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      Understanding the pathway between work and health outcomes for women during the preconception, pregnancy, and postpartum periods through the framing of maternal obesity

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          Summary

          The link between work and health outcomes for preconception, pregnant, and postpartum (PPP) working women is complex. Further, innovation and enhanced understanding are required to address the work‐related determinants of maternal obesity. However, workplace health promotion is not typically systems‐based nor attuned to the specific needs and context of individual PPP women. We propose that to improve health outcomes for PPP women, we must understand the pathways between paid work and health for the individual woman by taking a systems‐thinking approach. In this paper, we (a) outline the rationale for why the oversimplification or “dilution” of individual context may occur; (b) present a systems‐informed pathway model (the “Context‐Exposure‐Response” Model) and overview of potential work‐related impacts on health and wellbeing outcomes for PPP women using maternal obesity to provide context examples; (c) further investigate the role of motivational factors from a systems perspective; and (d) briefly examine the implications for policy, practice, and intervention design. It is anticipated that this research may act as a starting point to assist program developers, researchers, and policymakers to adopt a systems‐focused perspective while contributing to the health improvement and obesity prevention of PPP women.

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          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            Self-efficacy: Toward a unifying theory of behavioral change.

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              The behaviour change wheel: A new method for characterising and designing behaviour change interventions

              Background Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well they serve this purpose. This paper evaluates these frameworks, and develops and evaluates a new framework aimed at overcoming their limitations. Methods A systematic search of electronic databases and consultation with behaviour change experts were used to identify frameworks of behaviour change interventions. These were evaluated according to three criteria: comprehensiveness, coherence, and a clear link to an overarching model of behaviour. A new framework was developed to meet these criteria. The reliability with which it could be applied was examined in two domains of behaviour change: tobacco control and obesity. Results Nineteen frameworks were identified covering nine intervention functions and seven policy categories that could enable those interventions. None of the frameworks reviewed covered the full range of intervention functions or policies, and only a minority met the criteria of coherence or linkage to a model of behaviour. At the centre of a proposed new framework is a 'behaviour system' involving three essential conditions: capability, opportunity, and motivation (what we term the 'COM-B system'). This forms the hub of a 'behaviour change wheel' (BCW) around which are positioned the nine intervention functions aimed at addressing deficits in one or more of these conditions; around this are placed seven categories of policy that could enable those interventions to occur. The BCW was used reliably to characterise interventions within the English Department of Health's 2010 tobacco control strategy and the National Institute of Health and Clinical Excellence's guidance on reducing obesity. Conclusions Interventions and policies to change behaviour can be usefully characterised by means of a BCW comprising: a 'behaviour system' at the hub, encircled by intervention functions and then by policy categories. Research is needed to establish how far the BCW can lead to more efficient design of effective interventions.
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                Author and article information

                Contributors
                helen.skouteris@monash.edu
                Journal
                Obes Rev
                Obes Rev
                10.1111/(ISSN)1467-789X
                OBR
                Obesity Reviews
                John Wiley and Sons Inc. (Hoboken )
                1467-7881
                1467-789X
                01 September 2023
                December 2023
                : 24
                : 12 ( doiID: 10.1111/obr.v24.12 )
                : e13637
                Affiliations
                [ 1 ] School of Health Sciences, College of Health and Medicine University of Tasmania Launceston Tasmania Australia
                [ 2 ] Health and Social Care Unit, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia
                [ 3 ] Warwick Business School University of Warwick Coventry UK
                Author notes
                [*] [* ] Correspondence

                Helen Skouteris, Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.

                Email: helen.skouteris@ 123456monash.edu

                Author information
                https://orcid.org/0000-0002-6804-2667
                https://orcid.org/0000-0002-0323-4692
                https://orcid.org/0000-0002-4990-2334
                https://orcid.org/0000-0003-4993-3963
                https://orcid.org/0000-0002-7787-7201
                https://orcid.org/0000-0001-9959-5750
                Article
                OBR13637
                10.1111/obr.13637
                10909566
                37655832
                634d2800-0ccb-4f72-9f0f-ce1eafe4d7c9
                © 2023 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 25 July 2023
                : 05 December 2022
                : 09 August 2023
                Page count
                Figures: 2, Tables: 1, Pages: 13, Words: 11920
                Funding
                Funded by: Australian Government Research Training Program (RTP) Stipend and RTP Fee‐Offset Scholarship
                Funded by: National Health and Medical Research Council (NHMRC) , doi 10.13039/501100000925;
                Award ID: GNT1171142
                Categories
                Review
                REVIEWS
                Pregnancy and Pediatrics
                Custom metadata
                2.0
                December 2023
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.8 mode:remove_FC converted:03.03.2024

                Medicine
                context,obesity,systems thinking,workplace
                Medicine
                context, obesity, systems thinking, workplace

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