Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2024

Open Access 01-12-2024 | Research

A cross-sectional analysis of factors associated with the teachable moment concept and health behaviors during pregnancy

Authors: Linda M. Uzan, Michelle Brust, Joyce M. Molenaar, Eva Leistra, Klarke Boor, Jessica C. Kiefte-de Jong

Published in: BMC Pregnancy and Childbirth | Issue 1/2024

Login to get access

Abstract

Background

Pregnancy is often associated with a change in health behaviors, leading some to suggest that pregnancy could be a teachable moment for lifestyle change. However, the prevalence and underlying mechanism of this phenomenon is not well understood. The aim of this study is to explore the prevalence of a teachable moment during pregnancy, the psychosocial factors that are associated with experiencing such a moment, and its association with actual health behaviors.

Methods

In this cross-sectional study, 343 pregnant Dutch women completed an online questionnaire. Participants reported on their intentions to change lifestyle due to pregnancy, their current health behaviors, and several psychosocial factors that were assumed to be linked to perceiving a teachable moment during pregnancy: perceived risk, affective impact, changed self-concept, and social support. Multivariable linear and logistic regression were applied to the data analysis.

Results

Results demonstrate that 56% of the women experienced a teachable moment based on intentions to change their health behavior. Multivariate regression analyses revealed that changed self-concept (β = 0.21; CI = 0.11–0.31), positive affect (positive β = 0.28; CI = 0.21–0.48), and negative affect (β = 0.12; CI = 0.00-0.15) were associated with higher intentions to change health behavior. Conversely, more perceived risk was associated with lower intentions to change health behavior (β=-0.29; CI = 0.31 − 0.13). Multivariate regression analyses showed a positive association between intentions to change health behavior and diet quality (β = 0.11; CI = 0.82–1.64) and physical activity (OR = 2.88; CI = 1.66-5.00).

