Handling the challenges of accessing reliable and tailored information on physical activity during pregnancy: a mixed-methods, cross-perspective investigation.

backgroundPhysical inactivity during pregnancy remains a major public health challenge. Although many interventions have been shown to significantly increase physical activity (PA), their real‑world impact remains limited. Healthcare professionals represent a key lever for addressing this challenge, yet PA is still insufficiently promoted despite recognized health benefits. Embedding PA promotion into maternity care, particularly through midwives, appears promising, but how to ensure equitable implementation that supports informed decision‑making in practice remains unclear. This study therefore aims to better understand how behavioral determinants, professional PA promotion practices, and pregnant individuals' characteristics collectively influence decisions to engage in PA during pregnancy and to inform a framework for implementation.

methodsA mixed‑methods study was conducted in two maternity hospitals in Western Switzerland. Ninety‑five pregnant women completed a survey on their perceptions of PA communication across professions, and 16 participated in semi‑structured interviews. Additionally, 19 hospital‑based midwives were interviewed about their practices. Data collected in parallel were analysed separately using descriptive and inferential statistics, and thematic analysis informed by the Theoretical Domains Framework (TDF) and the Capability‑Opportunity‑Motivation‑Behavior (COM‑B) model. Integration of findings occurred after separate analyses using the Pillar Integration Process.

resultsMost participants were in their third trimester (76%), highly educated (79%), and followed by private obstetrician‑gynecologists (82%). Access to PA information often relied on women's own proactivity, with 37% receiving no information and 59% wanting more. Incomplete and non-spontaneous communication across professions negatively shaped women's PA decision‑making due to misbeliefs and negative emotions. Hospital‑based midwives frequently forgot or avoided the topic, especially when unconfident or perceiving low interest, due to limited training, procedures, and resources, contributing to inconsistent and inaccurate PA communication. Together, these insights informed a COM‑B‑based framework designed to strengthen hospital-based midwives' capability, opportunity, and motivation and promote spontaneous PA communication targeting knowledge, beliefs about consequences, and emotion to support tailored decision about PA during pregnancy.

conclusionThis study provides insights into how multilevel determinants shape access to PA information. It presents a theory‑driven framework to guide strategies for integrating systematic, spontaneous, and tailored PA communication into care to support informed decisions to engage in PA during pregnancy.