | Midwives | Pregnant women | Qualitative, 2 HEALTHCARE PROVIDERS & 17 consumers | Interviews | Healthcare providers: Lack of weight management resources to assist women; lack of formal training for midwives about caring for pregnant women with overweight and obesity. | Women: preference for midwives to discuss pregnancy weight management; support groups; smartphone weight-tracking apps and web-based resources for supporting weight management. |
Johnson M, et al. 2013 | USA | Systematic review/meta-analysis | General maternity settings, including community health | Healthcare professionals involved in the care of pregnant women | Pregnant women | Qualitative, 17 included studies | N/A | Women: Inconsistent use of advice and information; low health literacy and cooking skills; conflicting advice from families, partners, and healthcare providers; concerns about the safety of physical activity during pregnancy; lack of access to gym classes and outdoor physical activity facilities; pregnancy perceived to be as a socially acceptable excuse to be large; sensitivity and stigma of weight management. Healthcare providers: sensitivity of weight management; lack of knowledge about weight management; lack of continuity of care. | Appropriate access to information and advice; follow-up with the same healthcare providers; personal motivation. |
Kriebs JM. 2014 | USA | Discussion paper | General healthcare system | Hospital, Community based service | Pregnant women | N/A | N/A | Negative attitudes/weight stigma of healthcare providers; healthcare providers concerned about offending women; normalisation of obesity; lack of healthcare provider knowledge; lack of resources for healthcare providers; lack of healthcare provider concern about weight; low motivation of women. | Providing women with information about weight management; access to dieticians to refer women. |
Leslie WS, et al. 2013 | UK | Research paper | Hospital | N/A | Pregnant women | Mixed Methods, 428 consumers | Surveys | Failure to lose weight between pregnancies; lack of time to exercise; lack of access to resources and programs; caring responsibilities | Access to sport/leisure facilities; time off from work to exercise; group sessions; individual clinics. |
MacAulay S, et al. 2019 | UK | Research paper | GP, Community based service, hospitals and local councils | GPs, health service/ hospitals/ local council personnel | N/A | Mixed Methods, 378 surveys 14 interviews | Surveys Interviews | Â | Consumer involvement when planning weight management programs; adequate time, personnel and finances to run programs; adhering to guidelines; increasing confidence and communication skills of midwives to support weight management; healthcare providers having the time and necessary knowledge and skills to provide weight management. |
Macleod M, et al. 2013 | UK | Research paper | Hospital, Community based service | Midwives | N/A | Quantitative, 78 Healthcare providers | Surveys | Perceptions that weight management is not in midwifery scope of practice; competing demands in antenatal appointments; perception that women do not want to address overweight or obesity; sensitivities about discussing weight; lack of knowledge and confidence in weight management. | Referral processes to dietitians; training for midwives to build knowledge and confidence; a bank of weight management resources (written leaflets, web resources and contacts for local community-based groups). |
McCann MT, et al. 2018 | UK | Research paper | Hospital | Midwives | N/A | Qualitative, 17 Healthcare providers | Interviews | Midwives lack the knowledge, expertise, confidence and resources for weight management; normalisation of obesity; lack clinical guidelines; lack of clinical leadership; midwives to recognising weight management in scope of practice; lack of referral pathways to specialists; lack of time in antenatal appointments; concern about offending women; normalisation of obesity. | Â |
Miller M, et al. 2014 | Australia | Discussion paper | GP, Hospital, Community based service, | Midwives, Doctors | Pregnant women | N/A | N/A | Healthcare provider barriers: Lack of time, remuneration and capacity to engage in weight management during antenatal appointments; absence of weight-related policy; lack of weight monitoring & identification of gestational weight gain; limited provider knowledge and inadequate advice on perinatal physical activity; perception that weight status is not important; normalisation of obesity; sensitivity to raising weight issues; weight bias; pessimism about success of weight management Service level barriers: limited demand from women; inadequate consultation time; lack of suitable support staff; lack of low-cost, local referral systems; inconsistency in weight management advice from healthcare providers and other sources; limited continuity of care between hospital, specialist, general practice and public health services. | Pregnancy as an optimal time for health providers to engage women in weight management. |
Patel, C, et al. 2013 | England | Research, Qualitative | Community based service | N/A | Women who declined weight management service during pregnancy | Qualitative, 15 consumers | Interviews | Â | Midwives seen as an appropriate source of information. |
Smith SA, et al. 2011 | UK | Research paper | GP, Community based service | Nurses, Midwives, Doctors, Community service managers, family support workers, staff with a physical activity role, healthcare assistants, leisure centre gym staff, health visitor, teenage pregnancy support worker, project managers, leaders, and co-ordinators | N/A | Qualitative, 30 Healthcare providers | Interviews, Focus groups | Limited services available; financial constraints; environmental factors (e.g. transport); language barriers; lack of women’s understanding/ knowledge about nutrition, physical activity; lack of women’s concern about excessive weight gain in pregnancy; lack of knowledge of service providers for weight management in pregnancy; lack of appropriate specialist services, polices and guidance; financial costs to access services; funding restrictions to offer incentives for weight management; lack of management support within the organisation; lack of guidelines and evidence based information around maternal obesity; bureaucratic issues, such as working hours, reluctance to share information, and a lack of willingness of staff to change practice; time pressures of prioritising workloads; lack of resources such as sufficient manpower, capacity and suitable staff to deliver services; a lack of appropriate facilities such as the venue, location and building facilities. | Using services women already attending to support weight management; pregnancy / postnatal/breastfeeding ideal time to intervene for behaviour change and to engage women with obesity services; continuity of care; flexible access to services; multidisciplinary approach; use of appropriate language when discussing obesity; targeted services for women; group, peer and social support |
Walker R, et al. 2019 | Australia | Research paper | Primary Health Care Setting | General Practitioners | N/A | Qualitative, 20 Healthcare providers | Interviews | Lack of motivation in women; healthcare provider low awareness of guidelines; broader social and physical environment barriers (e.g., women’s capacity to put the advice they receive into practice). | General practitioners considering it their professional role to support women with weight management; prioritising the provision of weight management advice. |
Willcox, JC, 2012 | Australia | Research Paper | Rural and urban hospitals | Midwives | N/A | Qualitative, 15 Healthcare providers | Interviews | Gestational weight gain perceived as a lower priority within time limitations in antenatal appointments; perceptions that excess weight gain was not a significant health issue and women were not interested in weight management; limited education of midwives and lack of confidence in weight management; lack of weight monitoring in practice; limited resources; concern of sensitivities about discussing weight gain. | Midwives’ weight management advice; midwife education and training about weight management in pregnancy. |