Conclusions

This study suggests that pregnancy may be experienced as a teachable moment, therefore providing an important window of opportunity for healthcare professionals to efficiently improve health behaviors and health in pregnant women and their children. Results suggest that healthcare professionals should link communication about pregnancy-related health behaviors to a pregnant women’s change in identity, affective impact (predominantly positive affective impact) and risk perception to stimulate the motivation to change healthy behavior positively.
Appendix
Available only for authorised users
Literature
1.
Moore TG, Arefadib N, Deery A, West S. The first thousand days: an evidence paper. Parkville, Victoria; 2017.
2.
Gluckman PD, Hanson MA, Beedle AS. Early life events and their consequences for later disease: a life history and evolutionary perspective. Am J Hum Biology. 2007;19(1):1–19.CrossRef
3.
Wilkins E, Wickramasinghe K, Pullar J, Demaio AR, Roberts N, Perez-Blanco KM, et al. Maternal nutrition and its intergenerational links to non-communicable disease metabolic risk factors: a systematic review and narrative synthesis. J Health Popul Nutr. 2021;40(1):20.PubMedPubMedCentralCrossRef
4.
Ribeiro MM, Andrade A, Nunes I. Physical exercise in pregnancy: benefits, risks and prescription. J Perinat Med. 2022;50(1):4–17.PubMedCrossRef
5.
Teede HJ, Bailey C, Moran LJ, Bahri Khomami M, Enticott J, Ranasinha S, et al. Association of Antenatal Diet and Physical Activity-based interventions with gestational weight gain and pregnancy outcomes: a systematic review and Meta-analysis. JAMA Intern Med. 2022;182(2):106–14.PubMedCrossRef
6.
Gutvirtz G, Wainstock T, Landau D, Sheiner E. Maternal smoking during pregnancy and long-term neurological morbidity of the offspring. Addict Behav. 2019;88:86–91.PubMedCrossRef
7.
Cnattingius S. The epidemiology of smoking during pregnancy: smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob Res. 2004;6(Suppl 2):125–40.CrossRef
8.
Nykjaer C, Alwan NA, Greenwood DC, Simpson NA, Hay AW, White KL, et al. Maternal alcohol intake prior to and during pregnancy and risk of adverse birth outcomes: evidence from a British cohort. J Epidemiol Commun Health. 2014;68(6):542–9.CrossRef
9.
Römer P, Mathes B, Reinelt T, Stoyanova P, Petermann F, Zierul C. Systematic review showed that low and moderate prenatal alcohol and nicotine exposure affected early child development. Acta Paediatr. 2020;109(12):2491–501.PubMedCrossRef
10.
McBride CM, Emmons KM, Lipkus IM. Understanding the potential of teachable moments: the case of smoking cessation. Health Educ Res. 2003;18(2):156–70.PubMedCrossRef
11.
Lawson PJ, Flocke SA. Teachable moments for health behavior change: a concept analysis. Patient Educ Couns. 2009;76(1):25–30.PubMedCrossRef
12.
Rosenstock IM. Historical origins of the health belief model. Health Educ Monogr. 1974;2(4):328–35.CrossRef
13.
Cohen DJ, Clark EC, Lawson PJ, Casucci BA, Flocke SA. Identifying teachable moments for health behavior counseling in primary care. Patient Educ Couns. 2011;85(2):e8–15.PubMedCrossRef
14.
Brust M, Gebhardt WA, Numans ME, Kiefte-de Jong JC. [Teachable moments: the right moment to make patients change their lifestyle]. Ned Tijdschr Geneeskd. 2020;164.
15.
Schlossberg NK. The challenge of change: the transition model and its applications. J Employ Couns. 2011;48(4):159.CrossRef
16.
Prinds C, Hvidt NC, Mogensen O, Buus N. Making existential meaning in transition to motherhood—a scoping review. Midwifery. 2014;30(6):733–41.PubMedCrossRef
17.
Crozier SR, Robinson SM, Borland SE, Godfrey KM, Cooper C, Inskip HM. Do women change their health behaviours in pregnancy? Findings from the Southampton women’s Survey. Pediatr Perinat Epidemiol. 2009;23(5):446–53.CrossRef
18.
Olander EK, Darwin ZJ, Atkinson L, Smith DM, Gardner B. Beyond the ‘teachable moment’ - a conceptual analysis of women’s perinatal behaviour change. Women Birth. 2016;29(3):e67–71.PubMedCrossRef
19.
Heslehurst N, Hayes L, Jones D, Newham J, Olajide J, McLeman L, et al. The effectiveness of smoking cessation, alcohol reduction, diet and physical activity interventions in changing behaviours during pregnancy: a systematic review of systematic reviews. PLoS ONE. 2020;15(5):e0232774.PubMedPubMedCentralCrossRef
