Discussion
obesity, gestational diabetes
OBESITY, GESTATIONAL DIABETES
This paper reports the descriptive results of the GLOWING pilot trial relating to midwives reporting of their self-efficacy, outcome expectancies, intentions and routine behaviours in the context of UK guidelines for weight management during pregnancy. The data reported in this study provide some proof of concept for the evidence-based theoretical models that were developed to underpin the GLOWING intervention. Prior to GLOWING, the evidence-base suggested that health professionals’ low self-efficacy was central to the barriers and facilitators to the implementation of the UK guideline recommendations, and that the majority of barriers were related to the support/intervention-related behaviours. This is reflected in the GLOWING data which demonstrated that, pre-intervention, midwives’ self-efficacy was the lowest scoring construct across all behaviours, and the support/intervention-related behaviours tended to score lower than the communication-related behaviours. The GLOWING intervention was developed to address the evidence-based barriers incorporated in the SCT models. There was a particular emphasis on improving midwives’ self-efficacy for both communication- and support/intervention-related behaviours, but with more focus on the support/intervention related barriers to practice. The descriptive data reported by midwives in the GLOWING pilot trial suggests that there was limited change in self-efficacy for the control arm, whereas the self-efficacy scores increased in the intervention arm and were consistently higher than the control arm post-intervention. This was apparent for both communication- and support/intervention-related behaviours, but more so for the support/intervention-related behaviours. The pilot trial was not powered to be able to detect a significant difference between the intervention and control arms at follow-up or change in self-efficacy from pre- to post-intervention. However, the data are suggestive that the intervention may be impacting on the target construct of self-efficacy, particularly for the support/intervention-related behaviours.The data also suggested a potential ceiling effect for midwives reporting of intention and behaviour constructs for communication-related behaviours. Some of these behaviours (e.g. relating to measuring and discussing BMI at the booking appointment) are now embedded into routine care. The BMI measurement influences the further discussions and referrals required relating to clinical management of pregnancy, such as referral for routine screening for gestational diabetes or consultant obstetrician led care [This paper also reports data on midwives’ beliefs about people living with obesity using the BAOP scale. There was a similarity in pre-intervention BAOP data from midwives in this study (mean score 14.6 SD 5.7) to published data from a general population of UK adults (mean score 14.7 SD 6.7) [Despite the wealth of evidence of the multiple and complex barriers to practice for health professional guideline implementation relating to maternal obesity and weight management practice [There are strengths and limitations to this research. The intervention was developed following a rigorous approach using evidence-based theoretical models. A recent scoping review of implementation interventions in the maternity context identified that out of 158 published studies, only 14 reported the use of a theory, model and/or framework, and these typically guided data analysis or data collection rather than the design of the study [