title: What helps or hinders midwives to implement physical activity guidelines for obese pregnant women? A questionnaire survey using the Theoretical Domains Framework.
abstract: OBJECTIVE
  to investigate barriers and facilitators to physical activity (PA) guideline implementation for midwives when advising obese pregnant women.
  
  
  METHODS
  a cross-sectional, self-completion, anonymous questionnaire was designed using the Theoretical Domains Framework. this framework was developed to evaluate the implementation of guidelines by health care professionals. A total of 40 questions were included. These were informed by previous research on pregnant women's and midwives views, knowledge and attitudes to PA, and supported by national evidence based guidelines. Demographic information and free text comments were also collected.
  
  
  METHODS
  three diverse NHS Trusts in the North East of England.
  
  
  METHODS
  all midwives employed by two hospital Trusts and the community midwives from the third Trust (n=375) were invited to participate.
  
  
  METHODS
  mean domain scores were calculated. Factor and regression analysis were performed to describe which theoretical domains may be influencing practice. Free text comments were analysed thematically.
  
  
  RESULTS
  192 (53%) questionnaires were returned. Mean domain scores were highest for social professional role and knowledge, and lowest for skills, beliefs about capabilities and behaviour regulation. Regression analysis indicated that skills and memory/attention/decision domains had a statistically significant influence on midwives discussing PA with obese pregnant women and advising them accordingly. Midwives comments indicated that they felt it was part of their role to discuss PA with all pregnant women but felt they lacked the skills and resources to do so effectively.
  
  
  CONCLUSIONS
  midwives seem to have the necessary knowledge about the need/importance of PA advice for obese women and believe it is part of their role, but perceive they lack necessary skills and resources, and do not plan or prioritise the discussion regarding PA with obese pregnant woman.
  
  
  CONCLUSIONS
  designing interventions that improve skills, promote routine enquiry regarding PA and provide resources (eg. information, referral pathways) may help improve midwives' PA advice.
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Queen Victoria Road, Newcastle NE1 4LP, UK; Institute of Cellular Medicine, Newcastle University, 3rd Floor Leech Building, Framlington Place, Newcastle NE" 4HH, UK. Electronic address: Catherine.mcparlin@newcastle.ac.uk.
authors.forename: Catherine
authors.initials: C
authors.lastname: McParlin
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clarke Building, Richardson Road, Newcastle NE2 4AX, UK. Electronic address: Ruth.bell@ncl.ac.uk.
authors.forename: Ruth
authors.initials: R
authors.lastname: Bell
authors.affiliation: Institute of Cellular Medicine, Newcastle University, 3rd Floor Leech Building, Framlington Place, Newcastle NE" 4HH, UK. Electronic address: s.c.robson@ncl.ac.uk.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Robson
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clarke Building, Richardson Road, Newcastle NE2 4AX, UK. Electronic address: colin.muirhead@ncl.ac.uk.
authors.forename: Colin R
authors.initials: CR
authors.lastname: Muirhead
authors.affiliation: Institute of Health and Society, Newcastle University, Baddiley-Clarke Building, Richardson Road, Newcastle NE2 4AX, UK. Electronic address: vera.araujo-soares@ncl.ac.uk.
authors.forename: Vera
authors.initials: V
authors.lastname: Araújo-Soares
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004739:England; D015444:Exercise / Q000523:psychology*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008880:Midwifery / Q000379:methods*; D009765:Obesity / Q000523:psychology; D010353:Patient Education as Topic / Q000379:methods*; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D013222:State Medicine / Q000458:organization & administration; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: Midwives; Obesity; Physical activity; Pregnancy