Midwives' experiences of discussing health behaviour change within routine maternity care: A qualitative systematic review and meta-synthesis

Problem: Behaviours, such as smoking, alcohol use, unhealthy diet, lack of physical activity and vaccination nonadherence may lead to adverse pregnancy outcomes. Background: Pregnancy has been identified as an opportune time for midwives to support women to make health behaviour changes. Aim: To synthesise existing qualitative research exploring midwives' experiences of discussing health behaviour change with women within routine care. Methods: A systematic search was conducted across: Maternity and Infant Care, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Applied Social Sciences Index and Abstracts. Thematic analysis was used to synthesise the data. A professional and public advisory group provided feedback during the synthesis stage. Findings: Twenty-two studies, published between 2005 and 2023, which represented findings from eight countries, were included in the review. The meta-synthesis revealed three themes: The midwife-woman relationship; Reflective and tailored behaviour change communication; Practical barriers to behaviour change conversations. This led to one overarching theme: Although midwives recognised the importance of behaviour change discussions, these conversations were not prioritised in clinical practice. Conclusion: Health behaviour change discussions were de-prioritised in midwives' clinical practice. Future research should explore intervention development to support midwives with their health behaviour change communication.