Baby Steps: Using Intervention Mapping to Develop a Sustainable Perinatal Physical Activity Healthcare Intervention

Integrating 'undetectable equals untransmittable' into HIV counselling in South Africa: the development of locally acceptable communication tools using intervention mapping

BACKGROUND

The global campaign for "Undetectable equals Untransmittable" (U = U) seeks to spread awareness of HIV treatment as prevention, aiming to enhance psychological well-being and diminish stigma. Despite its potential benefits, U = U faces challenges in Sub-Saharan Africa, with low awareness and hesitancy to endorse it. We sought to develop a U = U communications intervention to support HIV counselling in primary healthcare settings in South Africa.

METHODS

We used Intervention Mapping (IM), a theory-based framework to develop the "Undetectable and You" intervention for the South African context. The six steps of the IM protocol were systematically applied to develop the intervention including a needs assessment consisting of a systematic review and qualitative research including focus group discussions (FGD) and key informant (KI) interviews. Program objectives and target population were determined before designing the intervention components and implementation plan.

RESULTS

The needs assessment indicated low global U = U awareness, especially in Africa, and scepticism about its effectiveness. Lay counsellors and clinic managers stressed the need for a simple and standardized presentation of U = U addressing both patients' needs for encouragement and modelling of U = U success but also clear guidance toward ART adherence behaviour. Findings from each step of the process informed successive steps. Our final intervention consisted of personal testimonials of PLHIV role models and their partners, organized as an App to deliver U = U information to patients in primary healthcare settings.

CONCLUSIONS

We outline an intervention development strategy, currently in evaluation stage, utilizing IM with formative research and input from key U = U stakeholders and people living with HIV (PLHIV).

Using Intervention Mapping to Develop a Workplace Digital Health Intervention for Preconception, Pregnant, and Postpartum Women: The Health in Planning, Pregnancy and Postpartum (HiPPP) Portal

Digital health interventions that specifically target working women across the preconception, pregnancy and postpartum (PPP) life stages may address the unique barriers to engaging in healthy lifestyle behaviours and self-care during this life phase. This paper describes the development of a workplace digital health intervention to promote healthy lifestyles and wellbeing for PPP women working at a community service organization in Australia. Intervention Mapping is a framework that guides program development, implementation, and evaluation. Steps 1 to 5 of Intervention Mapping methodology (needs assessment through to program implementation) were used, including identification of determinants and change objectives across socioecological levels (i.e., individual, interpersonal, and organisational) and iterative co-design and stakeholder engagement processes. The workplace digital health intervention was successfully developed and implemented as an online portal. Content included key strategies, information, and supports to promote health and wellbeing across PPP, including supporting the return to work in the postpartum period. Examples of resource pages included a parental leave checklist, process flows, Pride resources, and Aboriginal and Torres Strait Islander resources. Findings from a pilot feasibility study indicate the portal was accessible and beneficial for women in PPP life stages. The Intervention Mapping protocol may offer a valuable roadmap for collaborative design of interventions targeting PPP women's behaviour and organisational work culture. Future work is needed to evaluate whether such interventions lead to improvements in women's health and wellbeing.

Determinants of Changes in Women's and Men's Physical Activity and Sedentary Behavior across the Transition to Parenthood: A Focus Group Study

BACKGROUND

Becoming a parent may cohere with drastic changes in physical activity (PA) and sedentary behavior (SB). A clear understanding of determinants of changes in PA and SB during pregnancy and postpartum is needed to facilitate the development of tailored family-based interventions.

METHODS

Thirteen focus group discussions targeting determinants of changes in PA and SB behavior were conducted, involving a total of 74 expecting and first-time parents. A semi-structured question guide was used to facilitate the discussions.

RESULTS

Four main levels of determinants were identified: the individual (including psychological, situational and biological determinants), interpersonal, environmental and policy level. Some determinants were mentioned to be a barrier (e.g., "barriers to self-care") while others were a facilitator (e.g., "weight control"). Determinants were related to both PA and SB and applicable during pregnancy as well as postpartum (e.g., "self-regulation"), or only related to one behavior and/or one period (e.g., "feeding baby"). Some were described by both parents (e.g., "parenthood perceptions"), whereas others were mentioned by women (e.g., "PA knowledge") or men (e.g., "time opportunities") only.

CONCLUSIONS

Focus should be given to interventions aimed at improving parents' self-regulation skills and support on how to cope with interpersonal and situational constraints as well as parenthood perceptions.

Development and Validation of Prenatal Physical Activity Intervention Strategy for Women in Buffalo City Municipality, South Africa

Women rarely participate in physical activity during pregnancy, despite scientific evidence emphasising its importance. This study sought to develop an intervention strategy to promote prenatal physical activity in Buffalo City Municipality, Eastern Cape Province, South Africa. A multi-stage approach was utilised. The Strength, Weakness, Opportunity and Threat (SWOT) approach was applied to the interfaced empirical findings on prenatal physical activity in the setting. Subsequently, the Build, Overcome, Explore and Minimise model was then used to develop strategies based on the SWOT findings. A checklist was administered to key stakeholders to validate the developed strategies. Key strategies to promote prenatal physical activity include the application of the Mom-Connect (a technological device already in use in South Africa to promote maternal health-related information for pregnant women) in collaboration with cellphone and network companies; the South African government to integrate prenatal physical activity and exercise training in the medical and health curricula to empower the healthcare providers with relevant knowledge and skills to support pregnant women in prenatal physical activity counselling; provision of increased workforce and the infrastructure necessary in antenatal sessions and antenatal physical exercise classes and counselling; the government, in partnership with various stakeholders, to provide periodical prenatal physical activity campaigns based in local, community town halls and clinics to address the lack of awareness, misrepresentations and concerns regarding the safety and benefits of physical activity during pregnancy. The effective implementation of this developed prenatal physical activity by policymakers and health professionals may help in the promotion of physical activity practices in the context of women in the setting.