20.
McBride CM, Puleo E, Pollak KI, Clipp EC, Woolford S, Emmons KM. Understanding the role of cancer worry in creating a teachable moment for multiple risk factor reduction. Soc Sci Med. 2008;66(3):790–800.PubMedCrossRef
21.
McBride CM, Blocklin M, Lipkus IM, Klein WM, Brandon TH. Patient’s lung cancer diagnosis as a cue for relatives’ smoking cessation: evaluating the constructs of the teachable moment. Psychooncology. 2017;26(1):88–95.PubMedCrossRef
22.
Atkinson L, Teychenne M. Psychological, social and behaviour changes during pregnancy: implications for physical activity and exercise. Exercise and Sporting Activity during pregnancy. Springer; 2019. pp. 19–43.
23.
Dunkel-Schetter C, Sagrestano LM, Feldman P, Killingsworth C. Social support and pregnancy. Handbook of social support and the family. 1996:375–412.
24.
Rodriguez A, Bohlin G, Lindmark G. Psychosocial predictors of smoking and exercise during pregnancy. J Reproductive Infant Psychol. 2000;18(3):203–23.CrossRef
25.
Phelan S. Pregnancy: a teachable moment for weight control and obesity prevention. Am J Obstet Gynecol. 2010;202(2):135e1–8.CrossRef
26.
Davis DL, Raymond JE, Clements V, Adams C, Mollart LJ, Teate AJ, et al. Addressing obesity in pregnancy: the design and feasibility of an innovative intervention in NSW, Australia. Women Birth. 2012;25(4):174–80.PubMedCrossRef
27.
Hartley E, McPhie S, Skouteris H, Fuller-Tyszkiewicz M, Hill B. Psychosocial risk factors for excessive gestational weight gain: a systematic review. Women Birth. 2015;28(4):e99–e109.PubMedCrossRef
28.
Lindqvist M, Lindkvist M, Eurenius E, Persson M, Mogren I. Change of lifestyle habits - motivation and ability reported by pregnant women in northern Sweden. Sex Reproductive Healthc. 2017;13:83–90.CrossRef
29.
Atkinson L, Shaw RL, French DP. Is pregnancy a teachable moment for diet and physical activity behaviour change? An interpretative phenomenological analysis of the experiences of women during their first pregnancy. Br J Health Psychol. 2016;21(4):842–58.PubMedCrossRef
30.
Okely J, Mason C, Collier A, Dunnachie N, Swanson V. Diagnosis of gestational diabetes: a ‘teachable moment’. Diabet Medicine: J Br Diabet Association. 2019;36(2):184–94.CrossRef
31.
Okely J, Mason C, Collier A, Dunnachie N, Swanson V. Diagnosis of gestational diabetes: a ‘teachable moment’. Diabet Med. 2019;36(2):184–94.PubMedCrossRef
32.
Brust M, Gebhardt WA, van der Voorde NAE, Numans ME, Kiefte-de Jong JC. The development and validation of scales to measure the presence of a teachable moment following a cardiovascular disease event. Prev Med Rep. 2022;28:101876.PubMedPubMedCentralCrossRef
33.
Heaman MI, Gupton AL. Psychometric testing of the perception of pregnancy risk questionnaire. Res Nurs Health. 2009;32(5):493–503.PubMedCrossRef
34.
Engelen U, Peuter SD, Victoir A, Diest IV, Van den Bergh O. Verdere validering van de positive and negative affect schedule (PANAS) en vergelijking van twee Nederlandstalige versies. gedrag en Gezondheid. 2006;34(2):61–70.CrossRef
35.
Pesonen A-K, Lahti M, Kuusinen T, Tuovinen S, Villa P, Hämäläinen E, et al. Maternal prenatal positive affect, depressive and anxiety symptoms and birth outcomes: the PREDO Study. PLoS ONE. 2016;11(2):e0150058–e.PubMedPubMedCentralCrossRef
36.
Touliatos J, Perlmutter BF, Strauss MA, Holden GW. Handbook of family measurement techniques. Abstracts: Sage;; 2000.
37.
Meijer E, Gebhardt WA, van Laar C, van den Putte B, Evers AWM. Strengthening quitter self-identity: an experimental study. Psychol Health. 2018;33(10):1229–50.PubMedCrossRef
38.
Pedersen SS, Spinder H, Erdman RAM, Denollet J. Poor perceived social support in Implantable Cardioverter Defibrillator (ICD) patients and their Partners: Cross-validation of the Multidimensional Scale of Perceived Social Support. Psychosomatics. 2009;50(5):461–7.PubMedCrossRef
39.
Blumenthal JA, Burg MM, Barefoot J, Williams RB, Haney T, Zimet G. Social support, type A behavior, and coronary artery disease. Psychosom Med. 1987;49(4):331–40.PubMedCrossRef
