Pregnancy Activity Levels and Impediments in the Era of COVID-19 Based on the Health Belief Model: A Cross-Sectional Study

Abstract

Physical activity (PA) and exercise benefit both the mother and the fetus. Many pregnant women avoid or severely limit PA, leading to complications before and after delivery. This study elucidated the precise effect of each moderator variable on prenatal physical activity (PPA) by examining demographic factors, the PPA-related health belief level (HBL), and the current PPA level. The health belief model (HBM) in conjunction with the international prenatal physical activity questionnaire was used. The HBL in pregnant parous women (PPW) (3.42) was significantly higher than that in nonpregnant nulliparous women (NNW) (3.06). The PPA level in pregnant nulliparous women (PNW) (5.67 metabolic equivalent-hours per week (MET-h/week)) was lower than in the PPW (6.01 MET-h/week). All HBM dimensions (except for perceived barriers) were positively correlated with exercise expenditure in both PNW and PPW. According to the regression tree, participants in PNW aged ≤ 23 years with annual household incomes > CNY 100,001−150,000 had the highest energy expenditure (10.75 MET-h/week), whereas participants in PPW with a perceived benefit score of >4 had the highest energy expenditure (10 MET-h/week). The results demonstrated that the HBL in all groups was acceptable, whereas the PPA level was lower than the recommended PA level. In both PPW and PNW, the HBL was most strongly correlated with exercise expenditure. There is an urgent need to organize public-interest courses to alleviate household expenditure, raise the HBL about PPA in pregnant and NNW, and ensure personal health in the context of COVID-19.

Keywords: health belief level; health-belief model; individual perception; pregnant women; prenatal physical activity.

Figure 1

Health belief model (HBM) path diagram and the standardized path coefficient. PS: perceived susceptibility; PS*: perceived severity; HM: health motivation; PB: perceived benefits; PB*: perceived barriers; S-E: self-efficacy; CtA: cues to action; HBM: health belief model.

Figure 2

Comparison of health belief dimensions among nonpregnant, pregnant nulliparous, and pregnant parous women. Note: PPW: pregnant parous women; PNW: pregnant nulliparous women; Non-PNW: nonpregnant nulliparous women; ** p < 0.01; * p < 0.05.

Figure 3

Mean difference in physical activity expenditure between pregnant nulliparous and pregnant parous women. Note: MET-h/week: metabolic equivalent-hours per week; PPW: pregnant parous women; PNW: pregnant nulliparous women; * p < 0.05.

Figure 4

Heat maps of the Pearson correlation of demographic and health belief model (HBM) dimensions and prenatal physical activity. The pregnant nulliparous group is shown in the first map, and the pregnant parous group is shown in the second map. PS: perceived susceptibility; PS*: perceived severity; HM: health motivation; PB: perceived benefits; PB*: perceived barriers; BMI: body mass index; ToP: trimester of pregnancy; Edu: participant’s education background; Edu*: spouse’s education background; ***: significant correlation at p < 0.001; **: significant correlation at p < 0.01; *: significant correlation at p < 0.05. A darker color indicates a stronger association and vice versa; red is positively correlated, whereas blue is negatively correlated.

Figure 5

Heat maps of the Pearson correlation of demographic and health belief model (HBM) dimensions. The pregnant nulliparous group is presented in the first map. The pregnant parous group is shown in the second map. PS: perceived susceptibility; PS*: perceived severity; HM: health motivation; PB: perceived benefits; PB*: perceived barriers; Edu: participant’s education background; Edu*: spouse’s education background; BMI: body mass index; ToP: trimester of pregnancy. ***: significant correlation at p < 0.001; **: significant correlation at p < 0.01; *: significant correlation at p < 0.05. A darker color indicates a stronger correlation and vice versa; red is positively associated, whereas blue is negatively associated.

Figure 6

The classification and regression tree illustrated the predicted values of physical activity level in pregnant nulliparous women. Note: The values in the rectangle indicate the amount of energy expenditure (metabolic equivalent (MET)-hours per week) and the percentage of the samples taken.

Figure 7

The classification and regression tree illustrated the predicted values of physical activity level in pregnant parous women. Note: The values in the rectangle indicate the amount of energy expenditure (in MET-h/week) and the percentage of the samples taken.