“Moving for My Baby!” Motivators and Perceived Barriers to Facilitate Readiness for Physical Activity during Pregnancy among Obese and Overweight Women of Urban Areas in Northern Taiwan

Round 1

Reviewer 1 Report

The qualitative article focuses on the study of a sample of pregnant women in northern Taiwan, at risk of personal health and their fetus, due to their obesity, sedentary lifestyle and low levels of physical activity (PA).

In this regard, I make some observations and observations:

Summary and keywords:

The abstract includes the necessary aspects that determine the general vision of the manuscript, its background, the purpose (objective) of the study, the methods, results and an objective representation that does not exceed the main conclusions.

1. Introduction:

With a broad and understandable context, the importance of the study is highlighted, the purpose of the work and its meaning are defined, reviews are made on the current state of the research field, key and important publications are cited. Similarly, reference is made to the hypothesis that will be tested in the study. The main objective of the work is clear, and the main conclusions are highlighted.

2. Materials and methods:

In this section, the obtaining of the informed consents is confirmed. The method, data and associated protocols are described in sufficient detail. The study also indicates the exclusion of women with clinical diagnoses of depression or psychiatric disorders. Sufficient description facilitates subsequent replication from the published results.

3. Results

The table with the characteristics of the participants facilitates the understanding of the results, as well as the table with the 14 emerging themes that focus on the perceptions, motivation, difficulties and preferences of the women participating in the study. The figure also facilitates and clarifies the concept of preparation for physical activity among overweight and obese women during pregnancy.

The characteristics of the participants, their perceptions of motivation and disposition for physical activity, as well as the procedures, instruments, and data are satisfactorily indicated for their analysis with reference to reliability.

Strategies that have to do with the new lifestyle, communication and support are highlighted, with reference to the high level of motivation of PA for the health of their future babies, to improve delivery and maternal health.

Similarly, barriers and difficulties for PA are evident, specifying in detail some at a personal and social level, such as low support from colleagues and other significant others, as well as at an environmental level, highlighting heat, fatigue and daily work. among others.

The manuscript adequately details the need for advice, motivation and support to promote PA in the sample group. It is necessary to highlight the two-way communication style, the personalized attention and assistance of the experts, the elimination of personal and environmental barriers, to design a customized physical activity program.

It is evidenced in the qualitative study how pregnant women show empathy, share their emotions, joys, worries, frustrations and negative experiences.

4. Discussion

Results, findings and implications are discussed in a broad context and interpreted in perspective with previous studies: preparation for action, counseling on PA, etc.

It is satisfactorily reported on the increase in motivations, seeking the well-being and benefit of the health of the fetus, the control of gestational weight gain and the safety of a smooth delivery. It is reported that the greater the preparation for the control of gestational weight, the greater the motivation for PA. This highlights the importance of facilitating preparation for the activity.

It is indicated that social support is another great facilitator for action with FA, in the influence of their partners, family, friends and other sources and media. In free time, this social support and other relevant contexts are perceived more.

Barriers to physical activity for pregnant mothers are discussed, keeping quite in line with those of other studies. They refer to internal barriers (physical and psychological impediment) and external barriers (work, family, time and environmental situations). These barriers are revealed to be universal, cross-cultural, and multifaceted. To achieve the promotion of physical activity in this group, it is necessary to apply the WHO strategy by training all women during pregnancy.

The strengths of the study are highlighted: qualitative design, emerging issues and its theoretical approach; strategies for developing effective intervention programs; the technological training of the participants, etc.

The limitations of the work are listed, as well as the possibility of continuing the research with qualitative studies that help with the precision and communication necessary to build an accumulated evidence base.

5. Conclusions

It is concluded by pointing out that low levels of PA are a health problem among women with a sedentary lifestyle and overweight during pregnancy, associated with an increased risk of complications in maternal and fetal health, as a hypothesis test. Little is known about how active lifestyles can be enhanced by these women. Success requires a greater understanding of beliefs, motivations, and barriers to participating in physical activity.

The references seem adequate to me, although there are some self-citations by the authors.

I congratulate the authors for their detailed and clear work, appropriate to the style of the scientific article, providing the knowledge and reports that show the health benefit, through physical activity, of obese pregnant women and their future babies. This will facilitate the development of specific programs for this purpose.

Author Response

Thank you for your valuable time. On behalf of the authors, I have provided point-by-point explanations below to respond to your comments. 

Point 1: The reviewer kindly provided his/her observations, and sections of introduction, materials and methods, results, discussion and conclusion of our manuscript seem to meet the standard and in general, satisfactorily answer to the research questions.

By quoting the reviewer’s final comments, we determine that no changes are necessary. “I congratulate the authors for their detailed and clear work, appropriate to the style of the scientific article, providing the knowledge and reports that show the health benefit, through physical activity, of obese pregnant women and their future babies. This will facilitate the development of specific programs for this purpose.”

Reviewer 2 Report

Moving for My Baby!” Motivators and Perceived Barriers to 2 Facilitate Readiness for Physical Activity During Pregnancy 3 Among Obese and Overweight Women of Urban Areas in 4 Northern Taiwan

The authors explored the motivators and enablers, as well as the perceived barriers to physical activity (PA) participation among Taiwan obese and overweight pregnant women. The study specifically provide qualitative insights into motivators, environmental enablers, and the perceived barriers of PA. Given the low levels of prenatal physical activity across countries, such information is important to guide context-specific interventions during pregnancy and the postpartum phase.

The manuscript is scientifically, well-written and informative.

Only few queries noted, particularly in the abstract.

Abstract

Lines 13-14: “Low levels of physical activity (PA) are of a health concern among high body mass indexes (BMIs) women with a sedentary lifestyle, and being overweight or obese during pregnancy is associated with increased risks of maternal and fetal health complications.” I suggest rephrasing this sentence to read: ….high body mass index of women living a sedentary lifestyle, and are overweight or obese during pregnancy….

Line 19: Delete the word ‘greater; in the sentence. Also, the sentence should read…pregnant women’s decision to engage, or refrain from PA practice.

Line 19: Delete the ‘the total of’. Start the sentence with ‘Thirteen…..

Lines 22-23: The sentence is complex. Break it down. The phrase ‘to inductively categorize’ should be rephrase for clarity.

Line 24: Start the sentence with ‘The findings….Delete “Our qualitative findings”. The study by design is a qualitative study, so there is no need for ….

Lines 26-27: The phrasing “are to be effective focusing” is not grammatically correct.

Line 29: …. “to change”. This is incomplete sentence. What kind of change. Qualify the change.

Introduction

Line 58: “The 2015 guide- 58 lines published by the American College of Obstetrics and Gynecology (ACOG)… I suggest you cite the latest version, which is 2020 ACOG guideline.

Author Response

Thank you for your valuable time. On behalf of the authors, I have provided point-by-point explanations below to respond to your comments. 

 Point 1: In general, the reviewer gave positive feedbacks, “The manuscript is scientifically, well-written and informative.”

 Point 2: We have addressed queries pointed out by reviewer 2, mainly in the abstract.