Mixed Method Study of Drivers and Obstacles to Exposure-Reducing Behaviors to Endocrine-Disrupting Chemicals During Pregnancy

BACKGROUND: Pregnant women are particularly vulnerable to endocrine-disrupting chemicals (EDCs). However, there is limited evidence on the behavioral determinants of exposure-reducing practices during pregnancy. This gap underscores the need for mixed methods inquiry. OBJECTIVES: The aims of this study were to identify drivers and obstacles influencing EDC exposure-reducing behaviors (EDC-RB) among pregnant Korean women, guided by an extended theory of planned behavior. METHODS: A convergent mixed methods design was used. Quantitative data were collected from 200 pregnant women through structured surveys assessing psychosocial and behavioral factors, while qualitative data were obtained from 17 participants via in-depth interviews and focus groups. Quantitative analyses examined predictors of EDC-RB, and qualitative thematic analysis explored contextual determinants. Integration of findings was conducted using methodological triangulation to enhance interpretive validity. RESULTS: Quantitative analysis showed that perceived behavioral control, intention, risk perception, knowledge, education level, and prepregnancy drinking experience significantly predicted EDC-RB. Qualitative analysis identified five interrelated themes reflecting complex behavioral determinants. Integration revealed that knowledge and social influences functioned both as drivers and obstacles, providing explanatory depth to significant predictors and clarifying nonsignificant findings. Triangulation further highlighted interconnected factor relationships that were not evident through a single method. DISCUSSION: EDC-RB during pregnancy is influenced by multiple individual and social factors. Mixed methods integration clarified behavioral mechanisms and highlighted the importance of interventions targeting both personal and contextual barriers.