Many mothers with young children often do not achieve recommendations of at least 150-min moderate-to-vigorous physical activity (MVPA) each week. Previous qualitative work has generally focused on getting inactive mothers with young children to be active, so the characteristics of women who are active during early postpartum period are not well understood. This research set out to capture the characteristics of mothers with young children who engage in MVPA and how these women manage barriers and harness enablers to sustain in engagement in physical activity (PA) over an extended period.Thirty-two participants ranging in age from 27 to 42 years (35.2 ± 4.8), with age of their youngest child ranging from 6 weeks old to 5 years, participated in semi-structured interviews. Inductive thematic analysis revealed three overarching themes and fourteen sub-themes relating to the characteristics of active mothers with young children and the engagement and maintenance factors that recruit and sustain these women in group-based physical activity programs. Specifically, mothers with young children relish a welcoming and supportive environment that accommodates babies and young children, is affordable and convenient, focuses on building strength and functionality, and is non-judgmental.These findings advance knowledge by providing considerations and recommendations that support intervention and program designers to be able to develop group-based physical activity programs for mothers with young children. The health benefits of physical activity are well established and include a lower risk of cardiovascular disease, hypertension, diabetes, and breast and colon cancer and positive effects on mental health , 2. DespWomen’s postpartum MVPA trajectories vary; many women decrease MVPA, but some women maintain previous MVPA, and a small percentage increase their MVPA in the early postpartum period . RecentlResearch to date has helped to identify intention and self-efficacy as important constructs to target in interventions, but this literature still contains noteworthy limitations. First, most research has focused on inactive or overweight/obese mothers with young children or with comorbid conditions  , 14. ThiOne important social factor for supporting women with young children is social support , 9. GrouWith these limitations in mind, the purpose of the present study was to use qualitative methods to explore and develop an understanding of (1) the characteristics of active mothers with young children with children aged 0–5 years (defined as the postpartum period in this study); (2) factors that encourage mothers with young children to join group-based PA programs; and (3) factors that sustain mothers with young children’s participation in group-based PA programs. In doing so, the study aims to inform PA policies and support intervention and program designers to be able to develop group-based PA programs for mothers with young children in the future.The research was carried out between September and December 2020 in the surrounding regions of Sydney (including Newcastle and Wollongong) and Wagga Wagga, Australia. Semi-structured interviews were conducted to explore women’s characteristics, views and experiences relating to group-based PA programs during the postpartum period. Individual interviews were conducted using video-conferencing software (Zoom®) or face-to-face in a convenient location for both parties and utilised COVID-safe procedures which were in place at the time . Zoom® interviews were suitable in this population, due to COVID-19 restrictions, as well as being less burdensome for participants who may have found it hard to find the time to attend a face-to-face interview. All interviews were conducted by the first author (LP). Interview recordings were taken using a password-protected mobile phone recording device and saved as an audio (MP3) file. Written informed consent and verbal assent were obtained before each interview. MP3 files were transcribed verbatim by a transcription company and were checked for accuracy by the interviewer and by participants. Ethical approval was gained from the University of Sydney research ethics committee (Ref 2020/540).Women were eligible to take part if they were aged 18 years and over, engaged in a group-based PA program, lived in Australia, spoke fluent English, and had at least one biological child less than or 5 years old before the study recruitment date.https://www.abs.gov.au/websitedbs/censushome.nsf/home/seifahelpansuis).Thirty-two participants ranged in age from 27 to 42 years (35.2 ± 4.8), with age of the youngest child ranging from 6 weeks old to 5 years. Participants were well-educated (71.9% had at least a Bachelor’s degree) and were predominantly of Caucasian origin (84.4%). Two participants identified as Southern European, one as Aboriginal and Southern European, one as Asian, and one as Middle Eastern. Based on suburb postcode, 53.1% of participants lived in a suburb with a mean decile rank that was below the median on the Australian Bureau of Statistics’ Index of Relative Socioeconomic Disadvantage (Most women interviewed had two children (65.6%), followed by three children 18.8%). Five women (15.6%) had one child. Most women were in part-time employment in professional jobs (87.5%), with one woman returning to full-time employment (3%). In addition to employment, two were studying and most were married or living with a partner (90.6%). Two participants had previously competed in elite level sport (6%). Table 8.8%. FivA purposive sampling and variation sampling methods  were useN = 3). Code lists were compared between the two authors (85% agreement), and any discrepancies between codes were resolved by consensus resulting in an initial coding framework. The first author then coded all interview transcripts. This stage involved prolonged engagement with the data, including reading all transcripts, listening to audio files, editing transcripts for accuracy, and then re-reading for immersive comprehension. Deductive codes were created for key concepts from existing theoretical and research literature , and inductive codes were developed in response to patterns identified in the data. Multi-coding of the same text was allowed, where important codes overlapped on the same dialogue. The codes were then grouped according to similarity of topic and used to form potential themes. All authors individually developed theme names that captured all codes included within the theme, with theme names discussed when discrepancies occurred.The interviews were transcribed verbatim, and any identifying information was removed from the transcripts, and participants were assigned pseudonyms. The transcriptions and data were shared and managed via Dropbox. The analysis involved six phases: (1) familiarisation with the data; (2) generating initial codes; (3) searching for themes; (4) reviewing themes; (5) defining and naming themes; and (6) producing the report . InitialThemes presented in this paper focus on describing the characteristics of mothers with young children, their experiences of group-based PA programs, and the features of group-based PA programs that maintain their engagement. The themes are presented as considerations for the design of future PA programs for mothers with young children: Theme 1: Women do not need to have a strong PA history; Theme 2: Engagement factors that recruit mothers with young children into group-based PA programs; and Theme 3: Maintenance factors that sustain mothers with young children’s participation. Table  shaped by past PA behaviours and experiences. Each participant was subject to unique personal experiences relating to birth(s), and this allowed a slow, progressive return to PA (at least 12 weeks post-birth). Interestingly, women in this study were not heavily invested in group-based PA programs prior to bearing children.Participants outlined their engagement in PA before and during pregnancy to determine the role PA played in their lives. Three sub-themes captured the extent of PA variation across the lifespan: (1.1) PA in childhood and adolescence; (1.2) previous group-based PA program experience; and (1.3) birth and health check-ups. Across sub-themes, it was apparent that women’s PA history varied, with some participants n = 12; 38%) represented  