Supporting health behaviors in migrant women after childbirth with special emphasis on mHealth: An interview study with health care professionals

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The time after childbirth is considered an important period for health behavior change and mobile health (mHealth) interventions have shown promise in influencing health behaviors. Health care professionals have an important role in providing support for health behaviors and implementing mHealth tools in clinical care. This study therefore examined health care professionals’ experiences of health behavior promotion in migrant women and the potential for an mHealth intervention to improve health behaviors after childbirth. Twenty health care professionals in Sweden participated in individual semi-structured interviews. The informants had different professional backgrounds, ages, working experiences and all were females. Data was analyzed using thematic analysis and three main themes were generated. The first theme “Priorities and routines of health behavior promotion after childbirth” described a lack of priority for health behavior promotion after childbirth. The second theme “Social influences of health behaviors” described several factors that influenced possibilities of healthy behaviors after childbirth. In the third theme “mHealth in supporting health behaviors after childbirth”, informants stressed that a culturally appropriate smartphone app with reliable information had the potential to promote health behaviors after childbirth although further research is needed. Diet immigrant health physical activity practitioners qualitative study telemedicine Figures Figure 1 Introduction Europe hosts many international migrants, with about 15% of the adult population born in a different country from where they currently reside (hereafter referred to as migrants) ( 1 ). In Sweden, about 20% of the whole population and 25% of women of childbearing age are foreign-born ( 2 ). Thus, migrant health is a crucial public health priority that affects millions of people globally including in Europe ( 3 – 5 ). Migrant women often face significant challenges in accessing healthcare services and achieving optimal health outcomes, including their reproductive health, compared to native-born women ( 5 – 9 ). Nevertheless, it is important to note that migrants are a highly heterogeneous group. Factors such as socioeconomic and educational status, reason for migration, language barriers, the length of time spent in the new country and health behaviors may significantly influence health outcomes ( 4 – 6 ). Hence, it is important to understand the factors that may contribute to poorer health and health behaviors among migrant women in high-income countries. The period after childbirth is considered important for the future health of the mother ( 10 , 11 ). For instance, weight retention and changes in diet quality after childbirth have been associated with a higher risk of obesity and cardiovascular disease risk later in life ( 12 – 15 ). Thus, this period offers an opportunity for health behavior change and multiple studies show that various interventions could promote healthy body weight, diet and physical activity after pregnancy ( 11 , 16 , 17 ). Studies have also shown the promise of mHealth interventions such as smartphone apps to promote healthy behaviors and weight gain during pregnancy ( 18 ). However, there is a limited body of research about promoting health behaviors after childbirth through mHealth within health care ( 11 , 17 ) especially in migrant women ( 19 ). Thus, there is a need for adapted and culturally appropriate mHealth tools to support healthy lifestyle behaviors in migrant women after childbirth and to examine the effectiveness of such tools. Health care professionals have an essential role in supporting healthy lifestyle behaviors in clinical care ( 20 , 21 ) and in the implementation of mHealth tools into clinical practice ( 22 ). However, to the best of our knowledge, no previous study has explored the perspectives from health care professionals regarding the potential of an mHealth intervention to promote health behaviors in migrant women after childbirth. This study therefore aimed to examine Swedish health care professionals’ experiences of health behavior promotion in migrant women and the possibilities and requirements for an mHealth intervention to improve health behaviors after childbirth. Material and methods Study Design This qualitative study is part of the PRIMI (Promoting Reproductive health In MIgrant women) project which aims to develop and evaluate an mHealth intervention to promote healthy lifestyle behaviors in migrant women after childbirth. The study was executed according to the COnsolidated criteria for REporting Qualitative (COREQ) research checklist ( 23 ). Ethical approval for the study was granted from the Swedish Ethical Review Authority (reference number: 2022-06733-01) and all study procedures were conducted in accordance with the Declaration of Helsinki Study setting and recruitment This study was conducted within the health care setting in Sweden including maternity clinics, health care centers and public health units. The study included four different health care regions in Sweden, each with a highly diverse population in terms of birth regions and educational backgrounds, encompassing both rural and urban areas. Purposive sampling was used to recruit health care professionals within these four health care regions to obtain a variety of occupational and professional experience and expertise. Inclusion criteria were health care professionals with experience in health promotion after childbirth in migrant women. These inclusion criteria were set to recruit informants with various professions, age, and experiences. Eligible informants were recruited by MS (Maryam Shirvanifar), AL (Alice Lindh) and KA (Kajsa André) and ML (Marie Leksell). Forty-three professionals were invited to participate. They received information about the study by e-mail prior to interviews, had the opportunity to raise questions, and were informed about the aim of the study and confidentiality. Those who were interested in participating registered their interest by email. Five declined to participate due to lack of time and 18 did not respond. None of the interviewers knew the informants before the study. The final study population therefore consisted of 20 health care professionals with a wide range of health professions (including midwife, dietician, medical doctor and health communicator (Table 1 ). Their ages ranged from 28 to 68 years and their work experience ranged from 2 to 38 years. Table 1 Characteristics of the informants. Informant Profession Clinical experience A Midwife 20 years B Healthcare administrator 4 years C Dietician 37 years D Midwife 26 years E Dietician 2 years F Healthcare strategy manager 8 years G Medical doctor 5 years H Psychologist 24 years I Dietician and operations manager 9 years J Specialist doctor 30 years K Midwife 15 years L Midwife 8 years M Midwife 6 years N Midwife 28 years O Manager for healthcare administration 38 years P Health communicator 15 years Q Psychotherapist 23 years R Health communicator 16 years S Psychologist 16 years T District nurse 12 years Data collection An interview guide with semi-structured questions (Supplementary information) was developed by the authors, based on prior research and clinical experiences. The interview guide contained questions regarding the health professionals’ perceptions of possibilities and challenges in promoting health in migrant women after childbirth as well as the requirements and potential of an mHealth intervention. At the end of the interview, informants were given the opportunity to provide additional information. The interview guide was tested in two pilot interviews and minor revisions regarding the formulation of some follow up questions were made after these interviews. The two pilot interviews were included in the analysis. All interviews were conducted in February and March 2023. Each informant was interviewed individually one time by MS, KA or AL. A total of nine interviews were conducted in person at a location selected by the informant (e.g. workplace or meeting room at a university) and eleven interviews were conducted via video call in the Zoom application. The interviews were audio recorded with a dictaphone and no video recordings were made. The duration of the interviews ranged from 23 minutes to 109 minutes (median: 57.5 minutes). Notes were taken during all interviews, and reflective notes were written immediately after each interview. Interviews were transcribed by a professional transcription company. The research team comprised two female PhD students: MS, a registered dietician born outside Sweden with a master’s degree in international health, and ML, a medical specialist in orthopedics with a migrant background and previous experience in research. In addition, two female medical students (AL and KA) participated in the development of the interview guide and data collection process. The team also included a female associate professor (UM) with expertise in qualitative methodology and a female associate lecturer (JW) with wide experience in promoting migrant health and expertise in qualitative methodology. The principal investigator of the project was a male associate professor (PH) with previous experience in promoting health related to pregnancy and developing mHealth interventions including those targeting migrants. Data Analysis Inductive thematic analysis, as defined by Clarke and Braun ( 24 ) was used to analyze the data. Initially, agreement was verified between transcriptions and audio recordings. Potentially identifying details were changed or removed, and all informants were given pseudonyms to ensure confidentiality. The systematic thematic analyses involved an iterative process between the following steps: 1) Familiarization with the data: MS and AL listened to all audio files and read the respective transcripts several times. Overall impressions, ideas and thoughts were noted. 