The Formative Development of the Sleep GOALS (Goal-focused Online Access to Lifestyle Support) Intervention for...

While many perinatal weight loss interventions focus on caloric restriction and physical activity, few address sleep despite its independent effects on weight, diet, and physical activity and the high prevalence of sleep disturbances among postpartum individuals. This study aims to inform the program production stage of intervention development for an integrated sleep, diet, and physical activity intervention by identifying behavior change priorities, barriers, and delivery preferences.

We conducted individual interviews with 20 postpartum individuals following a preinterview survey that was sent alongside a newsletter summarizing findings from an earlier phase of the study. The survey assessed the perceived importance and difficulty of intervention components related to sleep, diet, and physical activity. The interview guide was designed to (1) identify which behavioral domain participants viewed as most important to address first; (2) explore the perceived difficulty of changing each behavior; (3) determine which topics to adapt and include in the intervention; and (4) elicit reflections on the newsletter with earlier study findings. The survey responses were summarized descriptively, and the interviews were analyzed via qualitative content analysis to identify key themes.

Five themes emerged. (1) The participants affirmed that the newsletter reflected their experiences but identified gaps related to mental health and partner/provider support. (2) Sleep is viewed as the most important behavior to change, with strong support for strategies targeting sleep efficiency, sleep routines, and sleep-related worry. (3) Sleep is also perceived as the most difficult behavior to change due to infant-related sleep disruptions, parental fatigue, and limited knowledge of effective strategies. (4) Participants offered differing views on where to begin-some preferred starting with sleep, others preferred starting with diet and physical activity, or an integrated approach. (5) Participants emphasized the need for support and accountability, including coaching, peer connection, and flexible tools.

The findings provide concrete guidance for tailoring intervention content, structure, and delivery to postpartum individuals' values, constraints, and readiness for change.