in at least one sport, which meant that they engaged in training and games most days of the week. Others were recreational participants who participated a couple of times per week. The types of sport and physical activities varied. Some had been engaged in individual sports such as dance, gymnastics, triathlon, tennis, and swimming; others were engaged in team or group sports such as netball, volleyball, and soccer and a few had been engaged in a combination of both individual and group sports and PA. Vivienne shows her strong intentions for PA throughout adolescence and into early adulthood and how this decreased before having children:Quite high intensity. I would go running. Go to a kickboxing class. Sometimes gym, although I’m more of an outdoor person. Play netball or touch football. That was more when I was younger though, as opposed to probably just prior to having kids.All except two of the participants were engaged in sport and physical activities during childhood and adolescence. Some of the participants mentioned that engagement in sport and physical activities decreased once they finished school (e.g. ‘but when I finished school I stopped…I was not interested’ (Jackie)), started tertiary study ), or when balancing work commitments ). The frequency of participation in sport and physical activities during childhood and adolescence differed among the participants. Some of the participants  seemed to have previous experiences with gym-based activities  during early adulthood after ceasing or reducing sport participation and balancing study/work commitments. Rachel encapsulates this transition from study to work and how she was able to maintain PA through group-based sessions at her workplace gym:So I’ve always been very active and then working at the uni, I’ve always been a member of the uni gym, so I can go into a group activity class at lunchtime…so pretty active when you look at it.Many participants . However, not all were previous group-based PA program participants before having children, and some did not like the gym environment. For example, Louise showed her previous distaste for gyms and group-based PA sessions as she disliked the environment: ‘One, I hated gyms. And two, I could never commit to anything’.Yeah. I took really good care of it and I probably ... I was more cautious. So [name of women’s health physiotherapist] would say, ‘I think you can run now’. And I’d be like, ‘No, another month’. So yeah, I didn’t run for 18 months after he was born. (Jessie)The participants, despite their varied birthing experiences, attended and completed the 6-week health check-ups conducted by their choice of medical personnel . After this check-up, many of the participants started to engage in some type of PA, namely, walking. If the check-up showed that there were still pregnancy or birthing injuries, a few of the women in the study continued with physiotherapy and medical support and were very cautious when returning to PA, particularly in relation to MVPA:n = 3) of physiotherapists in the participant sample. These participants stressed the importance of and the need to extend healthcare after birth and past the usual 12-week period, especially before resuming or starting high-intensity group-based PA programs:I also saw a women’s health physio, before I started in the gym, even though I’m a physio myself. I went to her to get checked over so she could check my level of pelvic activation, and she was happy, she ran through a few tests to make sure that she was happy for me to go back and start in the gym again and I did that at 12 weeks. (Jemma)There were a small number . These are captured in five sub-themes: (2.1) connection; (2.2) family support; (2.3) convenience/location/proximity; (2.4) cost and affordability; and (2.5) welcoming ethos. Across sub-themes, it was apparent that participants who were starting a group-based PA program utilised personal and professional social networks to connect with this new venture and perhaps without this connection would have missed out on this opportunity. It was also interesting that physical, social, and financial barriers relating to starting and sustaining participation in a group-based PA program were overcome, mainly through a welcoming environment, and were not considered an ongoing barrier.n = 27; 84%) noted that it was a significant other in their life that informed them of the benefits of participating in a group-based PA program after having child(ren). The significant other was likely to be a family member, friend, or associate  who knew of, was going to try, or was already a participant of a group-based PA program. For most of these women, it was an important introduction to the program at a time when juggling young child(ren) made it near impossible for them to find the time and the motivation to try a new program by themselves:And [my neighbour] said, you know what, I’ve started going to [group-based PA program name]...There’s a couple of other girls that I’ve just met. It’s a nice way for you to meet people…it was an introduction to a peer group of people and friendships when I was quite lonely and isolated because of little kids. (Vivienne)Most of the participants (The other women resumed participation in group-based PA programs that they were engaged in before having child(ren). Hence, their PA choice was shaped by past PA behaviours, although now needing to be modified due to early motherhood.n = 20; 63%) highlighted those supportive others were also an important key for participation in a group-based PA program. Specifically, these women noted that baby development and routines placed significant demands on their time and limited their participation in regular group-based PA program sessions, but it was usually a supportive family member that put strategies in place to help overcome such obstacles. These included grandmothers babysitting at home when the baby/toddler napped, ‘So my mum actually used to come and let [baby’s name] sleep…and I’d still get to go to the [group-based PA program name]’ (Melanie), and partners staying home or starting work late/leaving work early to accommodate the women’s wishes to get to a session: ‘Because [husband’s name] is such a good support for me, where he will hold back before leaving for work, so that I can get a workout into the day’ (Lottie).Many of the women Family support was particularly important for women that resumed participation in organised, group-based sport that did not cater for babies and young children (e.g. in-built babysitting). These women were extremely appreciative of supportive family members who would attend, watch, and supervise their baby/child(ren), with the acknowledgement that without family support, their participation would be minimised:n = 27; 84%) of the participants’ responses:…but the thing that really drew me in was that there were people there with their strollers. I was like, ‘Yes, I can go and take my baby along with me’. (Sharon)Due to the demands women felt they were placing on family to support their participation in group-based PA programs and the sustainability of this, most women favoured places and spaces that incorporated babysitting and child-minding. This was emphatically emphasised in many  revealed that the location of the group-based PA program was important, noting that their chosen group-based PA program was close to home or in a location where they preferred to be active (e.g. beach). These women mostly expressed a desire to be exercising outside, with their child/ren close by, in which they could easily walk to or commute in a car for a short period of time:I just saw that as a good opportunity for me to be outdoors, at the beach and doing exercise with someone minding the baby. So, it ticked a lot of boxes. (Lucy)I started to look for…like just a mum’s group, like exercise outdoors and I found [name of group-based PA program]. I’s only like a seven minutes drive from home. (Renee)Half of the women’s narratives All women in this study stated that variety was a major factor in joining the group-based PA program, as it allowed for them to work around babies, child(ren), and other professional and personal commitments. They also enjoyed the convenience of having many choices of sessions  and different timing of sessions per day and week or different