2) Developing initial codes: MS and AL independently identified 'meaning units'—specific pieces of text or data that encapsulate a single idea or concept pertinent to the research aim. These initial meaning units were then used to derive initial codes. After individual coding, the codes were compared and discussed. A joint set of codes was then systematically assessed across all transcripts. 3) Searching for patterns: the codes generated were organized into potential coding patterns and thereafter potential themes by MS and UM. 4) Mapping and building themes: themes were checked against the codes and refined during continuous discussions led by MS and validated by UM and PH. The themes were further organized and refined until consensus was reached. 5) Defining and naming the themes: final themes were reached during joint discussions with all authors. Results Three main themes emerged from the data: 1) Priorities and routines of health behavior promotion after childbirth, 2) Social influences on health behaviors 3) mHealth in supporting health behaviors after childbirth, as presented in Fig. 1 . Priorities and routines of health behavior promotion after childbirth Different aspects of priorities regarding health promotion targeting migrant women were revealed. One central aspect that was highlighted concerned priorities in resources and services. The informants claimed that care after childbirth risks falling between the cracks when it comes to health promotion. They explained that there is an uncertainty regarding who is responsible for health promotion since the care is shared between different professions within healthcare (e.g. midwives, physicians, nurses, dieticians, health coordinators) and sectors of healthcare. “The postpartum period tends to be a kind of no-man's land. There are many discussions at a strategic level. Who owns the question? It usually lands on which primary care you choose. There everyone looks at each other and wonders why we should work with healthy women.” Informant “F” Informants also believed that the lack of priority for health behavior promotion after childbirth also influenced the routines for such promotion. Thus, the informants expressed that the health care system in Sweden has a variety of routines for care after childbirth, but there is a lack of general routine monitoring of health behaviors of mothers after childbirth. Limited time in the meetings and shortages of staff were perceived to lead to the down-prioritizing of preventive care and healthy lifestyle advice. Informants also explained that available routine checkups after childbirth are not adopted nor tailored specifically for the migrant women. The informants suggested that some migrant women may need extended resources and services like using interpreters, pictures and translated brochures in order to fully access and benefit from healthcare services. According to some informants, such customized support may be difficult to provide since it is time-consuming. “I think it will be difficult for healthcare to provide /.../ It will probably take too much time to give individual advice to everyone.” Informant “E” Furthermore, informants pointed out that shortcomings related to priorities and routines of health behavior promotion after childbirth might lead migrant women to seek information from other sources. These sources can include unverified internet sites, social media, or non-professionals around them, which are not always reliable and may lead to the uptake of inaccurate or potentially harmful advice. “Then you seek information from people they know around you. Unfortunately, it can also happen that one receives incorrect information.” Informant “M” Some suggestions for improving the priorities and routines of health behavior promotion after childbirth for migrant women were given. Communication between migrant women and healthcare workers could be improved through targeted cultural education for the healthcare staff. Improved communication between health care staff and patients was considered to enhance mutual understanding and trust and increase the chance of providing information in a personalized manner. Further, healthcare professionals with a migrant background could be important resources to assist or educate their colleague if they have the same cultural background and speak the same language as the patient. “All of them [migrant health professionals] have been new in the country themselves and are language carriers. They have a large network of people that have migrated who have cultural competence in how to best convey information to a person with a different cultural background from Swedish. It's an incredible resource.” Informant “B” Social influences of health behaviors The informants believed that several factors linked to the social determinants of health affect health behaviors in migrant women. These factors were knowledge and language proficiency, economy, social network, and the prerequisites and transition of health behaviors in the migration process. All these factors were considered important and influenced the work toward promoting health behaviors in migrant women after childbirth. Language barriers and lack of knowledge about the importance of health behaviors and where to seek help in the healthcare system were seen as a factors that might reduce the opportunities for adopting healthy behaviors. Furthermore, diverse educational backgrounds of migrant women were thought to complicate meeting specific needs. “It can be difficult to really give that knowledge so that they can adapt it individually to their own lives. Then it easily becomes one-fits-all advice. And that's probably where it might become too generic and then it doesn't fit and then you renounce it completely.” Informant “E” Successful attempts for improving the knowledge in migrant women and minimize the language barriers are ongoing within healthcare. The informants explained that the family centers for instance, have groups in different languages, like “ mother-baby Swedish classes ” to provide comprehensive information for migrant women. These family centers also have health promotion sessions, talking about diet and physical activity in their own language, but they are not specifically for the period after childbirth. "At the family center, where they have had mother-baby Swedish classes for women who are at home with their babies. And there, we have had themes such as diet and physical activity. Such occasions should be held more often. And especially in their native tongue, so there will be a dialogue, a discussion around it.” Informant “P” The economy was suggested to play a significant role in some migrant women’s lifestyle choices. Maintaining a healthy and balanced diet with nutritious foods like fresh produce, whole grains, and low-sugar options is costly. Despite the large heterogeneity in the migrant population, many migrant families live on low incomes, and larger families face even greater challenges. This also applies to the possibilities of engaging in physical activities, as a gym membership, or suitable sportswear are also costly. “There I also believe that the economy serves as an obstacle. /.../ Yes, it does /.../ It is an obstacle if there are many people in the family. Even if you know how to do it.” Informant “I” Belonging to a group or a social network was another aspect of importance related to health promotion targeting migrant woman. The informants pointed out the “ sistership ” between migrant women and believed using these networks with a focus on promoting a healthy lifestyle would be motivating to make changes. Observing fellow members engaging in exercise for example, could serve as a motivational catalyst, generating a positive domino effect according to our informants. “You take after one another. If you see that there are others around you doing it, then it becomes that you can do it and must also do it.” Informant “P” Further, the influence of migrant women’s backgrounds on health behaviors was raised. This includes the transitioning from habits in their birth countries to those in their new home country, which may not always be the same. “I come from another country and the cultural thing is that you should preferably be at home 40 days after you have had a baby /.../ Then I met someone I knew, that thought that it was very strange. “What are you doing outside? You should be at home. You should not go out at all, you should be at home.” Informant “P” mHealth in supporting health behaviors after childbirth The informants believed that a smartphone app could possibly support the provision of health information in an accessible language and help users set goals for their progress in promoting lifestyle habits. They thought that an app could be beneficial for migrant women to easily access health advice. Furthermore, informants suggested such an app should contain accurate and accessible educational modules about the human body, nutrition, physical activity, and the impact of a healthy lifestyle on health, with well-translated explanations and helpful visuals for easy comprehension. The need for reliable information was stressed. “I see benefits in referring to something that has reliable information.” Informant “E” Further, the importance of a user-friendly and easy to use smartphone app was highlighted. To involve and engage women with limited literacy skills, informants suggested incorporating videos, images and an audio feature for listening to information instead of reading it. The lack of time due to family commitments was seen as a common reason migrant women were unable to attend physical appointments. The possibility of getting information through a smartphone app was seen as a way to improve accessibility to health information and promotion. “The women can watch for themselves at home while they are on their phones and looking for knowledge, when they have time. All that we don't have time for here (maternal health center). They can get what we present here themselves.” Informant “N” Features like the active input of personal