Development of a resilience-enhancing intervention during and after pregnancy: a systematic process informed by the behaviour change wheel framework

BMC Psychology Van Haeken et al. BMC Psychology (2023) 11:267 https://doi.org/10.1186/s40359-023-01301-4 Open Access RESEARCH Development of a resilience-enhancing intervention during and after pregnancy: a systematic process informed by the behaviour change wheel framework Sarah Van Haeken1,2*, Marijke A.K.A. Braeken3, Antje Horsch4,5, Mirjam Oosterman6 and Annick Bogaerts2,7,8 Abstract Background Pregnancy and the transition to parenthood are accompanied by multiple changes and stress exposure. Resilience has the potential to counteract the negative impact of stress and can be a protective factor against mental health problems. To date, the use of a theoretical framework in the development or application of resilience interventions during pregnancy up to one year postpartum is missing. The aim of this study is to develop an intervention to enhance resilience for pregnant women up to one year postpartum. Methods A systematic and theory-based approach informed by the Behaviour Change Wheel framework and the theoretical model of perinatal resilience was applied. The development took place in three phases and during the process, the target group, researchers and clinicians were involved. Results A combination of resilience-enhancing exercises, group sessions and an online support platform, including follow-up at six and twelve months after delivery, was designed to enhance resilience during pregnancy and up to one year postpartum. This intervention incorporates 5 intervention functions delivered by 18 behaviour change techniques. Conclusions This study responds to the need for theory-based intervention programs aiming to enhance resilience to improve the psychological health of pregnant women. We developed a multicomponent resilience-enhancing intervention for pregnant women up to one year postpartum. Keywords Psychological resilience, Perinatal Care, Primary Prevention, Public Health, Internet-based intervention *Correspondence: Sarah Van Haeken 1 Research & Expertise, Resilient People, UC Leuven-Limburg, Wetenschapspark 21, 3590 Diepenbeek, Belgium 2 Faculty of Medicine, department of Development & Regeneration, REALIFE Research Group, Women & Child KU Leuven, Leuven, Belgium 3 Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium 4 Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland 5 Department Woman-Mother-Child, Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland 6 Department of Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands 7 Department of Nursing and Midwifery, CRIC Centre for Research & Innovation in Care, University of Antwerp, Antwerp, Belgium 8 Faculty of Health, University of Plymouth, Devon, UK © The Author(s) 2023. 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The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Van Haeken et al. BMC Psychology (2023) 11:267 Introduction Pregnancy and the transition to parenthood are potentially challenging for the pregnant woman and her partner involving changes on multiple levels that can affect their (mental) health following stress exposure [1]. Feelings of distress may be associated with biological (e.g., hormone fluctuations), physical (e.g., weight gain), social (e.g., change in social activities), and psychological changes (e.g., increased sense of responsibility) [2]. Stress has a substantial impact on the health and mental wellbeing of the individual [3]. Stress during pregnancy can have adverse effects on the woman herself, and can negatively affect pregnancy outcomes, infant health, postpartum mother-child interaction, and child development [3–5]. Characteristics of resilience and resilience-promoting mechanisms may counteract the negative impact of stress and have been linked to lower levels of anxiety and depressive feelings in the general population [6, 7]. Within the perinatal context, resilience is described as a multi-factorial construct influenced by individual, sociocultural, and environmental factors [8]. A concept analysis and Delphi Survey of Van Haeken et al. (2020) [9] defined perinatal resilience for the first 1,000 days as: Perinatal resilience is a circular process toward a greater wellbeing in the form of personal growth, family balance, adaptation, or acceptance, when faced with stressors, challenges, or adversity during the perinatal period. The presence of resiliency attributes such as social support, sense of mastery, selfefficacy, and self-esteem enhance the capacity to be resilient and prevent mental health problems (p. 9). The perinatal period provides opportunities to promote mental health and resilience of future parents and, consequently, prevent the intergenerational transmission of stress and psychopathology in the next generation [10]. There is a clinical need for intervention programs aiming to enhance resilience by skill training and the application of evidence based tools [5, 11]. Previous meta-analyses of randomised and non-randomised controlled trials report positive intervention effects for increasing resilience in both clinical and non-clinical populations, such as college students and intensive care nurses [12, 13]. Although these interventions share the common aim to enhance resilience or resilience resources, they differ in terms of setting, outcome, content, format and length, which complicates evaluation [13–16]. Another limitation is the under-use of theoretical frameworks in intervention design [13, 14, 17]. The Medical Research Council (MRC) emphasizes the importance of using a theoretical framework in intervention development, resulting in interventions that are more likely to be successful [18]. The use Page 2 of 11 of theory also promotes evaluation, making it possible to elucidate why and how different components of an intervention contribute to the overall effectiveness (...truncated)