Optimising physical activity after gestational diabetes: a realist-inspired qualitative study

Gestational diabetes is a type of glucose intolerance that first appears in pregnancy and increases risk of type 2 diabetes 10-fold. Physical activity can independently help manage this risk. However, for many women physical activity levels tend to decrease from pre-pregnancy to postpartum. Lifestyle interventions and programs including physical activity which aim to reduce risk of type 2 diabetes do not address the unique barriers impacting a mother’s ability to participate. Additionally, where meaningful changes in weight and other lifestyle behaviours such as diet are seen, physical activity remains unchanged. How to optimise physical activity after gestational diabetes remains unknown. The thesis includes two separate systematic literature reviews and two qualitative studies with primary data collected regarding 1) women who have had gestational diabetes and 2) other stakeholders. A Patient and Public Involvement group was initiated, maintained and was used to inform the direction of the work, refined resources for the primary studies and had final input on the recommendations developed. A realist-inspired approach was adopted, and theories were developed through iterative rounds of refinement, with a pragmatic lens. The Socio-Ecological Model was used as an underpinning theoretical framework throughout the thesis. Use of the Socio-Ecological Model allowed exploration of what could work and why, identifying factors for intervention at all levels including individual, social, organisational, community and policy. The main findings highlight the complexity in aiming to optimise physical activity at this life stage, emphasising the need for multi-level solutions. Specifically, co-locating childcare with physical activity opportunities, access to activities in local spaces and ensuring access is flexible and tailored to individual needs is important. Support for women who have had gestational diabetes also needs to be improved. For example, through improving continuity of care and connecting women to existing resources which may be useful, such as exercise referral schemes.