data like body weight or blood sugar were assumed to enhance the relationship-building with health care professionals for migrant women and to engage them in monitoring their own health. Informants explained that some migrant women would probably appreciate receiving advice anonymously, in order to seek help or find reliable information without telling anyone or without visiting healthcare. Further, motivating notifications and an awarding system like getting stars or medals, with achievable challenges (e.g. short walks with health advice about its advantages) and daily advice were mentioned and seen as beneficial for using the app regularly. “So, I think you could probably click there for notifications. Now, you should go for a 30-minute walk.” Informant “K” Finally, informants described that using relatable images of people from similar backgrounds and recommendations in the form of familiar healthy foods that migrant women can relate to, were considered to make the smartphone app more inclusive and culturally appropriate which in turn may enhance the engagement levels. “Adapted to their cultural background, not Swedish information translated into Arabic; someone who knows how their regular diet looks, something confirmed by people who know what they are talking about regarding lifestyle.” Informant “E” Discussion This qualitative study examined health care professionals’ experiences of health behavior promotion in migrant women and the possibilities and requirements for an mHealth intervention to improve health behaviors after childbirth. We found that the informants experienced a lack of priorities and routines for promoting health behaviors after childbirth which was a major challenge. Furthermore, although informants highlighted the heterogeneity in the migrant population, they also experienced that several factors such as knowledge and language proficiency, economy and social networks influenced the possibilities of having healthy behaviors after childbirth. Finally, they believed that a culturally appropriate smartphone app with reliable information has the potential to promote health behaviors after childbirth. A significant finding in our study was that the informants reported an absence of prioritization and established routines for monitoring and promoting health behaviors after childbirth for mothers, including migrant women. This is critical as the period after childbirth represents a crucial phase for promoting health behaviors, particularly in terms of diet and physical activity ( 11 , 16 , 17 ). According to the informants, women require robust familial and social support to manage their weight, adopt a healthy diet, and engage in physical activities during this time. Addressing these challenges and actively promoting health behaviors and healthy body weight among women after childbirth may reduce the risk of negative health outcomes such as obesity and cardiovascular disease later in life ( 12 – 15 ). Cultural competence which is a term commonly used in the healthcare context ( 25 ), has been defined as “a set of congruent behaviors, attitudes and policies that enables healthcare workers to work and communicate effectively and appropriately in cross-cultural situations( 25 , 26 ) The informants believed that the cultural competence of the healthcare system could be enhanced by taking advantage of the diverse backgrounds of the health care professionals within the system. Further, they believed that such awareness was important to tailor health behavior promotion to better meet the specific needs of migrant women. Previous studies examining reproductive health in migrant women have also suggested the cultural competence training is important for understanding diverse perspectives and cultural norms to facilitate effective and empathic communication ( 27 , 28 ). The informants pointed out several other factors they believed influenced health behaviors, although they also highlighted the heterogeneity within the population of migrant women. For instance, they mentioned that language barriers, lack of knowledge about the importance of health behaviors, and uncertainty about where to seek help in the healthcare system seem to influence migrant women’s ability to adopt a healthy lifestyle. This is in line with several previous studies highlighting linguistic challenges as a barrier to delivering adequate and equitable healthcare to migrant women ( 27 , 29 – 31 ). In a review focusing on migrant women in Europe and their need for pregnancy-related care, a common theme across most studies was the issue of insufficient information and communication which could influence access to maternity services ( 32 ). Previous studies suggest that lack of knowledge about the importance of health behaviors( 29 , 33 ) and where to seek help in the health care system( 28 ) might reduce health-seeking behavior, which in turn may limit the opportunities to receive health behavior promotion within clinical care. Economy was another factor mentioned by the informants as significant in adapting health behaviors like a healthy diet and physical activity which is relevant since income/economy is well-recognized as a social determinant of health ( 34 ). Informants believed a smartphone app had potential to promote a healthy diet and physical activity after childbirth, either independently or in combination with physical meetings. They also noted that the app could provide accessible, reliable, evidence-based information in multiple languages. To the best of our knowledge, no previous qualitative study has explored the potential of an mHealth intervention to promote health behaviors in migrant women after childbirth. However, our results may be compared to such studies during pregnancy. One study reported that additional methods of information delivery methods (such as audio or video-files) may be useful for the creation of a smartphone app accessible to a diverse range of women ( 28 ). Furthermore, a review of pregnancy apps, with emphasis on culturally and linguistically diverse women, highlighted the need for reliable information from credible source as well as the importance of representing women with diverse backgrounds to ensure inclusivity ( 35 ). These aspects will be relevant to consider when developing a smartphone app to promote health behavior in migrant women after childbirth. Furthermore, future development should consider participatory design including the target group (i.e. migrant women after childbirth) ( 36 ) to inform the design of such a smartphone app. It is also important to consider person-centered care, cultural sensitivity, and health literacy responsiveness in the app's development. Finally, although the informants observed potential for smartphone app interventions to promote health behaviors in migrant women after childbirth, future studies are warranted to evaluate the effectiveness of such interventions. Additionally, future studies should explore the perceptions of migrant women to ensure the app meets their needs and preferences. Methodological considerations A qualitative design ( 37 ) was considered advantageous in gaining comprehensive insights into the perspectives of healthcare professionals about promoting a healthy lifestyle among migrant women. Several procedures were taken to fulfil the quality criteria for qualitative research; dependability, credibility and transferability to verify trustworthiness. To attain dependability, the research process was clearly described and reported ( 38 ) and the COREQ checklist was followed. We used a semi-structured interview guide for systematic data collection ( 39 ) and followed Clarke and Braun’s stages for thematic analysis ( 24 ) facilitating a structured and systematic process. The sample size was based on data saturation ( 40 ) and accordingly, data collection was finalized when we believed that the data reached satisfactory depth and complexity to answer the research questions. The credibility of the data analysis was enhanced by investigator triangulation ( 37 ) involving independent coding of the data by two researchers followed by rigorous discussions of the themes with the research team. In addition, to ensure transparency, excerpts from the transcribed texts are included as representative quotations ( 39 ). The data were collected from informants from four different healthcare regions in Sweden who had experience working with migrant women. Including diverse professions, ages and clinical experiences enriched the data with different perspectives. Furthermore, some informants were born outside Sweden, offering valuable insights relevant to the aim of the study. While the transferability of results to other regions may vary, depending on how care is organized, we consider the findings applicable to developing mHealth interventions to improve health behaviors after childbirth in similar settings. Noteworthy, our study had some important limitations to consider. Informants were purposefully recruited and were only female. The uneven distribution of men and women might limit the diversity of perspectives and experiences in our data. However, this is reflective of the maternal care profession in Sweden, for instance only 0.3% of midwives in Sweden were male in 2019 ( 41 ). Another possible limitation is the relatively small sample although we met saturation. Finally, this study solely explored healthcare professionals’ experiences of health behavior promotion in migrant women after childbirth. Although the perspectives of health care professionals are essential to improve clinical care, future studies within this project (the PRIMI project) will examine the corresponding perspectives of migrant women to ensure that all perspectives are comprehensively examined. Conclusion There is a lack of priorities and routines for health behavior promotion after childbirth in migrant women and cultural competence may improve such health promotion. Furthermore, several factors such as knowledge and language proficiency, economy and social networks may influence the possibilities of having healthy behaviors after childbirth