40.
Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess. 1990;55(3–4):610–7.PubMedCrossRef
41.
Hemsing N, Greaves L, O’Leary R, Chan K, Okoli C. Partner support for smoking cessation during pregnancy: a systematic review. Nicotine Tob Res. 2012;14(7):767–76.PubMedCrossRef
42.
Cohen K, Capponi S, Nyamukapa M, Baxter J, Crawford A, Worly B. Partner involvement during pregnancy and maternal Health behaviors. Matern Child Health J. 2016;20(11):2291–8.PubMedCrossRef
43.
van der Velde LA, Nyns CJ, Engel MD, Neter JE, van der Meer IM, Numans ME, et al. Exploring food insecurity and obesity in Dutch disadvantaged neighborhoods: a cross-sectional mediation analysis. BMC Public Health. 2020;20(1):569.PubMedPubMedCentralCrossRef
44.
Gezondheidsraad. Richtlijnen goede voeding. 2015.
45.
Gezondheidsraad. Voedingsaanbevelingen Voor Zwangere Vrouwen. Den Haag: Gezondheidsraad, Volksgezondheid WeS; 2021.
46.
van Lee L, Feskens EJ, Meijboom S, van Hooft EJ, van’t Veer P, de Vries JH, et al. Evaluation of a screener to assess diet quality in the Netherlands. Br J Nutr. 2016;115(3):517–26.PubMedCrossRef
47.
van Zwicht BS, Crone MR, van Lith JMM, Rijnders MEB. Group based prenatal care in a low-and high risk population in the Netherlands: a study protocol for a stepped wedge cluster randomized controlled trial. BMC Pregnancy Childbirth. 2016;16(1):354.PubMedPubMedCentralCrossRef
48.
49.
Weggemans RM, Backx FJG, Borghouts L, Chinapaw M, Hopman MTE, Koster A, et al. The 2017 Dutch Physical Activity guidelines. Int J Behav Nutr Phys Activity. 2018;15(1):58.CrossRef
50.
Lapadula MC, Rolfs S, Szyld EG, Hallford G, Clark T, McCoy M, et al. Evaluating patients’ and neonatologists’ satisfaction with the Use of Telemedicine for Neonatology prenatal consultations during the COVID-19 pandemic. Front Pead. 2021;9:642369.CrossRef
51.
Chipchase LS, Buttrum PJ, Dunwoodie R, Hill AE, Mandrusiak A, Moran M. Characteristics of student preparedness for clinical learning: clinical educator perspectives using the Delphi approach. BMC Med Educ. 2012;12:112.PubMedPubMedCentralCrossRef
52.
Menard S. Logistic regression: from introductory to advanced concepts and applications. Thousand Oaks, CA: Sage; 2010.CrossRef
53.
MICKEY RM GREENLANDS, THE IMPACT OF CONFOUNDER, SELECTION CRITERIA ON EFFECT ESTIMATION. Am J Epidemiol. 1989;129(1):125–37.PubMedCrossRef
54.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49(12):1373–9.PubMedCrossRef
55.
Bookari K, Yeatman H, Williamson M. Falling short of dietary guidelines - what do Australian pregnant women really know? A cross sectional study. Women Birth. 2017;30(1):9–17.PubMedCrossRef
56.
Bagherzadeh R, Gharibi T, Safavi B, Mohammadi SZ, Karami F, Keshavarz S. Pregnancy; an opportunity to return to a healthy lifestyle: a qualitative study. BMC Pregnancy Childbirth. 2021;21(1):751.PubMedPubMedCentralCrossRef
57.
Lerner JS, Li Y, Valdesolo P, Kassam KS. Emotion and decision making. Ann Rev Psychol. 2015;66:799–823.CrossRef
58.
Shiota MN, Papies EK, Preston SD, Sauter DA. Positive affect and behavior change. Curr Opin Behav Sci. 2021;39:222–8.CrossRef
59.
Van Cappellen P, Rice EL, Catalino LI, Fredrickson BL. Positive affective processes underlie positive health behaviour change. Psychol Health. 2018;33(1):77–97.PubMedCrossRef
60.
Rockliffe L, Peters S, Heazell AEP, Smith DM. Understanding pregnancy as a teachable moment for behaviour change: a comparison of the COM-B and teachable moments models. Health Psychol Behav Med. 2022;10(1):41–59.PubMedCrossRef
61.
Rockliffe L, Peters S, Heazell AE, Smith DM. Factors influencing health behaviour change during pregnancy: a systematic review and meta-synthesis. Health Psychol Rev. 2021;15(4):613–32.PubMedCrossRef
62.
Gupton A, Heaman M, Cheung LWK. Complicated and uncomplicated pregnancies: women’s perception of risk. J Obstetric Gynecologic Neonatal Nurs. 2001;30(2):192–201.CrossRef
63.
Hussien NA, Shuaib N, Baraia ZA, Laradhi AO, Wang W, Zhang Z. Perceived Cardiovascular Disease Risk following Preeclampsia: a cross-sectional study. Healthc (Basel). 2023;11:16.
64.
Lee S, Ayers S, Holden D. Risk perception of women during high risk pregnancy: a systematic review. Health risk Soc. 2012;14(6):511–31.CrossRef
