Katie Edwards


Using mHealth to support weight management among women with history of gestational diabetes: a mixed methods study Katie Jane Edwards Background: Women who experience gestational diabetes mellitus (GDM) are at significant risk of developing type 2 diabetes and recurrent GDM in subsequent pregnancies, particularly if they are overweight (body mass index (BMI)>25) or obese (BMI >30). Prevention of chronic disease in this population is of major public health concern, but formalised support in the UK is disjointed and limited. Women face considerable barriers to maintain motivation when undertaking and sustaining weight management, despite desires to improve their health. Motivation is a predictor of long-term weight loss; however, few interventions focus on providing women with prior GDM motivational support. A newly developed intervention, Functional Imagery Training (FIT), aims to strengthen motivation using goal-related mental imagery. Evidence suggests FIT holds promise as an effective weight management intervention and it has been translated into an app, FITZ. However, the effectiveness of delivering FIT via mobile app remains unclear, as do the intricacies of implementation among women with history of GDM. Research question: Could a motivational mHealth app (FITZ) be a needed, acceptable, and feasible weight management intervention for women with history of GDM? Aim: Motivated by identified gaps in knowledge, the aims of this project were twofold: 1) to better understand the need for, and the role of, mHealth to support women with a history of GDM following birth and 2) to explore, among key stakeholders, the feasibility and acceptability of the FITZ app as a potential weight management intervention for women with history of GDM. Methods: This project was underpinned by the pragmatist paradigm and incorporated mixed methods over two phases. Seven individual studies were undertaken using a scoping review, surveys, semi-structured interviews, feasibility assessments and a co-production workshop. Results: Few mHealth interventions exist for supporting women to manage their health following a pregnancy complicated by GDM. Few interventions were guided by behavioural theory and only a limited range of behaviour change techniques were incorporated. Women highly valued the use of social media, but health care professionals (HCPs) were reluctant to recommend this as a source of credible information due to lack of governance and fear of misinformation spread. Women found existing behaviour change apps did not meet their needs and few mHealth resources were recommended by professionals. Women and their HCPs expressed desire for motivational support to achieve a healthy next pregnancy and beyond. The concept of FITZ aligned with women’s goals and the barriers they experienced in achieving them. The app was perceived as useful by some women who tried it and most HCPs answering a survey. Nevertheless, women and HCPs recognised significant limitations that would impact engagement and implementation. Suggestions for adaptions to FITZ to maximise impact included adapting and tailoring content, integrating FITZ with other programmes, and incorporating peer support. Conclusion: The findings from this project suggest current mHealth interventions require a broader focus to meet women’s motivational and peer support needs. mHealth interventions underpinned by behaviour change techniques, such as FITZ, hold potential to provide women with history of GDM a highly scalable weight management intervention that aligns with their goals and addresses their unique barriers, following birth. To optimise penetration, implementation and participation among this population, adaption is required to include tailored content and peer support. Future iterative development should involve co-production with key stakeholders and taking advantage of the online spaces women already use and value, such as social media.

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