levels and grades for organised sport:n = 4; 13%) preferred to be active early in the morning, without child(ren) and before the members of their household woke: ‘And this women’s running club just goes at 5:00 in the morning…I didn’t have to organize anybody or ask for help with looking after the kids’ (Claire). Having programs that had scheduled times early in the morning allowed for this to occur and should be considered in future group-based PA programs.Some of the participants Another consideration highlighted by the mothers with young children was the length of the sessions and the need for it to be shorter to ensure that those who brought babies and child(ren) along would be able to do so without interrupting eating and napping schedules. However, these women also clearly communicated that the intensity would need be appropriate for shorter sessions to improve their fitness and strength, as it was paramount that these sessions rebuilt their functional capacity:n = 30; 94%) spoke about the financial costs of participating in group-based PA programs, and that this was an important consideration when joining as most were on leave or working in a reduced capacity . Some of the women explained the need for program designers and trainers to consider no contract, pay-as-you-go options as these allowed mothers with young children the flexibility to not worry about missing a session or week due to baby and child(ren) sickness or other personal and professional commitments:And just the ease of not having that locked in contract, because that’s hard for a parent, especially a new mum to turn off, my baby didn’t sleep or is sick, but I’ve locked myself in and I have to go, because I have spent 50 bucks a week to go. While this way, I turn up and I apologize (if I have missed a session). (Rachel)Many of the women Alternatively, others stated that the contractual costs of a program were suitable by reinforcing that there were many attributes to the program that were included in the membership. These attributes included attending as many sessions as they chose each week, free babysitting/child-minding, and sharing the membership with their partner:Oh, it would’ve been once a week. Yeah, that was about all I felt comfortable doing until I figured my place in it all and until I felt comfortable doing the activities in the sessions. (Louise)Despite the participants’ ability to sustain their participation in a group-based PA program, their initial foray was mixed. Most started slowly after giving birth or resuming PA participation, but some of the other reasons for hesitance was due to uncertainty about the social environment, the physical capabilities needed to participate, and balancing baby and child(ren) routines with PA sessions. For example, for those who had only limited experiences in the gym or in a group-based situation prior to having child(ren), they attended once or twice a week until they had developed belief and confidence in their abilities and established social connections within the group and with the trainers:Well, I think that’s what most women want is you want someone who’s going to take the time to get to know you and what you can do and where your body’s at and not go and compare you to others. It’s somewhere that’s a safe environment that you can feel comfortable in going in six weeks postpartum or a year after you’ve had a baby. (Nicola)The number one external factor that helped women overcome their initial hesitancy and lack of confidence was the welcoming ethos that was prevalent in all the group-based PA program environments. The women spoke wholeheartedly about the supportive environment created by the trainers, the other participants, and the shared journey. They also downplayed the importance of the physical space, further enhancing the influence of a positive emotional and social environment for recruiting mothers with young children: ‘It doesn’t matter about equipment or space or anything like that. It’s all about the emotional and social connections with the trainers and other participants’ (Jemma). An important component of creating a welcoming ethos and a positive emotional and social environment for mothers with young children was the absence of peer comparison and judgement:The third theme was identified as participants explained their motivation for continuing to engage in group-based PA programs. Four sub-themes captured the personal and environmental factors that supported them: (3.1) child friendly; (3.2) body positive; (3.3) role modelling for children; and (3.4) social and psychological benefits. Although these sub-themes are different to the ones that helped women join group-based PA programs in the first place, it should be acknowledged that family support, convenience, location, affordability, and a welcoming ethos were still influential in sustaining participants’ participation. Across sub-themes, it was apparent that the women’s motivation to continually engage in the group-based PA sessions was usually tied to several internal and environmental motivational factors.And then it’s just knowing that I can take my kids. That is everything to me because I have to work part-time. It’s always been a thing for us financially that I’ve had to do. So, I don’t want to put them back in care…So, being able to take them with me and still have them play and have a good time and have access to different toys and me. (Vivienne)The main reason for the women in this study to be able to maintain their participation in a group-based PA program was that the environment allowed for babies/child(ren) to be in the same vicinity as the mother. Most of the women chose or had to bring their child(ren) to the PA space, so they appreciated that the program and trainers were accommodating of child(ren) and had constructed a space, physically and emotionally, that allowed mothers and child(ren) to have direct access to each other during the session in a safe manner:I remember there was about a month straight where I’d bring [child’s name] and he just cried the whole time and the women in here are just so magical. They saw that I needed this exercise. I was struggling and they would stop what they were doing and go and take [child’s name] for a walk. I still remember, there was about three sessions where [name of trainer] just stroked [child’s name] head for 45 minutes straight. (Kristy)The women in this study who brought their child(ren) to the PA space understood the PA sessions may be interrupted. However, there was also an understanding between trainers and mothers that this was reasonable, and that, if possible, the trainers would modify the session or help and support the mother with her child(ren). The environment was fluid and dynamic, which made the mothers in this study feel comfortable but also still benefit from being physically active:Motivation to continually engage in the group-based PA sessions was also attributed to an environment which promoted what the women’s body could do, rather than what their bodies looked like. Some of the women noted that this was a positive change from previous PA experiences before child(ren): ‘It always used to be about appearance for me, but now it’s more about functionality…And the [name of group-based PA program] does this’ (Kim).And [name of trainer] drives that self-satisfaction with her praise and feedback. And she always says to me, ‘Oh well, Anna, you know when you started, you couldn’t even squat two centimetres, and now you can almost squat this far’. So she always gives you feedback and praise, which I think is a big thing that you need. (Anna)Several women in this study shared specific examples of how the environment and the trainers were able to maintain the focus on the functionality of the body. The women stressed that the absence of mirrors, specific and individualised feedback on improvement in completing exercises or building strength, and modifications or progressions for focus be continually placed on body functionality and capability:I guess just physically I’m doing things I never did pre-baby because I never went to the gym and stuff like that beforehand…And now I just feel really strong. My body shape has definitely changed and I feel strong... I definitely feel like I’m the fittest I’ve ever been and that’s post-baby and I never thought