Not you but WE: Supporting aT-risk women before and dUring pregnancy through an integrateD, autonomy- and identitY-based approach (WE-STUDY)

Noor is a 25 year-old woman with primary school education who became pregnant by accident. She smokes 15 cigarettes a day, and her BMI is 28. Since her partner has left her upon hearing about the pregnancy, she has been feeling very stressed and lonely. Her midwife Bibi is distraught at Noor’s problems and unsure how to discuss Noor’s problems in a way that is positive, motivating and supports Noor’s identity and autonomy. Bibi wonders whether trying to address these problems is worthwhile, as she has negative experiences with attempting to do so. In the WE-STUDY project, we would like to help people like Bibi and Noor to pursue a healthy pregnancy – and prevent negative effects of risk factors on both mother and child – by taking an integrated approach. We aim to empower (pre)pregnant at-risk women to deliver a healthy baby by helping them to achieve a healthier lifestyle. The WE-STUDY will focus on the reduction of overweight, stress, alcohol use, and smoking in women and their partners as these are key modifiable risk-factors for adverse health outcomes in mother and child, in a way that supports the identity and autonomy of the woman and (if applicable) her partner. In close collaboration with women, partners and professionals throughout the project, we will enhance existing interventions for the target group and training materials for professionals by integrating an identity- and autonomy-focused approach; and address socio-economic problems through proactive connections with professional help in the social domain. A major novelty of our approach is that we focus on the woman’s and partner’s identity and autonomy: rather than starting with the risk-factors, we focus on the woman and her partner as individuals, who they want to become as a (new) parent and their values. This is important, as research increasingly shows that behavior change interventions for (pre)pregnant women are not as effective as we would like, and do not sufficiently reach women at-risk. Feeling forced to change behavior is counterproductive while success is more likely when the new, healthy behavior fits the woman’s identity, and when she feels autonomous in her choices. Lastly, the focus on active and warm work relationships and referral networks between the medical and social domain has shown to make a significant difference in the lives of at-risk pregnant women. The project builds on Self-Determination Theory (SDT) and identity theories. SDT is posits autonomous self-regulation and perceived competence as important determinants of health behavior change and its maintenance. Intrinsic motivation (motivated by enjoyment) is the most desired form of self-regulation and facilitates sustainable behavior change. Importantly, SDT states that behavior that fits a person’s identity is the closest one can get to intrinsic motivation. People preferably behave in line with their identity: the core perceptions that we, as humans, have of who we are. Strongly embedded identities provide stronger guides for behavior than for example rational beliefs. However, despite the clear importance of autonomy and identity for (pre)pregnant women and their partners, it is as yet unknown how these can best be integrated in interventions for the target group and training programs for professionals. The project has 2 work packages (WP). WP1 will develop identity- and autonomy-focused intervention and training components, combining existing knowledge and materials with the expertise from our target group and professionals. In Step 1, we will conduct a systematic overview of existing intervention and training programs, available in the Netherlands. In Step 2, we will conduct in-depth interviews with at-risk (pre)pregnant women and partners to gain insight into identity, autonomy, and needs in relation to the risk factors (being overweight, smoking, alcohol, and stress). In depth-interviews and surveys among medical and social domain professionals will show what drives and blocks them in communicating with at-risk women and their partners. In Step 3, we will develop the intervention and training materials in cocreation with (pre)pregnant at-risk women, partners, and professionals, following the Participatory Learning and Action approach and building on Steps 1 and 2. WP2 will evaluate the intervention and training (combining eLearning with a group meeting) programs in a real-life setting, using a pre-post mixed method design in 4 Dutch municipalities with Kansrijke Start coalitions, with a 3-month control period before the intervention and training are implemented, and a 3-month follow-up period afterwards. Outcome measures (client outcomes for mother, partner and child, as well as implementation and service outcomes and its determinants) will be assessed directly after the training and intervention, as well as 3 months later. We hope that our approach ensures that women who most need help receive it; resulting in positive health outcomes for mother and child.