although there is considerable heterogeneity within the migrant population. Finally, informants believed that a culturally appropriate smartphone app with reliable information might have the potential to promote health behaviors after childbirth. However, further studies are warranted to examine the effectiveness of such an mHealth intervention to promote health behaviors in migrant women after childbirth. Declarations Acknowledgements We would like to thank all our informants for participating in our interview study and sharing their experiences with us. We want to especially thank Emira Bajric and Malin Creutz for their help with recruitment and Marie Leksell and Kajsa Andre for their help with data collection. Authors' contributions PH conceptualized the research idea and obtained funding. MS, AL, JW, UM and PH contributed to the study design and interview guide. MS and AL conducted the interviews and derived initial codes. MS analyzed the qualitative data and derived themes with assistance from UM and PH. MS drafted the manuscript with assistance from UM and PH which was critically reviewed by AL and JW. All authors approved the final version of the manuscript and the decision to submit it for publication. Competing interests The authors declare no competing interests. Funding This study was supported by a grant from the Swedish Research Council (2021-00915). Availability of data and materials To safeguard the identities of informants, complete data (transcribed interviews and audio files) will not be made available to the public. However, transcribed interviews may be available from the corresponding author on reasonable request. Ethics approval The study was approved by the Swedish Ethical Review Authority (reference number: 2022-06733-01). The informants provided their informed consent prior to interviews. References European Commission. Statistics on migration to Europe. Available from: https://commission.europa.eu/strategy-and-policy/priorities-2019-2024/promoting-our-european-way-life/statistics-migration-europe_en (accessed November 22, 2024). Statistics Sweden. Utrikes födda i Sverige (Foreign-born in Sweden). 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Naturalistic Inquiry. 1st ed. Beverly Hills, CA: Sage Publications; 1985. Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract. 2018;24:120-124. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893-1907. Vårdfokus (Health care focus). Available from: https://www.vardfokus.se/nyheter/allt-farre-man-blir-barnmorskor (accessed November 22, 2024). Additional Declarations No competing interests reported. Supplementary Files Supplementaryinformation.pdf Cite Share Download PDF Status: Published Journal Publication published 17 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 23 Jan, 2025 Reviews received at journal 21 Jan, 2025 Reviews received at journal 20 Jan, 2025 Reviewers agreed at journal 12 Jan, 2025 Reviewers agreed at journal 11 Jan, 2025 Reviewers invited by journal 11 Dec, 2024 Editor assigned by journal 11 Dec, 2024 Editor invited by journal 02 Dec, 2024 Submission checks completed at journal 29 Nov, 2024 First submitted to journal 29 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5547734","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":397704498,"identity":"99f049db-eb4b-4cd7-808d-36b6949df9e2","order_by":0,"name":"Maryam Shirvanifar","email":"","orcid":"","institution":"Linköping University","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Shirvanifar","suffix":""},{"id":397704499,"identity":"f3551572-4d68-42ff-82b7-f2076fdad92b","order_by":1,"name":"Ulrika Müssener","email":"","orcid":"","institution":"Linköping University","correspondingAuthor":false,"prefix":"","firstName":"Ulrika","middleName":"","lastName":"Müssener","suffix":""},{"id":397704500,"identity":"0a103031-db78-41ff-bc11-de107bd0be1d","order_by":2,"name":"Alice Lindh","email":"","orcid":"","institution":"Linköping University","correspondingAuthor":false,"prefix":"","firstName":"Alice","middleName":"","lastName":"Lindh","suffix":""},{"id":397704501,"identity":"5351c1e9-bc42-4009-b512-2ae7f096b054","order_by":3,"name":"Josefin Wångdahl","email":"","orcid":"","institution":"Karolinska Institutet and Stockholm University","correspondingAuthor":false,"prefix":"","firstName":"Josefin","middleName":"","lastName":"Wångdahl","suffix":""},{"id":397704502,"identity":"e7b874ae-7202-4e7e-816b-7d70872646e1","order_by":4,"name":"Pontus Henriksson","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIie2QsQrCMBCGIwW7VFxbBH2FlA5F8GG8xUlcXJxipNCp4tqivkN9AhsydBFnxcXi6qB7B5M6OaTi5pBvuIRwH/9dENJo/pihLIzKagY0+9LdoJ+KxX5Qqhuygdb2++Yyv1klmrQ7y4LFJen6TrHgFiJdldKPjhC0QjR1Njlmu5B7/TVQoXBPpeDT2A1aFEF6GiFW0AzSS6VkyvEqRQwGe6lcSwLpmUmFzOuVpkixhZI2DRHXkIoxVO9ycJNtaEMsUxKxCz4AZRvMXVWKb0b4cS8HsIpHxjMSP4Zzzh/3Gekp138ftuK9RtFoNBpNDS+rvWHlJS7RrgAAAABJRU5ErkJggg==","orcid":"","institution":"Linköping University","correspondingAuthor":true,"prefix":"","firstName":"Pontus","middleName":"","lastName":"Henriksson","suffix":""}],"badges":[],"createdAt":"2024-11-29 09:08:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5547734/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5547734/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-01147-3","type":"published","date":"2025-05-17T15:57:25+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73310951,"identity":"6ef7f9b8-c5c1-4289-b6ac-3108c24e2ff4","added_by":"auto","created_at":"2025-01-08 18:09:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55860,"visible":true,"origin":"","legend":"\u003cp\u003eThemes from thematic analysis\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5547734/v1/7f4404b58b4fc6f85809c91f.png"},{"id":83067914,"identity":"5b4bf9e4-a699-4bba-845a-7da9d680bb8a","added_by":"auto","created_at":"2025-05-19 16:08:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":654065,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5547734/v1/38904809-91c6-4227-b284-07b59cf5e137.pdf"},{"id":73310952,"identity":"8f75d56c-625c-4578-a7b5-81cfd96150e6","added_by":"auto","created_at":"2025-01-08 18:09:36","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":53418,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryinformation.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5547734/v1/3f29f9be00cd1a2d61f5af02.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Supporting health behaviors in migrant women after childbirth with special emphasis on mHealth: An interview study with health care professionals","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEurope hosts many international migrants, with about 15% of the adult population born in a different country from where they currently reside (hereafter referred to as migrants) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In Sweden, about 20% of the whole population and 25% of women of childbearing age are foreign-born (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Thus, migrant health is a crucial public health priority that affects millions of people globally including in Europe (\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Migrant women often face significant challenges in accessing healthcare services and achieving optimal health outcomes, including their reproductive health, compared to native-born women (\u003cspan additionalcitationids=\"CR6 CR7 CR8\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Nevertheless, it is important to note that migrants are a highly heterogeneous group. Factors such as socioeconomic and educational status, reason for migration, language barriers, the length of time spent in the new country and health behaviors may significantly influence health outcomes (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Hence, it is important to understand the factors that may contribute to poorer health and health behaviors among migrant women in high-income countries.\u003c/p\u003e \u003cp\u003eThe period after childbirth is considered important for the future health of the mother (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). For instance, weight retention and changes in diet quality after childbirth have been associated with a higher risk of obesity and cardiovascular disease risk later in life (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Thus, this period offers an opportunity for health behavior change and multiple studies show that various interventions could promote healthy body weight, diet and physical activity after pregnancy (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Studies have also shown the promise of mHealth interventions such as smartphone apps to promote healthy behaviors and weight gain during pregnancy (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). However, there is a limited body of research about promoting health behaviors after childbirth through mHealth within health care (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) especially in migrant women (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThus, there is a need for adapted and culturally appropriate mHealth tools to support healthy lifestyle behaviors in migrant women after childbirth and to examine the effectiveness of such tools. Health care professionals have an essential role in supporting healthy lifestyle behaviors in clinical care (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) and in the implementation of mHealth tools into clinical practice (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). However, to the best of our knowledge, no previous study has explored the perspectives from health care professionals regarding the potential of an mHealth intervention to promote health behaviors in migrant women after childbirth. This study therefore aimed to examine Swedish health care professionals\u0026rsquo; experiences of health behavior promotion in migrant women and the possibilities and requirements for an mHealth intervention to improve health behaviors after childbirth.