I would be like that. (Jessie)Despite the focus on the functionality of the body, some of the women still grappled with their postpartum body, often comparing it with the pre-baby body and highlighting the differences. However, when the women did this, there was also a positive frame in terms of being able to acknowledge its differences, as well as their postpartum body’s new capabilities. This highlights that the body image–exercise relationship varied during early motherhood for these participants but tended to be influenced by participation in a group-based PA program:n = 28; 88%) recognised that a motivating factor for sustaining their participation was having their child(ren) participating when possible. The reasons for this was the belief that the child(ren), especially those who were 2 years or older, were learning from being not only observers, but also active participants:My oldest was, ‘Look at me, I can carry this one’. …And I think I can see connections with them mimicking what I’m doing. If they see my yoga mat lying around at home, next thing it’s rolled out on the floor and they’re doing push-ups and trying to count. (Lucy)Most mothers with young children  believed that they were also teaching the value of self-care to their child(ren) and emphasising that mothers also need to complete tasks and enjoy activities too:…and the fact that the kids then put value on self-care. ‘This is mummy’s time to do mummy’s thing. You’ve got time and I will support you on that. Sometimes, its mummy’s turn is to do this’. … That skill is valuable too. (Belinda)The role modelling theme was reinforced with the participants’ narratives highlighting an element of hope that their child(ren) would maintain these PA behaviours over an extended period or the child(ren) would recognise that participation was important for their mothers’ mental health and wellbeing. As P4 mentions: ‘Hopefully she understands that I’m doing this to be not only physically active, but for my own mental health and wellbeing as well’ (Laura). Interestingly, a few of the mothers with young children In addition to the social benefits, many of the women claimed several mental health and wellbeing benefits. These included being ‘a happier mum and a happier wife’ (Lottie), ‘I feel like I’m ready for the day’ (Claire), ‘it’s my stress outlet’ (Kristy), and ‘it’s filling my cup first which then helps with my whole family’ (Natasha). For those who were living with a mental health condition, the group-based PA program was a mechanism for alleviating the symptoms or minimising or ceasing the intake of medication:Or, wow, I felt like such a bad mum because I yelled. And everyone’s like we have all done that. And then just being able to normalize those feelings. (Vivienne)Some of the mothers with young children also used PA to gain relief from the requirements and expectations of being a mother. Some of the women explicitly spoke about this, as seen in Lily’s comment: ‘I think the biggest thing for me is, that keeps me going back is just the fact that it just gives me a little bit of independence, it gives me, the, me time, I get to be me instead of just mum. And that’s probably the biggest thing for me that keeps me going back’. However, it seems that most of the women used the group-based PA program as a resource rather than an escape or refuge. It was a time to share parenting situations, ask for help or ideas, and reflect on strategies used and shed emotions about parenting in a safe and supportive environment. This buoyed mothers with young children’s social and mental wellbeing as well:The aim of this qualitative study was to provide an in-depth understanding of mothers with young children’s perceptions and experiences that led to their initial engagement and sustained participation in group-based PA programs. Three themes were identified which focused on mothers with young children’s previous PA engagement, recruitment factors that engaged mothers with young children’s in group-based PA programs, and sustainable factors that maintained mothers with young children’s participation in group-based PA programs.Overall, mothers with young children  emerged as a significant opportunity for women to reconnect or initiate engagement in PA, regardless of prior experiences. Although underlying beliefs and perceptions play an important role in the decision-making processes of being physically active , there iEach postpartum woman was subject to unique personal experiences relating to pregnancy(ies) and birth; however, the slow and progressive return to MVPA was similar for each woman in this study. This is interesting, as participants in other studies have described pressure to get back into shape quickly postpartum, often referencing specific influential people on social media, and therefore tend to increase the frequency and intensity of PA too quickly . All parInterestingly, existing postpartum interventions have largely utilised flexible delivery methods that facilitate women’s engagement in PA on their own  in an aIn conclusion, there are many factors that recruit and sustain mothers with young children’s engagement in group-based PA programs. Evidence from this study shows that mothers with young children have different perceptions and meanings of PA; however, they relish a welcoming and supportive environment that accommodates babies and young children, is affordable and convenient, focuses on building strength and functionality, and is non-judgmental. These types of exercise environments allowed mothers with young children in the present study to experience the social and psychological benefits of MVPA and helped them sustain their engagement. Future group-based PA and community sport programs, as well as workplaces with mothers as employees, should design PA interventions targeting these appropriate features, as well as connecting with local health professionals and practitioners to ensure that mothers with young children access group-based PA programs that are safe, designed to be developmentally appropriate, and are connected to women’s health specialists allowing for women to have direct access to help and support when needed.


The time period before, during and after pregnancy represents a unique opportunity for interventions to cultivate sustained healthy lifestyle behaviors to improve the metabolic health of mothers and their offspring. However, the success of a lifestyle intervention is dependent on uptake and continued compliance. To identify enablers and barriers towards engagement with a lifestyle intervention, thematic analysis of 15 in-depth interviews with overweight or obese women in the preconception, pregnancy or postpartum periods was undertaken, using the integrated-Promoting Action on Research Implementation in Health Services framework as a guide to systematically chart factors influencing adoption of a novel lifestyle intervention. Barrier factors include time constraints, poor baseline knowledge, family culture, food accessibility, and lack of relevant data sources. Enabling factors were motivation to be healthy for themselves and their offspring, family and social support, a holistic delivery platform providing desired information delivered at appropriate times, regular feedback, goal setting, and nudges. From the findings of this study, we propose components of an idealized lifestyle intervention including (i) taking a holistic life-course approach to education, (ii) using mobile health platforms to reduce barriers, provide personalized feedback and promote goal-setting, and (iii) health nudges to cultivate sustained lifestyle habits. In line with the Developmental Origins of Health and Disease (DOHaD) paradigm, where early-life developmental influences are associated with later-life health and disease, optimizing the health of the mother can achieve the greatest benefit for mother and child10. Healthy diet and physical activity are key factors in addressing the obesity pandemic and related health complications11.Overweight or obese women in the reproductive age group have an increased lifetime risk of adverse metabolic sequelae, along with subfertility, adverse obstetric outcomes in the mother and long-term adverse health outcomes for the child16. However, large randomized controlled studies of lifestyle interventions, such