Strategies used by midwives to support prenatal physical activity: A scoping review

Context: Despite the well-known benefits of prenatal physical activity for the health of both the mother and her future child, and the existence of international Guidelines for prenatal physical activity, few pregnant women are sufficiently active. Prenatal health care providers, notably midwives, play an important role in promoting prenatal physical activity. Unfortunately, they face several challenges that hinder strategies used to support prenatal physical activity to their clients. The mode of communication used when giving advice and counselling is part of these strategies, as is the content of the information provided. However, little is known about how midwives communicate with their clients when it comes to recommendations about prenatal physical activity, whether it is general or specific recommendations, and about personal factors that may influence their recommendations. Objective: To present a comprehensive analysis of the existing literature on strategies used by midwives to support prenatal physical activity to their clients, focusing on the mode of communication used, the content of the recommendation provided, as well as personal factors that can influence their recommendations. Method: A scoping review was conducted to retrieve original research articles on strategies used by midwives to support prenatal physical activity, published up to May 2023 and available in English and French. The search databases included CINAHL, MEDLINE, Cochrane, Scopus, PubMed, Psychology and behavioural Sciences Collection, and APA PsycINFO. Studies that fulfilled the eligibility criteria were selected for data extraction. The main findings were organized by the mode of communication used (unidirectional and bidirectional) and the type of recommendation provided (general versus specific). Midwives' knowledge, beliefs and attitudes towards prenatal physical activity were also extracted. Results: A total of 1 307 articles were retrieved and 19 were included. The use of unidirectional mode of communication was identified in 64 %, 64 % and 14 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. The use of bidirectional mode of communication was identified in 43 %, 21 % and 7 % of the studies when it comes to provide general recommendations, specific recommendations and information on safety, respectively. Midwives had knowledge gaps about prenatal physical activity, their beliefs were not always aligned with the most recent recommendations, and they sometimes feel vulnerable in the way they support physical activity. However, they expressed the desire to improve the support they are providing. Conclusion: Results of this study highlight that when it comes to support prenatal physical activity, the unidirectional mode of communication is the most often used by midwives. Unfortunately, it is not considered effective as it does not allow discussing and explaining the information provided. Moreover, midwives exhibited some knowledge gaps about prenatal physical activity. Future work will be needed to better understand their challenges and needs in order to improve their initial training and clinical practice.