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis qualitative study is part of the PRIMI (Promoting Reproductive health In MIgrant women) project which aims to develop and evaluate an mHealth intervention to promote healthy lifestyle behaviors in migrant women after childbirth. The study was executed according to the COnsolidated criteria for REporting Qualitative (COREQ) research checklist (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Ethical approval for the study was granted from the Swedish Ethical Review Authority (reference number: 2022-06733-01) and all study procedures were conducted in accordance with the Declaration of Helsinki\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting and recruitment\u003c/h3\u003e\n\u003cp\u003eThis study was conducted within the health care setting in Sweden including maternity clinics, health care centers and public health units. The study included four different health care regions in Sweden, each with a highly diverse population in terms of birth regions and educational backgrounds, encompassing both rural and urban areas. Purposive sampling was used to recruit health care professionals within these four health care regions to obtain a variety of occupational and professional experience and expertise. Inclusion criteria were health care professionals with experience in health promotion after childbirth in migrant women. These inclusion criteria were set to recruit informants with various professions, age, and experiences. Eligible informants were recruited by MS (Maryam Shirvanifar), AL (Alice Lindh) and KA (Kajsa Andr\u0026eacute;) and ML (Marie Leksell). Forty-three professionals were invited to participate. They received information about the study by e-mail prior to interviews, had the opportunity to raise questions, and were informed about the aim of the study and confidentiality. Those who were interested in participating registered their interest by email. Five declined to participate due to lack of time and 18 did not respond. None of the interviewers knew the informants before the study. The final study population therefore consisted of 20 health care professionals with a wide range of health professions (including midwife, dietician, medical doctor and health communicator (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Their ages ranged from 28 to 68 years and their work experience ranged from 2 to 38 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the informants.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInformant\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfession\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical experience\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare administrator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDietician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDietician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare strategy manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDietician and operations manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpecialist doctor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMidwife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManager for healthcare administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth communicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychotherapist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth communicator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychologist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDistrict nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 years\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eAn interview guide with semi-structured questions (Supplementary information) was developed by the authors, based on prior research and clinical experiences. The interview guide contained questions regarding the health professionals\u0026rsquo; perceptions of possibilities and challenges in promoting health in migrant women after childbirth as well as the requirements and potential of an mHealth intervention. At the end of the interview, informants were given the opportunity to provide additional information. The interview guide was tested in two pilot interviews and minor revisions regarding the formulation of some follow up questions were made after these interviews. The two pilot interviews were included in the analysis.\u003c/p\u003e \u003cp\u003eAll interviews were conducted in February and March 2023. Each informant was interviewed individually one time by MS, KA or AL. A total of nine interviews were conducted in person at a location selected by the informant (e.g. workplace or meeting room at a university) and eleven interviews were conducted via video call in the Zoom application. The interviews were audio recorded with a dictaphone and no video recordings were made. The duration of the interviews ranged from 23 minutes to 109 minutes (median: 57.5 minutes). Notes were taken during all interviews, and reflective notes were written immediately after each interview. Interviews were transcribed by a professional transcription company.\u003c/p\u003e \u003cp\u003eThe research team comprised two female PhD students: MS, a registered dietician born outside Sweden with a master\u0026rsquo;s degree in international health, and ML, a medical specialist in orthopedics with a migrant background and previous experience in research. In addition, two female medical students (AL and KA) participated in the development of the interview guide and data collection process. The team also included a female associate professor (UM) with expertise in qualitative methodology and a female associate lecturer (JW) with wide experience in promoting migrant health and expertise in qualitative methodology. The principal investigator of the project was a male associate professor (PH) with previous experience in promoting health related to pregnancy and developing mHealth interventions including those targeting migrants.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eInductive thematic analysis, as defined by Clarke and Braun (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) was used to analyze the data. Initially, agreement was verified between transcriptions and audio recordings. Potentially identifying details were changed or removed, and all informants were given pseudonyms to ensure confidentiality. The systematic thematic analyses involved an iterative process between the following steps:\u003c/p\u003e \u003cp\u003e1) Familiarization with the data: MS and AL listened to all audio files and read the respective transcripts several times. Overall impressions, ideas and thoughts were noted.\u003c/p\u003e \u003cp\u003e2) Developing initial codes: MS and AL independently identified 'meaning units'\u0026mdash;specific pieces of text or data that encapsulate a single idea or concept pertinent to the research aim. These initial meaning units were then used to derive initial codes. After individual coding, the codes were compared and discussed. A joint set of codes was then systematically assessed across all transcripts.\u003c/p\u003e \u003cp\u003e3) Searching for patterns: the codes generated were organized into potential coding patterns and thereafter potential themes by MS and UM.\u003c/p\u003e \u003cp\u003e4) Mapping and building themes: themes were checked against the codes and refined during continuous discussions led by MS and validated by UM and PH. The themes were further organized and refined until consensus was reached.\u003c/p\u003e \u003cp\u003e5) Defining and naming the themes: final themes were reached during joint discussions with all authors.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThree main themes emerged from the data: 1) Priorities and routines of health behavior promotion after childbirth, 2) Social influences on health behaviors 3) mHealth in supporting health behaviors after childbirth, as presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePriorities and routines of health behavior promotion after childbirth\u003c/h2\u003e \u003cp\u003eDifferent aspects of priorities regarding health promotion targeting migrant women were revealed. One central aspect that was highlighted concerned priorities in resources and services. The informants claimed that care after childbirth risks falling between the cracks when it comes to health promotion. They explained that there is an uncertainty regarding who is responsible for health promotion since the care is shared between different professions within healthcare (e.g. midwives, physicians, nurses, dieticians, health coordinators) and sectors of healthcare.\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The postpartum period tends to be a kind of no-man\u0026apos;s land. There are many discussions at a strategic level. Who owns the question? It usually lands on which primary care you choose. There everyone looks at each other and wonders why we should work with healthy women.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Informant \u0026ldquo;F\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eInformants also believed that the lack of priority for health behavior promotion after childbirth also influenced the routines for such promotion. Thus, the informants expressed that the health care system in Sweden has a variety of routines for care after childbirth, but there is a lack of general routine monitoring of health behaviors of mothers after childbirth. Limited time in the meetings and shortages of staff were perceived to lead to the down-prioritizing of preventive care and healthy lifestyle advice. Informants also explained that available routine checkups after childbirth are not adopted nor tailored specifically for the migrant women. The informants suggested that some migrant women may need extended resources and services like using interpreters, pictures and translated brochures in order to fully access and benefit from healthcare services. According to some informants, such customized support may be difficult to provide since it is time-consuming.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think it will be difficult for healthcare to provide\u0026nbsp;\u003c/em\u003e/.../\u003cem\u003e\u0026nbsp;It will probably take too much time to give individual advice to everyone.