Exploring fear in healthcare and physical activity engagement: perspectives of culturally diverse pregnant women, mothers, and health professionals

MovingthroughMotherhood, a multidisciplinary research group, held workshops with mothers who emphasised the influence of fear on pregnancy and physical activity (PA) behaviours on culturally diverse women. There is large cultural diversity amongst pregnant women and mothers. Roughly 29% of 600,000 births in England and Wales were to non-UK born mothers in 2020, and consequences of pregnancy for ethnic minority mothers include increased risk of gestational diabetes mellitus and obesity postpartum. Anatomical changes and requirements of motherhood can lead to fear of judgement and PA concerns. PA is known to improve the pregnancy experience for most women, but less than 11% of expectant mothers meet PA guidelines, and limited research prioritises ethnic minority mothers' narratives of socio-cultural discourses impacting PA participation. A barrier to being active is likely to include unclear information provided by healthcare professionals leading to fear. Ethnic minority women are also most likely to report being physically inactive, concerning when previous findings have shown their perceptions of health services to be culturally incompetent for PA provision.

The interdisciplinary project aims to identify cultural differences in women's experiences of PA and fear during pregnancy and understand how more women can be supported. It will collaboratively address imbalance of knowledge with under-represented women and health care professionals, progressing and straddling the strategic priorities of the ESRC (Equality, Diversity, and Inclusion) and MRC; a cross-council project. An interdisciplinary approach is critical to understand how the NHS can effectively support wellbeing and appropriate physical activity of women through pregnancy and beyond, by drawing on knowledge and research methods from public health, psychology, and sociology.

Research questions
What are the differences in women's PA and healthcare experiences across cultures?

How does fear differ across ethnic groups and between different PA levels? When do these fears usually occur?

How does the relationship with key NHS stakeholders of culturally diverse women impact their fear, perceptions, health behaviours, and care?

Collaboration
Royal United Hospitals NHS Maternity department will provide allied health care professionals for recruitment, a placement to map maternity care and provide links to policy makers.
Black Mother's Matter, a national group, will provide mothers for recruitment, support research question design, and provide a placement.
Dope Black Moms are a local community group in Bristol, involved in co-producing research questions and recruiting mothers.

Methods
The project will use a mixed-methods (quantitative and qualitative) approach of data collection (work packages 1-4), and analysis. The procedures will be influenced by key theoretical frameworks: Psychological Empowerment, Self-determination Theory and Fear of judgment.

Work package 1: Scoping review
Summarising the evidence relating to women's experiences and physical, psychological, and behavioural consequences of fear during pregnancy.

Work Package 2: Diaries
Exploring fear experiences on PA, of culturally diverse mothers and key health professionals, over 1-2 months. (Qualitative analysis- manual and NVivo). Participants: Culturally diverse pregnant women and key health professionals (10-20).

Work Package 3: Semi-structured interviews and focus groups
Extending on diaries. A verbal discussion drawing out possible cultural differences in personal experiences. (Qualitative analysis- manual and NVivo). Participants: Work package 2

Work Package 4: Survey
Testing the relationship between fear, motivation, psychological health, and wellbeing across cultures in southwest. Survey co-produced with previous participants and distributed online to pregnant women, mothers, health professionals. (Quantitative SPSS analysis)