as dietary education, physical activity tracking, counselling workshops, and various combinations of these, have failed to achieve sustainable results18. In particular, lifestyle interventions initiated during pregnancy have been unsuccessful in preventing gestational diabetes or large for gestational age babies19. Few weight loss interventions have been conducted for women before conception20. While some have been shown to improve fertility, they did not result in significant improvements in metabolic outcomes23. Although there is considerable research and clear consensus regarding the goals of effective lifestyle interventions20, difficulty translating the evidence into clinical practice is widely documented. Key challenges to achieving outcomes in lifestyle interventions lie in successful engagement of participants and continued compliance with the intervention24. Enablers and barriers to behavioral change may arise from family and community characteristics, the local setting, and by social, environmental and policy contexts26. However, few studies have engaged with implementation science theories and integrated research findings to develop interventions that enable high engagement and sustained behavioral change. Hence, the optimal components of a lifestyle intervention for pregnancy that is acceptable, sustainable, and tailored to the concerns and needs of the target population needs to be determined.Various lifestyle interventions have been implemented in the preconception or pregnancy phases, which represent unique opportunities for cultivating sustained healthy lifestyle behaviors27. Specifically, it was designed to guide complex interventions in healthcare, providing a framework to systematically chart factors affecting implementation. By identifying barriers and enablers as perceived by users, it has previously been identified as a useful tool for iterative planning of the implementation of patient‐reported outcome measures (PROM) into routine oncology care28. As the eventual goal of this study is to create a lifestyle intervention program targeted at women with high body mass index (BMI), utilizing this framework will help to identify both enabler and barrier factors that should be resolved when designing a successful behavioral change intervention. Hence, the i-PARIHS framework was applied as a guide to understand how perceived enablers and barriers would influence the adoption of a lifestyle intervention program for the overweight or obese among preconception, pregnant and postnatal women, from which features of an ideal lifestyle intervention program with improved uptake and compliance are suggested.The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework supports successful implementation of evidence-based outcomes into real-world practice29. Participants were recruited from the general public and patients at KK Women’s and Children’s Hospital (KKH), Singapore, from clinical settings including pre- and post-natal clinics and the ward, as well as voluntary responses. A quota sampling method with a predetermined sample size was used to ensure that opinions surrounding all periods of preconception, pregnancy and postpartum were obtained. In total, 15 in-depth interviews were conducted at KKH between September 2020 to December 2020. Participants were females between 21 and 40 years of age with BMI ≥ 25 kg/m2. They were either in the preconception (n = 5), pregnancy (n = 5), or postnatal (n = 5) phases of their journey.As the goal is to develop an intervention program that serves to accompany women throughout their preconception, pregnancy and postnatal journey, qualitative research was conducted as it provides medical researchers with deep insight into their patients’ life-worlds30.Data was gathered via two methods in each participant: by questionnaire and an in-depth interview session. Before the start of the interview session, participants filled out a short questionnaire that captured demographic data including age, ethnicity, BMI, smoking exposure, alcohol use, supplement use, educational attainment and employment status. One-to-one in-depth interviews were conducted due to the potentially sensitive topics surrounding obesity, weight and personal pregnancy experiences33. The interview guide  consisted of a standardized set of open-ended questions focusing on the knowledge, attitudes and perceptions of women towards a lifestyle intervention program, followed by further probing questions. These aimed to find out the perceived importance of their own and their offspring’s health; their baseline understanding of healthy behaviors, weight and health goals; motivators and barriers to achieving their goals; and acceptable dietary or other lifestyle interventions that they would be willing to undertake.A semi-structured interview guide was used during the in-depth interview session to provide systematic coverage of topics, allowing flexibility to explore the responses of participants when needed. This guide was developed based on a preliminary literature review into the knowledge, attitudes and beliefs regarding nutrition and lifestyle behavior among overweight and obese women before, during and after pregnancyThe in-depth interview sessions were conducted by three researchers who developed the interview guide. The interview sessions lasted around 60 min, were conducted in person using the English language, audio-recorded and transcribed verbatim. A team of research assistants transcribed the audio-recordings, which were mutually cross-checked for accuracy. Two independent researchers subsequently verified the transcripts for accuracy.34. All transcripts were analyzed using NVivo , a qualitative data analysis software35. Two study team members coded the transcripts independently. Subsequently, these codes were then discussed between the two study team members, resulting in identified themes. The development of codes and themes was an iterative and reflexive process where the team members shared their perspectives. Any discordances were resolved through consensus discussion. Themes generated were checked for data saturation, by ensuring that themes identified were elicited from the responses of multiple participants, to ensure an adequate sample size as it was unlikely that new information would be obtained from recruiting additional participants36.The in-depth interview transcripts were analyzed inductively using thematic analysisRecipient, Context, Innovation and Facilitation. These constructs were identified to be important considerations for a successful implementation of research findings37. The Recipient construct refers to a person’s characteristics that may affect implementation of the intervention27. The Context construct refers to non-people factors that can act to enable or constrain implementation, such as culture, leadership, the wider health system or organization27. Within this, we delved into how manipulating the environment surrounding a potential user may influence engagement with an intervention. The Innovation construct refers to the circumstantial interpretation of how the evidence should be applied to practice, which often involves tailoring to Recipient and Context factors27. The Facilitation construct refers to implementation processes that comprises of a facilitator (role) applying a process (a set of strategies and actions)27. As the facilitators apply the innovation on the recipients in the given context, each of the other constructs interact with the Facilitation construct.The identified themes were subsequently mapped onto the i-PARIHS framework, which has four key constructs at its core: Initial mapping was done independently by two study team members with discordance resolved through consensus discussions with a third study team member. Across the four i-PARIHS constructs, several barrier and enabler factors were identified. The finalized thematic map and its codes can be found in Additional file 2.The current study was reviewed and approved by the SingHealth Centralized Institutional Review Board (CIRB Ref: 2020/2530). All participants signed an informed consent form before participating in the study. Identifying information was removed from the data prior to the analysis and all methods were performed in accordance with the relevant guidelines and regulations.The