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformant \u0026ldquo;E\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eFurthermore, informants pointed out that shortcomings related to priorities and routines of health behavior promotion after childbirth might lead migrant women to seek information from other sources. These sources can include unverified internet sites, social media, or non-professionals around them, which are not always reliable and may lead to the uptake of inaccurate or potentially harmful advice.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Then you seek information from people they know around you. Unfortunately, it can also happen that one receives incorrect information.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformant \u0026ldquo;M\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eSome suggestions for improving the priorities and routines of health behavior promotion after childbirth for migrant women were given. Communication between migrant women and healthcare workers could be improved through targeted cultural education for the healthcare staff. Improved communication between health care staff and patients was considered to enhance mutual understanding and trust and increase the chance of providing information in a personalized manner. Further, healthcare professionals with a migrant background could be important resources to assist or educate their colleague if they have the same cultural background and speak the same language as the patient.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;All of them [migrant health professionals] have been new in the country themselves and are language carriers. They have a large network of people that have migrated who have cultural competence in how to best convey information to a person with a different cultural background from Swedish. It\u0026apos;s an incredible resource.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Informant \u0026ldquo;B\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocial influences of health behaviors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe informants believed that several factors linked to the social determinants of health affect health behaviors in migrant women. These factors were knowledge and language proficiency, economy, social network, and the prerequisites and transition of health behaviors in the migration process. All these factors were considered important and influenced the work toward promoting health behaviors in migrant women after childbirth.\u003c/p\u003e\n\u003cp\u003eLanguage barriers and lack of knowledge about the importance of health behaviors and where to seek help in the healthcare system were seen as a factors that might reduce the opportunities for adopting healthy behaviors. Furthermore, diverse educational backgrounds of migrant women were thought to complicate meeting specific needs.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It can be difficult to really give that knowledge so that they can adapt it individually to their own lives. Then it easily becomes one-fits-all advice. And that\u0026apos;s probably where it might become too generic and then it doesn\u0026apos;t fit and then you renounce it completely.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Informant \u0026ldquo;E\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eSuccessful attempts for improving the knowledge in migrant women and minimize the language barriers are ongoing within healthcare. The informants explained that the family centers for instance, have groups in different languages, like \u0026ldquo;\u003cem\u003emother-baby Swedish classes\u003c/em\u003e\u0026rdquo; to provide comprehensive information for migrant women. These family centers also have health promotion sessions, talking about diet and physical activity in their own language, but they are not specifically for the period after childbirth.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;At the family center, where they have had mother-baby Swedish classes for women who are at home with their babies. And there, we have had themes such as diet and physical activity. Such occasions should be held more often. And especially in their native tongue, so there will be a dialogue, a discussion around it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformant \u0026ldquo;P\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003eThe economy was suggested to play a significant role in some migrant women\u0026rsquo;s lifestyle choices. Maintaining a healthy and balanced diet with nutritious foods like fresh produce, whole grains, and low-sugar options is costly. Despite the large heterogeneity in the migrant population, many migrant families live on low incomes, and larger families face even greater challenges. This also applies to the possibilities of engaging in physical activities, as a gym membership, or suitable sportswear are also costly.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There I\u0026nbsp;\u003c/em\u003e\u003cem\u003ealso believe that the economy serves as an obstacle.\u0026nbsp;\u003c/em\u003e/.../ \u003cem\u003eYes, it does\u0026nbsp;\u003c/em\u003e/.../ \u003cem\u003eIt is an obstacle if there are many people in the family. Even if you know how to do it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformant \u0026ldquo;I\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eBelonging to a group or a social network was another aspect of importance related to health promotion targeting migrant woman. The informants pointed out the \u0026ldquo;\u003cem\u003esistership\u003c/em\u003e\u0026rdquo; between migrant women and believed using these networks with a focus on promoting a healthy lifestyle would be motivating to make changes. Observing fellow members engaging in exercise for example, could serve as a motivational catalyst, generating a positive domino effect according to our informants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;You take after one another. If you see that there are others around you doing it, then it becomes that you can do it and must also do it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformant \u0026ldquo;P\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003eFurther, the influence of migrant women\u0026rsquo;s backgrounds on health behaviors was raised. This includes the transitioning from habits in their birth countries to those in their new home country, which may not always be the same.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I come from another country and the cultural thing is that you should preferably be at home 40 days after you have had a baby\u0026nbsp;\u003c/em\u003e/.../\u003cem\u003e\u0026nbsp;Then I met someone I knew, that thought that it was very strange. \u0026ldquo;What are you doing outside? You should be at home. You should not go out at all, you should be at home.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Informant \u0026ldquo;P\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003emHealth in supporting health behaviors after childbirth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe informants believed that a smartphone app could possibly support the provision of health information in an accessible language and help users set goals for their progress in promoting lifestyle habits. They thought that an app could be beneficial for migrant women to easily access health advice. Furthermore, informants suggested such an app should contain accurate and accessible educational modules about the human body, nutrition, physical activity, and the impact of a healthy lifestyle on health, with well-translated explanations and helpful visuals for easy comprehension. The need for reliable information was stressed.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I see benefits in referring to something that has reliable information.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformant \u0026ldquo;E\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFurther, the importance of a user-friendly and easy to use smartphone app was highlighted. To involve and engage women with limited literacy skills, informants suggested incorporating videos, images and an audio feature for listening to information instead of reading it. The lack of time due to family commitments was seen as a common reason migrant women were unable to attend physical appointments. The possibility of getting information through a smartphone app was seen as a way to improve accessibility to health information and promotion.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The women can watch for themselves at home while they are on their phones and looking for knowledge, when they have time. All that we don\u0026apos;t have time for here (maternal health center). They can get what we present here themselves.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Informant \u0026ldquo;N\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFeatures like the active input of personal data like body weight or blood sugar were assumed to enhance the relationship-building with health care professionals for migrant women and to engage them in monitoring their own health. Informants explained that some migrant women would probably appreciate receiving advice anonymously, in order to seek help or find reliable information without telling anyone or without visiting healthcare. Further, motivating notifications and an awarding system like getting stars or medals, with achievable challenges (e.g. short walks with health advice about its advantages) and daily advice were mentioned and seen as beneficial for using the app regularly.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;So, I think you could probably click there for notifications. Now, you should go for a 30-minute walk.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;Informant \u0026ldquo;K\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFinally, informants described that using relatable images of people from similar backgrounds and recommendations in the form of familiar healthy foods that migrant women can relate to, were considered to make the smartphone app more inclusive and culturally appropriate which in turn may enhance the engagement levels.