The communication behaviours used by midwives in health behaviour change interactions in the antenatal booking appointment: A qualitative non-participant observation.

OBJECTIVE: Pregnant women are often motivated to improve their health behaviours; however, sub-optimal health behaviours remain prevalent. Midwives are ideally placed to support women to achieve positive change, with effective communication fundamental to support this change. To date, no research has explored how midwives communicate with pregnant women about health behaviours. The study aim was to observe midwives' communication behaviours when discussing health behaviour change in the antenatal booking appointment. METHODS: Qualitative non-participant observations of 21 booking appointments were conducted. The researcher was present, took field notes and used the Behaviour Change Counselling Index (BECCI). Observations were audio-recorded and transcribed, and analysed using qualitative inductive content analysis. RESULTS: Health behaviour change was routinely discussed in the booking appointment, but to varying extents. BECCI scores indicated that behaviour change counselling was conducted "To some extent". Qualitative content analysis of midwives' communication behaviours revealed that midwives were skilful behaviour change communicators, able to knowledgably provide information, individualise support and navigate sensitive topics. However, some of their communication behaviours suggested that pregnancy health behaviour taboos persist, specifically relating to typically stigmatised behaviours, such as; weight management, alcohol and substance use, mental health and partners' smoking. With these behaviours, midwives often acknowledged the delicate nature of the topic, focused on risk avoidance in favour of health promotion and overlooked women's disclosures. CONCLUSION: Health behaviour change is routinely and skilfully discussed in the antenatal booking appointment. However, there are opportunities to improve midwives' communication when discussing certain health behaviours, so that midwives may continue to positively improve the health of women and their families. PRACTICE IMPLICATIONS: Educational interventions underpinned by psychological theory may be an effective way to support midwives to communicate about stigmatised health behaviours without assumptions, with a focus on positive health promotion and capitalising on women-initiated conversations where motivation may be high.