authors declare that they provide consent for publication.2.Table Recipient, Context, Innovation and Facilitation.Ten basic themes representing participants’ perceived barriers and enablers to program participation and engagement were identified. They were organized into four main themes according to the constructs in the i-PARIHS framework, namely “As a mother, as a housewife, as a daughter-in-law, and as a person, I need to find time to do it all, to do everything. That is going to be very challenging” (Interviewee 02). Another participant said: “Taking care of the kids and working, we really (sic) didn’t have time to exercise” (Interviewee 06).Participants indicated that time pressure was a major challenge preventing them from engaging in healthy behaviors. They explained that the multiple roles and duties in their lives restrict them from having time to adopt healthy lifestyle habits such as exercising. “Other than my weight, I don’t think there are any other health concerns” (Interviewee 14). Similar responses were given when participants were probed further on the potential health risks of obesity. “Author: Do you have any thoughts about the impact of having a high BMI? Interviewee 02: Err no. Author: But specifically, do you know whether there are any negative effects? Interviewee 02: I don’t think so.” Participants were also unaware about the implications of obesity on their offspring’s health. “I feel that despite being overweight and obese, the risk to baby is minimal to none” (Interviewee 01).Not all participants were aware of the health implications of being overweight and obese. “There are apps out there that track and tell you what to expect in pregnancy, what foods to eat, and what exercises to do, but they are only representative of western countries. I cannot find anything that is applicable to the local context so that’s why I’m not motivated to learn or follow the advice” (Interviewee 07). Some participants commented that existing sources are mostly contextualized in western cultural settings, which are not easily adopted in the local context nor appealing to Asian women. “I think it’s because (these lifestyle apps are) are tailored to the angmoh^ context. Those apps are designed in western countries, (like) pumpkin soup (which) is not very Singaporean” (Interviewee 08). .Participants are not able to access data sources relevant to their context. They pointed out that currently available information on guiding maternal healthy living, which are not relatable to the local culture, hinder them from making lifestyle changes. “I think the old people are heavily influenced by their parents’ mindset. They tell me not to eat certain foods… Or to do certain things” (Interviewee 04). They expressed difficulty in communicating with their elderly in the family. “My mother-in-law helped during my confinement period. We were totally lost. She assumed that what she did was the norm. But we have new products in the market now to help with childcare. She doesn’t know about them and she doesn’t believe in them. So it’s a bit tough with a bit of a clash, (and) my husband had to be the middleman” (Interviewee 07). Eating together is a social practice in Asia38. During social gatherings and activities, individuals may adopt different eating behaviors that are not aligned with healthy diets. “…when we are not meeting with our families, it’s probably easier to stick to the diet but when you meet during weekends, you’re happy, and there’s so much food, good food, to order in so we caved in many times” (Interviewee 06). In addition, family members living in the same household often share meals and lifestyle habits which are difficult to modify individually, separate from other household members. “To be honest, because I don’t prepare my own food, I’m at the mercy of what my mom feels like cooking that day” (Interviewee 09).Participants mentioned that the traditional mindset from elder family members plays a major part in determining their daily lifestyle practices. “because I’m late from work and I’m so hungry, because of the clinic schedule, we look at which (sic) shop doesn’t have a queue. Old Chang Kee* for example is the fastest, so its tempting to just buy (from there)” (Interviewee 13). (* Old Chang Kee is an established food retail chain in Singapore that sells deep fried snacks). This participant also added: “…because every day when I come to work I’ll buy a lot of breakfast snacks, like from McDonalds probably (sic). So I just get one meal and sometimes I’ll order extra hash browns as well” (Interviewee 13).Finally, there is a lack of an enabling environment to support positive lifestyle and dietary changes. Accessible and convenient unhealthy food options is a factor that perpetuates unhealthy diets. Having a baby motivates (me) a lot, because I want to be there to see them grow up and I want to lose weight for my four children” (Interviewee 02). Another participant said: “Yes, I can live for a long time (sic) to see my child get married (and) to have grandchildren” (Interviewee 05). Participants were also motivated to change for their children. “It’s my child who changed my diet. As my toddler joins me for meals, I (must) make sure the food is not fried, is not (sic) high in fat or seasoning, so I’m motivated by my child’s need(s) to eat healthily.” (Interviewee 08).Participants expressed motivation to make a healthy change, with the desire to be in better physical health for their offspring(s) when they grow up. ““We were at our fittest together and we both encourage each other. So we both motivate each other” (Interviewee 06). One participant highlighted the importance of engaging their partner in the program. “(The program) should not just reach out to the mother, but also reach out to the father. (It) will be helpful if the partner, the father, also knows (the content of the program)” (Interviewee 07). Support of the immediate family in the care of a young baby was also pivotal for new mothers to engage in healthy behaviors. “My mother helps me to take care of the baby for about two hours, so that I can hit the gym or have a walk” (Interviewee 04). Participants in our study also valued making social connections with peers to form a community of people going through similar experiences and provide mutual support. “Mummies groups (sic) are good. Every pregnancy is different. Each baby is different. Everything is different. So with sharing by (sic) different mummies, it will give (me) confidence to hear that someone’s pregnancy (experience) is similar to mine. Then, I’m not the odd one out” (Interviewee 07). Another participant stated: “Because there are things you cannot tell your parents, you cannot tell your other half. So telling people in the mummies group who understand you, then you will (sic) feel like, oh I’m not alone. And you do make good friends. Then (sic) you go for outings with the baby and learn from each other’s parenting. So I think it’s quite a good one” (Interviewee 05).Within the immediate environment, participants reported that family and social support would be a strong enabler. In particular, partner engagement with lifestyle changes alongside the prospective mother enabled mutual motivation. “I want to learn more about diet intake (sic), the type of exercises I can do, how to breastfeed, and also sleep training for the baby. I also want more assurance on the type of exercises that I can do, and for how long” (Interviewee 08). Another participant added: “More on (the) breastfeeding issue … I still see (many) mummies struggling with breastfeeding” (Interviewee 05). Participants commented it was important that the information delivered was compatible with the specific needs and challenges faced at different phases of the journey from preconception to postpartum, necessitating different information, and intervention intensity. “Before delivery you can provide (information) so they can be more well-equipped and at the same time, during the pregnancy, they can still go back to it to read up again” (Interviewee 09). Participants were also keen to receive information about the postpartum period as early as preconception. “Ideally, before I get pregnant, I want to learn about breastfeeding and sleep training. I only got in touch with breastfeeding and sleep training during pregnancy. I find