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Adapted to their cultural background, not Swedish information translated into Arabic; someone who knows how their regular diet looks, something confirmed by people who know what\u0026nbsp;\u003c/em\u003ethey\u003cem\u003e\u0026nbsp;are talking about regarding lifestyle.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformant \u0026ldquo;E\u0026rdquo;\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis qualitative study examined health care professionals\u0026rsquo; experiences of health behavior promotion in migrant women and the possibilities and requirements for an mHealth intervention to improve health behaviors after childbirth. We found that the informants experienced a lack of priorities and routines for promoting health behaviors after childbirth which was a major challenge. Furthermore, although informants highlighted the heterogeneity in the migrant population, they also experienced that several factors such as knowledge and language proficiency, economy and social networks influenced the possibilities of having healthy behaviors after childbirth. Finally, they believed that a culturally appropriate smartphone app with reliable information has the potential to promote health behaviors after childbirth.\u003c/p\u003e \u003cp\u003eA significant finding in our study was that the informants reported an absence of prioritization and established routines for monitoring and promoting health behaviors after childbirth for mothers, including migrant women. This is critical as the period after childbirth represents a crucial phase for promoting health behaviors, particularly in terms of diet and physical activity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). According to the informants, women require robust familial and social support to manage their weight, adopt a healthy diet, and engage in physical activities during this time. Addressing these challenges and actively promoting health behaviors and healthy body weight among women after childbirth may reduce the risk of negative health outcomes such as obesity and cardiovascular disease later in life (\u003cspan additionalcitationids=\"CR13 CR14\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCultural competence which is a term commonly used in the healthcare context (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), has been defined as \u0026ldquo;a set of congruent behaviors, attitudes and policies that enables healthcare workers to work and communicate effectively and appropriately in cross-cultural situations(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) The informants believed that the cultural competence of the healthcare system could be enhanced by taking advantage of the diverse backgrounds of the health care professionals within the system. Further, they believed that such awareness was important to tailor health behavior promotion to better meet the specific needs of migrant women. Previous studies examining reproductive health in migrant women have also suggested the cultural competence training is important for understanding diverse perspectives and cultural norms to facilitate effective and empathic communication (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe informants pointed out several other factors they believed influenced health behaviors, although they also highlighted the heterogeneity within the population of migrant women. For instance, they mentioned that language barriers, lack of knowledge about the importance of health behaviors, and uncertainty about where to seek help in the healthcare system seem to influence migrant women\u0026rsquo;s ability to adopt a healthy lifestyle. This is in line with several previous studies highlighting linguistic challenges as a barrier to delivering adequate and equitable healthcare to migrant women (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR30\" citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). In a review focusing on migrant women in Europe and their need for pregnancy-related care, a common theme across most studies was the issue of insufficient information and communication which could influence access to maternity services (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Previous studies suggest that lack of knowledge about the importance of health behaviors(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) and where to seek help in the health care system(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) might reduce health-seeking behavior, which in turn may limit the opportunities to receive health behavior promotion within clinical care. Economy was another factor mentioned by the informants as significant in adapting health behaviors like a healthy diet and physical activity which is relevant since income/economy is well-recognized as a social determinant of health (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eInformants believed a smartphone app had potential to promote a healthy diet and physical activity after childbirth, either independently or in combination with physical meetings. They also noted that the app could provide accessible, reliable, evidence-based information in multiple languages. To the best of our knowledge, no previous qualitative study has explored the potential of an mHealth intervention to promote health behaviors in migrant women after childbirth. However, our results may be compared to such studies during pregnancy. One study reported that additional methods of information delivery methods (such as audio or video-files) may be useful for the creation of a smartphone app accessible to a diverse range of women (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Furthermore, a review of pregnancy apps, with emphasis on culturally and linguistically diverse women, highlighted the need for reliable information from credible source as well as the importance of representing women with diverse backgrounds to ensure inclusivity (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). These aspects will be relevant to consider when developing a smartphone app to promote health behavior in migrant women after childbirth. Furthermore, future development should consider participatory design including the target group (i.e. migrant women after childbirth) (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) to inform the design of such a smartphone app. It is also important to consider person-centered care, cultural sensitivity, and health literacy responsiveness in the app's development. Finally, although the informants observed potential for smartphone app interventions to promote health behaviors in migrant women after childbirth, future studies are warranted to evaluate the effectiveness of such interventions. Additionally, future studies should explore the perceptions of migrant women to ensure the app meets their needs and preferences.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003eMethodological considerations\u003c/h2\u003e \u003cp\u003eA qualitative design (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) was considered advantageous in gaining comprehensive insights into the perspectives of healthcare professionals about promoting a healthy lifestyle among migrant women. Several procedures were taken to fulfil the quality criteria for qualitative research; dependability, credibility and transferability to verify trustworthiness. To attain dependability, the research process was clearly described and reported (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e) and the COREQ checklist was followed. We used a semi-structured interview guide for systematic data collection (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e) and followed Clarke and Braun\u0026rsquo;s stages for thematic analysis (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) facilitating a structured and systematic process. The sample size was based on data saturation (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e) and accordingly, data collection was finalized when we believed that the data reached satisfactory depth and complexity to answer the research questions. The credibility of the data analysis was enhanced by investigator triangulation (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e) involving independent coding of the data by two researchers followed by rigorous discussions of the themes with the research team. In addition, to ensure transparency, excerpts from the transcribed texts are included as representative quotations (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The data were collected from informants from four different healthcare regions in Sweden who had experience working with migrant women. Including diverse professions, ages and clinical experiences enriched the data with different perspectives. Furthermore, some informants were born outside Sweden, offering valuable insights relevant to the aim of the study. While the transferability of results to other regions may vary, depending on how care is organized, we consider the findings applicable to developing mHealth interventions to improve health behaviors after childbirth in similar settings.\u003c/p\u003e \u003cp\u003eNoteworthy, our study had some important limitations to consider. Informants were purposefully recruited and were only female. The uneven distribution of men and women might limit the diversity of perspectives and experiences in our data. However, this is reflective of the maternal care profession in Sweden, for instance only 0.3% of midwives in Sweden were male in 2019 (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Another possible limitation is the relatively small sample although we met saturation. Finally, this study solely explored healthcare professionals\u0026rsquo; experiences of health behavior promotion in migrant women after childbirth. Although the perspectives of health care professionals are essential to improve clinical care, future studies within this project (the PRIMI project) will examine the corresponding perspectives of migrant women to ensure that all perspectives are comprehensively examined.