Table 3 Barriers and facilitators of physical activity (PA) in women with GDM mapped onto COM-B and TDF components & Behavioural analysis and diagnosis of the behavioural sources that contribute to physical activity (PA) in this group

Psychological capability

Information is considered as important, awareness of specific benefits of PA with GDM (Both mother & Baby), (+)

Information can positively influence individuals’ intentions towards maintaining PA (+)

Family/partners understanding of the importance of PA affects the women’s attitudes to PA (+)

Resilience to make change (+)

Lack of knowledge & understanding of what counts towards PA, types of PA & location of specific resources (−)

Fear over safety of activity (−)

Lack of awareness of the implication of being inactive with GDM (−)

Knowledge & understanding decision making

Awareness of specific benefits from a credible source, given permission, support from partner/family

Awareness what activity is safe for them

Self- monitoring, Women expressed interest in goal setting (+)

Behaviour regulation

Physical capability

Effects/Medical conditions of pregnancy & symptoms (nausea, fatigue) (−)

Ability to perform activity due to pregnancy (high risk) concerns (−)

PA can improve physical symptoms (+)

Skills

No change required - the individuals will have the exercise capacity to maintain PA

Social opportunity

Exercise based programmes from Maternity HCP is regarded as safe/supportive as they are associated with the health care system (+)

Support and understanding from HCPs is important e.g. HCPs provide a sense of security/comfort (+)

Maintenance of support from family and friendly is important, e.g. partner provide a sense of solidarity/support (+)

Acceptability & culture of PA in pregnancy, particularly within families (e.g. overprotective) (+/)

Interaction with other pregnant women

Home responsibilities; caring for child or partner limits PA opportunities (−)

Negative pressure/culture from family leads to avoidance of PA (−)

Social influences (Process that can change thoughts feelings or behaviours – social pressure)

Individuals confident with PA programmes

Support from HCP

Physical opportunity

Lack of access to physical activity/leisure (facilitates) (−)

Lack of outdoor space to be space (−)

Lack of time (childcare/work commitments) (−)

Environmental context and resources (persons situation

or environment)

Time, resources and location influence PA choice, affecting behaviour.

Reflective motivation

Belief about capacity ‘time for change’ particularly for the benefit of the baby’) (+)

PA is associated with feeling of guilt or frustration/concerns due to reduce capacity compared to pre-pregnancy, which leads to avoidance of PA (−)

Feeling responsible (+)

Beliefs about capability (acceptance of the truth, reality

or validity about an ability, perceived behavioural

control, self-esteem, confidence)

Self-efficacy influences approach to PA.

Belief about capability toward PA

Increased self-monitoring and feedback

Recognition of improvements through self-monitoring and feedback leads individuals to recognise their capabilities and increase motivation for PA (+)

Goals

Belief that PA is enjoyable and leads to health benefits (+)

Self-efficacy: activity may lead to harm & avoidance of PA (due to health beliefs)

Belief about consequences

Automatic motivation

PA is associated with discomfort/pain, which leads to avoidance of PA (−) (due to negative emotions associated activity)

Establishing a routine (+) and maintaining habits after (+) are important in the maintenance of PA

Pre-pregnancy PA habits (+/−)

Apprehensive of PA in public place (−)

Fear/anxiety based on previous pregnancy/miscarriage _(−)

Emotion

Habits and routines influence behaviour