that is too late and as a new mom, I don’t know how to analyze and filter all the information, so if there is some information on this during preconception, I can be mentally prepared for motherhood” (Interviewee 08). The desired frequency and intensity of intervention was highlighted by a participant: “(During) preconception, I would prefer to receive information every month, or every 2 months. As for health tips or nudges, I don’t mind receiving such information every day. During pregnancy, I would prefer receiving information every week. (In the) Postpartum period, I am happy to receive weekly newsletters” (Interviewee 08).Participants indicated that concrete information about specific topics, such as healthy eating, exercise guide, mental health and breastfeeding support, should be included in the intervention program. “There are apps online, but none are three-in-one—before pregnancy, pregnancy and postnatal, the whole journey. If you have an app that puts everything together, this app would be very widely used” (Interviewee 05). Most of the participants preferred a mobile application to deliver the intervention, with one of them saying: “Mobile application, like an all-in-one application that I can refer to as and when I want to” (Interviewee 11). Another participant expressed a similar sentiment. “Yes I will still prefer the app. Because you might be working. You might not have time to attend. I think the most efficient method is to have weekly classes. Because you need to know what to expect each week, what needs to be done. But no one will have time to attend a physical class every week. So I think an app is still better” (Interviewee 08). However, there were others who were hesitant to embrace new technology. “I prefer physical classes that are face to face because I cannot concentrate when classes are online” (Interviewee 15).Participants wanted a single platform to deliver preconception, pregnancy and postnatal care which allows users to continue using the tool throughout the journey. “Monitor our diet intake and exercise, that may keep us more engaged” (Interviewee 11). This would help to provide ongoing motivation and enable them to troubleshoot their lifestyle. “To improve engagement, you can have a monitoring logbook, get a gift or something to motivate (us)” (Interviewee 02). The desire for an interactive process was echoed by another participant: “Yeah. Especially when there’s a section where you can actually (sic) ask a question, and get an answer, maybe not instantaneously but you know you may get one within the day, or maybe within a week, but there will be someone who answers the question. Or it could be become like a thumb’s up thing, where most voted questions get answered faster” (Interviewee 09). Participants also suggested nudges to support regular re-engagement, which would provide reminders and ongoing motivation to promote sustained behavior change. “I feel like it would be good if there are notification pushes periodically maybe once or twice a week, but also if I were interested and I were to search it up within the app itself, its listed there as well. So, if I want to read forward, beyond those week by week pregnancy information pushes. For example what size (the baby bump) will be the following week, I can find that information (on the app) if I’m interested” (Interviewee 09). Another participant added: “Each of these nudges serves as a reminder when it’s time to run. Perhaps a nudge for the parents to think about whether they have any questions to ask the doctor” (Interviewee 06).Some participants suggested the use of a monitoring logbook to monitor their health and feedback reports to guide healthy behaviors. 41. Hence, we propose an intervention that mitigates these barriers and capitalizes on enabling factors identified in the results to ensure successful implementation and sustainable impact.Ten enabler and barrier factors emerged from the interview process. These were framed through the lens of the i-PARIHS framework to understand how perceived barriers and enablers towards adoption of lifestyle changes shape participation and engagement with intervention programs. Among women of childbearing age who were overweight or obese, at different stages from preconception to postnatal, factors surrounding individual women, the sociocultural context, and key characteristics determining the uptake and continued efficacy of a lifestyle intervention were identified. Not tailoring the intervention sufficiently to these factors could explain the variable efficacy of existing interventions that aim to effect behavioral changes, such as diet modifications and increased physical activity33. Specifically, women are unaware that obesity before and during pregnancy has lifelong impact on maternal and child health. This may stem from insufficient guidance on healthy lifestyle behaviors applicable to the local context25. Addressing these through education will enable participants to perceive value in optimizing health for themselves and their children in the long-run, while providing practical suggestions that are culturally convenient, so women can act42. These form the considerations in designing an educational package as part of a lifestyle intervention program, aligned with our findings in this study.Despite strong motivation among mothers and prospective mothers to adopt healthier lifestyles for their babies, knowledge gaps and misconceptions are barriers that prevent the adoption of such behaviors45. Notably, this indicates that participants desired a holistic intervention, which extends beyond their medical needs or a specific health concern to address their personal concerns as a woman and mother-to-be.First, the intervention should address the spectrum of needs and concerns beyond obesity and physical health, including physical activity and exercise, breastfeeding, and infant feeding practices. Participants of other studies have brought up similar concerns that are beyond the scope of the clinician’s agenda of targeting obesity or a specific health problem. Some topics of interest include support for miscarriage, sleep, mental health, postpartum care and baby care in the first year of lifeSecond, the educational package should be relevant to users throughout the journey from preconception to postnatal phases. Information should be tailored to each phase as motivation and concerns for women differ at each of these phases. Before conceiving, the primary concern for prospective mothers is getting pregnant and optimizing fertility, hence information targeted at these topics are most likely to catch their interest. During pregnancy, women are concerned about how their lifestyle habits or symptoms affect the wellbeing of their fetus. Pregnancy-safe exercise plans at different trimesters are an example of information that can be provided. After delivery, women may worry about their recovery and care for their newborn, so topics such as breastfeeding and sleep training may be more relevant. In addition, women experience different time constraints during each phase. They have the least time postpartum as they are caring for their newborns, and the most time preconception where there are few medical visits and no fatigue from pregnancy. Thus, the intensity should also be tailored to these time constraints, with the greatest intensity before pregnancy, easing up during and after pregnancy.46, but desire a comprehensive application that would serve all of their needs throughout the journey from preconception to postnatal. Taking a life-course approach achieves this by recognizing that an individual’s needs and concerns evolve over time, and tailors the intervention to suit their needs at different phases of the journey. In addition, initiating the intervention before conception gives women enough time to acquire nutrition knowledge and develop exercise habits47, enabling long-lasting lifestyle changes that are sustained before, during, and beyond pregnancy47. Continuing to support healthy behaviors in the postnatal period45 improves metabolic health when entering a subsequent pregnancy, and later in life.There are many applications already available on the market, however these largely target a specific phase or aspect of the journey. Pregnant women currently use varying combinations of these