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is a lack of priorities and routines for health behavior promotion after childbirth in migrant women and cultural competence may improve such health promotion. Furthermore,\u003c/p\u003e \u003cp\u003eseveral factors such as knowledge and language proficiency, economy and social networks may influence the possibilities of having healthy behaviors after childbirth although there is considerable heterogeneity within the migrant population. Finally, informants believed that a culturally appropriate smartphone app with reliable information might have the potential to promote health behaviors after childbirth. However, further studies are warranted to examine the effectiveness of such an mHealth intervention to promote health behaviors in migrant women after childbirth.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all our informants for participating in our interview study and sharing their experiences with us. We want to especially thank Emira Bajric and Malin Creutz for their help with recruitment and Marie Leksell and Kajsa Andre for their help with data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePH conceptualized the research idea and obtained funding. MS, AL, JW, UM and PH contributed to the study design and interview guide. MS and AL conducted the interviews and derived initial codes. MS analyzed the qualitative data and derived themes with assistance from UM and PH. MS drafted the manuscript with assistance from UM and PH which was critically reviewed by AL and JW. All authors approved the final version of the manuscript and the decision to submit it for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a grant from the Swedish Research Council (2021-00915).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo safeguard the identities of informants, complete data (transcribed interviews and audio files) will not be made available to the public. However, transcribed interviews may be available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Swedish Ethical Review Authority (reference number: 2022-06733-01). The informants provided their informed consent prior to interviews.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eEuropean Commission. Statistics on migration to Europe. Available from: https://commission.europa.eu/strategy-and-policy/priorities-2019-2024/promoting-our-european-way-life/statistics-migration-europe_en (accessed November 22, 2024). \u003c/li\u003e\n\u003cli\u003eStatistics Sweden. Utrikes f\u0026ouml;dda i Sverige (Foreign-born in Sweden). 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Interventions including a nutrition component aimed at managing gestational weight gain or postpartum weight retention: a systematic review and meta-analysis. JBI Database System Rev Implement Rep. 2019;17:297-364.\u003c/li\u003e\n\u003cli\u003eDodd JM, Deussen AR, O\u0026rsquo;Brien CM, Schoenaker DAJM, Poprzeczny A, Gordon A, et al. Targeting the postpartum period to promote weight loss: a systematic review and meta-analysis. Nutr Rev. 2018;76:639\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eSandborg J et al. Effectiveness of a Smartphone App to Promote Healthy Weight Gain, Diet, and Physical Activity During Pregnancy (HealthyMoms): Randomized Controlled Trial. JMIR Mhealth Uhealth. 2021;9:e26091. \u003c/li\u003e\n\u003cli\u003eRedden K, Safarian J, Schoenborn C, Shortall C, Gagnon AJ. Interventions to Support International Migrant Women\u0026apos;s Reproductive Health in Western-Receiving Countries: A Systematic Review and Meta-Analysis. 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Healthcare Professionals\u0026apos; Perceptions of Promoting Healthy Lifestyle Behaviors in Pregnant Migrant Women and the Potential of a Digital Support Tool-A Qualitative Study. Int J Environ Res Public Health. 2022;19:2328.\u003c/li\u003e\n\u003cli\u003eNystr\u0026ouml;m ME, Larsson EC, Pukk H\u0026auml;renstam K, Tolf S. Improving care for immigrant women before, during, and after childbirth - what can we learn from regional interventions within a national program in Sweden? BMC Health Serv Res. 2022;22:662.\u003c/li\u003e\n\u003cli\u003eLyberg A, Viken B, Haruna M, Severinsson E. Diversity and challenges in the management of maternity care for migrant women. J Nurs Manag. 2012;20:287-95. \u003c/li\u003e\n\u003cli\u003eBains S, Sundby J, Lindskog BV, Vangen S, S\u0026oslash;rbye IK. Newly Arrived Migrant Women\u0026apos;s Experience of Maternity Health Information: A Face-to-Face Questionnaire Study in Norway. Int J Environ Res Public Health. 2021;18:7523. \u003c/li\u003e\n\u003cli\u003eBalaam MC et al. A qualitative review of migrant women\u0026apos;s perceptions of their needs and experiences related to pregnancy and childbirth. J Adv Nurs. 2013;69:1919-30.\u003c/li\u003e\n\u003cli\u003eRyan RA, Lappen H, Bihuniak JD. Barriers and Facilitators to Healthy Eating and Physical Activity Postpartum: A Qualitative Systematic Review. J Acad Nutr Diet. 2022;122:602-613.e2. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1 (accessed November 22, 2024).\u003c/li\u003e\n\u003cli\u003eHughson JP, Daly JO, Woodward-Kron R, Hajek J, Story D. The Rise of Pregnancy Apps and the Implications for Culturally and Linguistically Diverse Women: Narrative Review. JMIR Mhealth Uhealth. 2018;6:e189. \u003c/li\u003e\n\u003cli\u003eRoura M, Dias S, LeMaster JW, MacFarlane A. Participatory health research with migrants: Opportunities, challenges, and way forwards. Health Expect. 2021;24:188-197.\u003c/li\u003e\n\u003cli\u003ePatton, M.Q. Qualitative Research and Evaluation Methods. 4th ed. Thousand Oaks, CA: SAGE Publications; 2015.\u003c/li\u003e\n\u003cli\u003eLincoln, Y.S. \u0026amp; Guba, E.G. Naturalistic Inquiry. 1st ed. Beverly Hills, CA: Sage Publications; 1985.\u003c/li\u003e\n\u003cli\u003eKorstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. Eur J Gen Pract. 2018;24:120-124.\u003c/li\u003e\n\u003cli\u003eSaunders B, Sim J, Kingstone T, Baker S, Waterfield J et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893-1907. \u003c/li\u003e\n\u003cli\u003eV\u0026aring;rdfokus (Health care focus). Available from: https://www.vardfokus.se/nyheter/allt-farre-man-blir-barnmorskor (accessed November 22, 2024).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Diet, immigrant health, physical activity, practitioners, qualitative study, telemedicine","lastPublishedDoi":"10.21203/rs.3.rs-5547734/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5547734/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMigrant health, including reproductive health, is a public health priority. The time after childbirth is considered an important period for health behavior change and mobile health (mHealth) interventions have shown promise in influencing health behaviors. Health care professionals have an important role in providing support for health behaviors and implementing mHealth tools in clinical care. This study therefore examined health care professionals\u0026rsquo; experiences of health behavior promotion in migrant women and the potential for an mHealth intervention to improve health behaviors after childbirth. Twenty health care professionals in Sweden participated in individual semi-structured interviews. The informants had different professional backgrounds, ages, working experiences and all were females. Data was analyzed using thematic analysis and three main themes were generated. The first theme \u0026ldquo;Priorities and routines of health behavior promotion after childbirth\u0026rdquo; described a lack of priority for health behavior promotion after childbirth. The second theme \u0026ldquo;Social influences of health behaviors\u0026rdquo; described several factors that influenced possibilities of healthy behaviors after childbirth. In the third theme \u0026ldquo;mHealth in supporting health behaviors after childbirth\u0026rdquo;, informants stressed that a culturally appropriate smartphone app with reliable information had the potential to promote health behaviors after childbirth although further research is needed.\u003c/p\u003e","manuscriptTitle":"Supporting health behaviors in migrant women after childbirth with special emphasis on mHealth: An interview study with health care professionals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-08 18:09:30","doi":"10.21203/rs.3.rs-5547734/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-01-23T06:10:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-21T20:22:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-01-20T11:40:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"213036554302729075372606035874449315012","date":"2025-01-12T12:12:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"198027016576065976172176302084912030959","date":"2025-01-11T20:56:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-12-11T16:23:52+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-12-11T16:21:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-12-02T09:25:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-29T14:26:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-11-29T09:04:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2e8b5fa5-0667-4bb3-a508-6030aa5cf3f9","owner":[],"postedDate":"January 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T16:03:35+00:00","versionOfRecord":{"articleIdentity":"rs-5547734","link":"https://doi.org/10.1038/s41598-025-01147-3","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-17 15:57:25","publishedOnDateReadable":"May 17th, 2025"},"versionCreatedAt":"2025-01-08 18:09:30","video":"","vorDoi":"10.1038/s41598-025-01147-3","vorDoiUrl":"https://doi.org/10.1038/s41598-025-01147-3","workflowStages":[]},"version":"v1","identity":"rs-5547734","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5547734","identity":"rs-5547734","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}