65.
Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324–473.CrossRef
66.
Stockton J, Nield L. An antenatal wish list: a qualitative systematic review and thematic synthesis of UK dietary advice for weight management and food borne illness. Midwifery. 2020;82:102624.PubMedCrossRef
67.
Heaman M, Gupton A, Gregory D. Factors influencing pregnant women’s perceptions of risk. MCN: Am J Maternal/Child Nurs. 2004;29(2):111–6.
68.
69.
Bergner RM, Holmes JR. Self-concepts and self-concept change: a status dynamic approach. Psychother Theory Res Pract Train. 2000;37(1):36.CrossRef
70.
Kearney MH, O’Sullivan J. Identity shifts as turning points in health behavior change. West J Nurs Res. 2003;25(2):134–52.PubMedCrossRef
71.
Thornton PL, Kieffer EC, Salabarría-Peña Y, Odoms-Young A, Willis SK, Kim H, et al. Weight, diet, and physical activity-related beliefs and practices among pregnant and postpartum latino women: the role of social support. Matern Child Health J. 2006;10(1):95–104.PubMedCrossRef
72.
van der Wulp NY, Hoving C, de Vries H. Correlates of partner support to abstain from prenatal alcohol use: a cross-sectional survey among Dutch partners of pregnant women. Health Soc Care Community. 2016;24(5):614–22.PubMedCrossRef
73.
McBride CM, Baucom DH, Peterson BL, Pollak KI, Palmer C, Westman E, et al. Prenatal and postpartum smoking abstinence a partner-assisted approach. Am J Prev Med. 2004;27(3):232–8.PubMed
74.
Brust M, Gebhardt WA, Numans ME, Kiefte-de Jong JC. The COVID-19 Crisis as a teachable moment for Lifestyle Change in Dutch Cardiovascular Disease patients. Front Psychol. 2021;12:678513.PubMedPubMedCentralCrossRef
75.
Solomon LJ, Quinn VP. Spontaneous quitting: self-initiated smoking cessation in early pregnancy. Nicotine Tob Res. 2004;6(Suppl2):203–S16.CrossRef
76.
Sheeran P, Webb TL. The intention–behavior gap. Soc Pers Psychol Compass. 2016;10(9):503–18.CrossRef
77.
Evenson KR, Chasan-Taber L, Symons Downs D, Pearce EE. Review of self‐reported physical activity assessments for pregnancy: summary of the evidence for validity and reliability. Paediatr Perinat Epidemiol. 2012;26(5):479–94.PubMedPubMedCentralCrossRef
78.
Locke A. Putting the ‘teachable moment’ in context: A view from critical health psychology. J Health Psychol. 2022:13591053221101750.
79.
Tuithof M, Siauw R, van Dorsselaer S, Monshouwer K. Factsheet Monitor Zwangerschap en Middelengebruik. Utrecht: Trimbos-instituut; 2017.
80.
Meltzer LR, Unrod M, Simmons VN, Brandon KO, Piñeiro B, Palmer AM, et al. Capitalizing on a teachable moment: development of a targeted self-help smoking cessation intervention for patients receiving lung cancer screening. Lung Cancer. 2019;130:121–7.PubMedCrossRef
81.
82.
White M, Adams J, Heywood P. How and why do interventions that increase health overall widen inequalities within populations? Social inequality and public health. Policy; 2009. pp. 65–82.
83.
Metadata
Title
A cross-sectional analysis of factors associated with the teachable moment concept and health behaviors during pregnancy
Authors
Linda M. Uzan
Michelle Brust
Joyce M. Molenaar
Eva Leistra
Klarke Boor
Jessica C. Kiefte-de Jong
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2024
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-024-06348-8

Other articles of this Issue 1/2024

BMC Pregnancy and Childbirth 1/2024 Go to the issue

Research

Emergency cervical cerclage in delayed-interval delivery of twin pregnancies: a scoping review

Research

Offspring of women with hyperemesis gravidarum are more likely to have cardiovascular abnormalities

Editorial

Fostering the social and physical challenges of female recreational or professional athletes in pregnancy and postpartum

Research

Critical congenital heart disease: contemporary prenatal screening performance and outcomes in a multi-centre perinatology service

Research

Association between maternal health service utilization and under-five mortality rate in China and its provinces, 1990–2017

Research

Two laser-assisted hatching methods of embryos in ART: a systematic review and meta-analysis