apps49.Third, the identified barriers of contextual factors coupled with a lack of reliable locally relevant data sources show that difficulty integrating recommendations for lifestyle changes into local practices and habits prevent engagement with an intervention. Thus, the educational package must be designed with local practices, culture, and diet in mind. In particular, the influence of family culture on a person’s diet should be mitigated by engaging family members, especially partners, in the intervention program, which can be done by providing tips for exercising together or meal plans for the whole family. Not only does this promote healthy eating and lifestyle habits, but it also helps to establish spousal support throughout the journey of preconception, pregnancy and postpartum care. As it is a common practice for locals to purchase foods from food courts and food retailers (43), there is a need to incorporate education in identifying healthier food choices while eating out. This can integrate and augment current government policies and public health messaging such as the Healthier Dining Programme and Healthier Choice Symbol20. Strategies to enable these are a topic of interest and research24. Social support has been identified to be vital in promoting healthy behavior both in this study and others46. Meanwhile, time is a well-documented barrier to healthy lifestyle behaviors (e.g. exercising), particularly during the time surrounding pregnancy and motherhood46. Okesene-Gafa and colleagues (2016) found that perceived time constraint was cited as a likely reason for predicted non-participation if a nutritional intervention was created16. A longitudinal study conducted on Australian women showed that women’s perception of time pressure increased with number of children, as well as working hours they experienced50. Notably, majority of our participants are employed (73%) and thus our data provided a reflection of working women’s experiences and time constraints. For a lifestyle intervention to successfully enable behavioral change, time as a barrier needs to be sufficiently addressed.The ultimate goal of lifestyle interventions is to cultivate sustained, long-term changes in behavior52. Nudges can be delivered in the form of push notifications or short text messages, e.g. via social media that provide information or guidance, motivational messages, activity reminders, or promote interaction with the intervention53. This facilitates short and regular interactions with the lifestyle intervention, continuously re-engaging the user and providing consistent reminders for habit formation to drive long-term behavioral change45. Importantly, the intervention needs to be responsive to users’ needs. Incorporating built-in self-evaluation and feedback processes would enable users to support change independently, thereby enhancing self-efficacy and self-control54. It also allows personalization of healthy messages and nudges through goal-setting and feedback, which have previously been found to be more effective than non-customized messages in improving self-efficacy and dietary behaviors55.Nudge interventions are increasingly used to influence health behavior to regularly re-engage users, and as promising adjuncts to educational interventions to counteract the adverse effects of decision biases that inhibit people from acting rationally56. The main advantage of using a mHealth platform compatible with smartphones is that it can be accessed anywhere at any time46. The intervention can be delivered through small but frequent interactions with the mobile app that can be completed in pockets of free time, which fits in well with the modern lifestyle of city-dwelling women, who have also expressed that they do not want to be given too much information at once43. Further, each interaction with the intervention can be tailored to the amount of available time, for instance completing short exercise sessions or consuming bite-sized information43, allowing changes to be flexibly incorporated into daily life.Taken together, a sustainable intervention needs to incorporate a range of complex features providing guidance and education throughout the pregnancy life-course, while enabling a high degree of personalization to individual needs with feedback, goal setting and regular nudges. This is best achieved through a mobile health  platform. mHealth is broadly defined as medical and public health practice supported by mobile devices such as smartphones57.A major strength of this study is the inclusion of the important phases in a woman’s life journey, from preconception to pregnancy and postpartum, and with recruitment from community and hospital settings. The codes and themes that arose from women in the preconception, pregnancy or postpartum phases were similar and is likely to represent women’s attitudes towards lifestyle interventions throughout these phases in general. Singapore is a multi-racial country, and this cultural diversity is reflected in our sample, which may be representative of most Asian countries. However, given the small sample size, the generalizability of our findings will need to be further studied. Nevertheless, these findings may represent enablers and barriers in other first-world regions with similar characteristics where women lead modern lifestyles, taking on multiple roles at home, work and socially, with widespread use of mobile phones, as similar enablers and barriers have been reported in studies in other such localities27. However, there is a paucity of research that integrates the interplay of perspectives of multiple stakeholders in a lifestyle intervention, which should be a topic of further research.However, this study only interrogates the perspectives of end-users, and does not take into consideration the perspective of other stakeholders. This study has identified women’s partners and families as potential enablers. However, this is not explored in our study and should be a topic of further research given their apparent influence on an individual’s lifestyle habits. In addition, the literature in implementation science research has established lifestyle interventions as multidisciplinary and multistakeholder efforts, with constraints and barriers from other perspectives such as healthcare professionals, organizations, managers, policy makers and other public bodies that would influence the success of the intervention aside from that of end-users58. These were mitigated to some degree by clearly defining the tools and methods for collecting data to ensure responses were recorded and analyzed systematically36. The status of interviewers as healthcare professionals would predispose to response biases such as social desirability bias, which was mitigated to a degree through use of individual interviews59.The study is further limited by the role of the researchers as interviewers, which may have given rise to a degree of interviewer and response biasObesity caused by poor lifestyle behaviors, including dietary choices and lack of physical activity, has long-term adverse health effects in women and their children. The preconception, pregnancy and postpartum time period represents a unique opportunity for intervening to cultivate sustained healthy lifestyle behaviors. Although most pregnancies are planned and mothers are intrinsically driven to provide the best for their offspring, they may not be equipped with knowledge about preconception, pregnancy and postnatal care to put this into effect. The success of a lifestyle intervention is heavily dependent on uptake and requires continued compliance, which has been a challenge in previous studies. Using the i-PARIHS framework to explore the perceived enablers and barriers of adopting a lifestyle intervention program among preconception, pregnant and postpartum women who are overweight or obese, we propose components of an idealized lifestyle intervention to improve metabolic health. This includes a holistic education package taking a life-course approach to improve women’s baseline knowledge of health; using a mobile health platform to reduce barriers to adopting lifestyle changes, provide personalized feedback and goal-setting; and regular health nudges to cultivate sustained lifestyle habits.Supplementary Information 1.Supplementary Information 2.