Barriers and Enablers in the Implementation of Physical Activity Improvement for Pregnant Women With Gestational Diabetes Mellitus: A Mixed‐Methods Study

ABSTRACT Aim To identify the barriers and enablers in the implementation of evidence‐based physical activity (PA) programmes for the improvement of health outcomes among pregnant women with gestational diabetes mellitus (GDM), and to develop strategies for implementing this evidence in clinical practice. Methods A convergent mixed‐methods study was conducted, integrating a descriptive qualitative research design with a cross‐sectional survey. In‐depth interview was used to collect the views and cognitions about physical activity from medical staff, leaders and pregnant women. The qualitative data was analysed using directed content analysis, guided by the Ottaw Model of Research Use (OMRU). A self‐designed questionnaire, which was based on the current best evidence for physical activity during pregnancy, was administered to gather data regarding nurse’ knowledge of physical activity (PA safety, managing blood glucose with PA, etc.), their management practice (timing of assessments, provision of information, etc.), as well as the knowledge levels of physical activity among pregnant women with GDM (principles of exercise, PA precautions, etc.). Results A total of 12 medical staff members and 14 pregnant women were interviewed. Ten nurses and 102 pregnant women with GDM completed the questionnaire. We generated 12 subthemes organised within three themes of the OMRU from the data, including insufficient professional autonomy, positive attitudes towards evidence implementation, shortage of nursing staff, implementation climate, etc. The average knowledge score of physical activity among nurses and pregnant women was 5 (SD 2.36) points and 5.2 (SD 1.70) points, respectively. Ten strategies for overcoming barriers and amplifying enablers for the implementation of the physical activity improvement programme for pregnant women with GDM, under the guidance of the OMRU were constructed. Conclusion An accumulation of evidence, adopters and practice environment factors across the OMRU domains explains why physical activity improvement initiatives for pregnant women with GDM are hard to implement. Impacts This study helps to recognise barriers and facilitators to physical activity improvement particularly at the evidence, potential adopter and practical environment level. Patient Healthcare workers (doctors, nurses, etc.) and pregnant women with GDM in a university hospital located in Sichuan Province.