Evaluating the barriers to physical activity during pregnancy: a sequential explanatory mixed-methods study

Despite strong evidence supporting the maternal and fetal benefits of physical activity during pregnancy, many pregnant women fail to achieve the recommended levels of activity for various reasons. Previous studies have largely examined barriers to physical activity from a quantitative perspective, with limited attention to deeper social, interpersonal, intrapersonal, and environmental factors. Therefore, this study aimed to identify and explain barriers to physical activity among Iranian pregnant women using a sequential explanatory mixed-methods approach.

This explanatory mixed-methods study was conducted in two sequential phases: quantitative, followed by qualitative. In the quantitative phase, 351 pregnant women aged 18-45 years who met the inclusion criteria were recruited using convenience sampling. Data collection tools included a socio-demographic and obstetric questionnaire and the Pregnancy Physical Activity Perceived Barriers Scale (BPAPS). Data were analyzed using descriptive statistics and univariate and multivariate linear regression in SPSS v.23. In the qualitative phase, women with high barrier scores (BPAPS ≥ 97) were purposively invited for semi-structured interviews. Data saturation was reached after 10 interviews. Qualitative data were analyzed using conventional content analysis. Finally, quantitative and qualitative data were integrated in the interpretation of the study results.

A total of 351 pregnant women were included in the analysis. The mean age of participants was 29.06 ± 5.99 years, and the mean total barrier score was 78.07 ± 16.25. The mean standardized scores for subscales were: environmental barriers 43.67 ± 17.80, pregnancy-related intrapersonal barriers 43.16 ± 16.40, non-pregnancy-related intrapersonal barriers 41.68 ± 18.80, and interpersonal barriers 38.74 ± 17.93. Multivariate regression analysis indicated that older age, lower education, unemployment, and lack of pre-pregnancy physical activity were significantly associated with higher barriers to physical activity (P < 0.05). In the qualitative phase, one overarching theme, "Multidimensional Barriers to Physical Activity During Pregnancy," and four main categories were identified: intrapersonal barriers, knowledge and communication gaps, socio-cultural limitations, and structural/environmental barriers. The most frequently reported categories from women's lived experiences were related to intrapersonal barriers and knowledge/communication gaps.

In the quantitative phase, environmental barriers had the highest mean score among the subscales. In the qualitative phase, intrapersonal barriers and knowledge/communication gaps emerged as key themes in women's lived experiences. This difference is not a contradiction but reflects the complementary nature of the two methods: quantitative data capture population-level frequency, while qualitative data provide deeper insight into barriers that are most personally impactful. Overall, the integrated findings suggest that barriers to physical activity during pregnancy are multidimensional. Based on these findings, we recommend three specific public health policy actions: (1) integrating self-efficacy and self-care training into preconception care programs, (2) establishing free or low-cost, female-only safe exercise spaces for pregnant women, and (3) mandating physical activity counseling during all routine antenatal visits.