"Listening to understand," exploring postpartum women's perceptions of their social networks and social support in relation to their health behaviors and weight: A qualitative exploratory study.

Abstract

Background: Postpartum is a critical period to interrupt weight gain across the lifespan, decrease weight-related risk in future pregnancies, promote healthy behaviors that are often adopted during pregnancy, and improve long-term health. Because the postpartum period is marked by unique challenges to a person's ability to prioritize healthy behaviors, a multi-level/domain approach to intervention beyond the individual-level factors of diet and activity is needed.

Objectives: The purpose of this study was to understand postpartum people's perceptions about the relationship between their social networks and support, and their health behaviors and weight.

Design: We used a qualitative descriptive approach and in-depth interviews.

Methods: Participants (aged 18+, 12-15 months postpartum, who had a pre-pregnancy body mass index ⩾25) engaged in one-on-one, in-depth interviews conducted via Zoom (n = 28). Additional qualitative data came from open-ended responses to an online survey (n = 84) and a personal social-network survey (n = 84). Qualitative analysis used content and thematic analysis in stages of deductive coding applying codes derived from social-network and support theories, followed by inductive coding.

Results: Thirty-eight participants (38.4%) returned to or weighed less than pre-pregnancy weight. We identified two overarching themes grounded in social-network and support theories. They were: (1) normative influence impacts health behaviors, body image, and experiences of weight stigma, and (2) network social support is related to health goals and overall postpartum health. Postpartum networks/support hindered and supported participants' goals. Partners provided an important source of accountability but were often associated with barriers to healthier behaviors.

Conclusion: Our findings reinforce the importance of the social context when considering how to support healthy behaviors and weight during the postpartum period. Healthcare providers should focus on health indicators other than maternal weight, and those wishing to support healthy postpartum behaviors could focus on child and family health, rather than solely on maternal weight and health behaviors.