Designing a lifestyle intervention to optimise cardiovascular health in high-risk prenatal and postnatal women: a qualitative co-design workshop

Cardiometabolic pregnancy complications (gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR), preterm birth (PTB)) present a unique sex-specific risk factor for future cardiometabolic disease (1–5) . Lifestyle modifications and healthful behaviour change (diet and physical activity), which can be supported by the delivery of evidence-based lifestyle interventions, are important factors in modifying risks of cardiometabolic conditions (2,6,7) . Pregnancy and postpartum present unique windows of opportunity to intervene and prevent or delay the onset of cardiometabolic pregnancy complications and future cardiometabolic disease (2,8) . Co-design considers the end-users wants, needs, preferences, characteristics and abilities throughout the entirety of the design process (9,10) . Co-design processes engage women with lived experience alongside other key stakeholders including; community organisations, healthcare professionals, primary healthcare and health promotion experts 14 . In line with patient-centred care it offers the opportunity to design lifestyle interventions that are adapted to suit end-users, in the hope of increasing uptake, engagement, implementation success and sustainability (11) . This study aims to co-design and explore stakeholders’ perspectives of the acceptability and feasibility of a lifestyle and screening intervention to reduce cardiometabolic risk amongst women at risk of or diagnosed with a cardiometabolic pregnancy complication. A descriptive qualitative research design was utilised. Two 2-hour co-design group workshops and a series of one-on-one semi-structured interviews were conducted with women with prior GDM, HDP, IUGR and/or PTB (n = 11), and research partners (obstetricians, endocrinologists, community health representatives, researchers, midwives, general practitioners, dietitians) (n = 14). Participants were provided with an overview of a potential lifestyle intervention, discussed the acceptability of each intervention component (outlined by the TIDieR framework; brief name, why, what, who provided, how, where, when and how much, tailoring, modifications, how well (12) ), and the feasibility of implementation (outlined by the Theoretical Framework of Acceptability (13) and the APEASE criteria for intervention design (14) ). Workshops and interviews were audio recorded, transcribed and analysed using template analysis. Analysis highlighted 10 key themes. Participants recommended the intervention is holistic, user-friendly, empowering, empathetic, patient-centred and culturally sensitive. Participants highlighted the importance of good risk communication, focusing on a positive, healthy pregnancy as opposed to risk reduction. Participants recommended providing additional resources and access to health services to complement intervention content. Participants suggested the intervention be delivered by female healthcare professionals from a range of cultural backgrounds with expertise in cardiometabolic pregnancy complications and postpartum management. Participants discussed the importance and value of the proposed intervention in filling what was perceived as a current healthcare gap for women at risk and diagnosed with cardiometabolic conditions during and following pregnancy. Engaging stakeholders to co-design an intervention that aligns with women’s and the healthcare system’s preferences, needs and priorities will support the development of an acceptable intervention for implementation in a real-world setting.