Table 3 Themes and sub-themes mapped to the Theoretical Domains Framework. Solutions to address barriers to the implementation of GWG guidelines are mapped to the COM-B system for behaviour change (COM-B = Capability, Opportunity, Motivation - Behaviour)
From: ‘Weighty issues’ in GP-led antenatal care: a qualitative study
Themes and sub-themes | Barrier ✗ | Enabler ✓ | TDF domain | Possible solution |
|---|---|---|---|---|
THEME 1: Despite low awareness of guidelines, GWG advice is provided Sub-theme: Knowledge of guidelines is low Sub-theme: Providing advice, but only to those who need it most | Knowledge | Capability: Clear GWG guidelines Effective dissemination of guidelines | ||
Despite low awareness of GWG guidelines, GPs provide many women with advice and support regarding weight management in pregnancy. | ✗ | ✓ | ||
THEME 2: ‘I should do this more’ | Social/professional role and identity Beliefs about capabilities/ consequences | |||
General Practitioners considered it their professional role to support women with weight management in pregnancy. | ✓ | |||
Providing GWG advice is often deprioritised in busy consultations. | ✗ | |||
Many GPs said that they would prioritise the provision of advice about this important topic in the future. | ✓ | |||
THEME 3: Lack of everyday resources Sub-theme: Lack of time Sub-theme: Lack of resources Sub-theme: Lack of clear guidance | Skills Environmental context and resources Behavioural regulation | Capability: Clear guidelines Additional training Opportunity: Access to multidisciplinary team and/or practice nurses | ||
Barriers to GPs providing women with weight management advice are national health policy and funding-based. | ✗ | |||
THEME 4: Working ‘against the odds’ at times Sub-theme: Meeting women where they are at Sub-theme: Social environment | Social influences Reinforcement | Motivation: Public health messages that promote the importance of weight management for pregnancy | ||
Women’s motivation and perceptions of weight management in pregnancy, and the broader social environment can be barriers and/or enablers for the implementation of GWG guidelines. | ✗ | ✓ | ||
THEME 5: Optimism and reality | Optimism Environmental context and resources | Motivation: Affirmation in role | ||
General Practitioners generally believe that primary care is an ideal setting to provide GWG advice and that women respond well to the advice they receive. | ✓ | |||
On the other hand, women’s capacity to put the advice they receive into practice is challenged by the broader physical and social environment. | ✗ |