During and after pregnancy, many women experience physical and mental health issues. However, through regular exercise, these issues can be solved. Walking is the most recommended type of physical activity (PA) for our target group since it can easily fit into the daily routine. Lacking sufficient information or rich personalization, current interventions do not seem to increase the low exercise rates among new mothers. The aim of this project is designing a theoretical framework and an intervention to encourage mothers to engage in PA, especially in the postpartum period for a healthy lifestyle.
Saligheh (2016) investigated the barriers that prevent women from doing PA regularly. She divides the impediments between personal and environmental factors. Among the personal factors, lack of time was the fundamental impediment for PA followed by considering exercise a low priority and social isolation. According to Saligheh (2016), the environmental barriers that women have to face are related to the lack of accessible and appropriate exercise facilities. On the other hand, the factors that enable PA for postpartum mothers were related to the support from their partner, mother’s group, or group of friends. Especially, meeting other mothers in the same situations helps them with postpartum education and allows them to share their similar experiences. Leading ultimately to an increase in the motivation for doing PA(Saligheh et al., 2016).
Usually, there are several physical activities recommended for during and post-pregnancy periods:stationary cycling, spinning, brisk walking, and weight training. Walking is the most relevant intervention during pregnancy and the postpartum period (Pereira et al., 2007). Around 43% of women choose walking between all the exercises which provide for an increased sense of well-being and reduced physical problems (Clapp, 2000).
In the past few years, mobile technologies have been used for pregnancy care to encourage mothers to do exercises according to their physical condition. Apps usually help to set up a goal and motivate mothers to maintain a goal. For example, many apps are aimed at the maintenance of daily sufficient physical activity like walking. One of the examples is the Garmin app which is connected to a smartwatch (Bailey, 2021). Another web page is Fit4MOM which is a platform that was born for providing social support and encouraging moms to do exercise. One of their programs “Stroller Strides” has become really popular, providing mothers, who take care of their babies, an opportunity to be part of a group of women in the same situation (FIT4MOM, n.d.).
The design intervention proposed is based on the Transtheoretical model due to its relevance in the change of behaviour. We aim to promote physical activities to postpartum mothers with the purpose of promoting a healthy lifestyle. To do so, we combine several theories introduced above in the literature review. Since different theories focus on different stages of the TTM, and several strategies derive from it, this is how we end up with the following design framework(see figure below).
Moreover, the social cognitive theory proposes that both environmental factors and personal behaviour factors have a bi-direction effect in behaviour change process (Bandura, 1977). Interventions derived from social cognitive theory have focused on the importance of the ability that one could control the behaviour and how changes happened to the environment that results in behaviour change. Strategies derived from social cognitive theory such as goal-setting, relapse prevention training (King, 1988),and social support (Brownell, 1986) promote changes in physical activity participation. Next, there is another approach that provided reference for this project. The relapse prevention approach aims to maintain a new behaviour for the long run. Its focus is to teach individuals that a lapse from exercising (e.g. missing an exercise session) need not lead to relapse (e.g. a week without exercising); a lapse can be prevented from escalating into a complete relapse or a collapse (e.g. return to the previous unhealthy lifestyle).
Based on TTM, promoting a new physical activity behaviour starts from the pre-contemplation stage, in which people do not consider physical activity at all. At this stage, forming and strengthening a positive health belief is needed. Next, we move to the contemplation stage, in which people start realizing the benefit brought from physical activity. The preparation stage is the stage in which postpartum women gain enough motivation to start preparing for engaging in PA. It is good to know that from social cognitive theory, environmental factors and personal behaviour have an interactive impact as determinants of behaviour. At the action stage, from a learning perspective, physical activity is a behaviour that can be modified through gaining and maintaining period. Finally, we enter the maintenance stage, where preventing relapse is one of the important things to design. The relapse prevention theory focuses on teaching individuals that a lapse from exercising(e.g. missing an exercise session) need not lead to relapse (e.g. a week without exercising).
The intelligent cart is the main intervention of this project. We propose that the intelligent cart would help mothers in doing physical activities and socializing at the same time. The cart has two elements:lights and haptics. The lights have two main functions, communicating to other mothers that they are willing to be paired with someone, and indicating to the mother that she has reached a goal in the exercise plan.
As mentioned before, mothers in the postpartum period do not have time to do physical activities.Also, due to the lack of time they feel socially isolated taking care of their babies and running the household. Among the factors that enable women to engage in physical activity, social support from partners, friends, or family is one of the most important factors when maintaining and adopting healthier behaviours (Faleschini et al., 2019). The support mothers receive from friendsor family is related to higher engagement and motivation in doing light/moderate physical activity(Faleschini et al., 2019).
Since social support positively influences the mothers for doing physical activity, it is going to be considered as a determinant factor in our intervention. Furthermore, the engagement they can get from family and friends is key to develop a behaviour change and ultimately to reach maintenance. In short, our intervention should consider social support from family and/or friends to achieve a change in physical activity behaviour. It can be joining a motherhood community where mothers could communicate and support each other, share experiences and stories, and develop friendship through companionship.
The App(in Appendix A, Fig 6,7,8) works collaboratively with the intelligent cart, in providing the tracking data, valuable feedback, goal setting function as well as checking paired information. Based on the goal-setting theory, we see the importance of shaping exercise, meaning to have a customized goal depending on the person, to prevent drop out and abandonment of the new behaviour. Thus, in the design of the App, goal-setting is a big functional page which allows postpartum moms to set their compatible goals according to their feelings of the body.
Three main pages of the App were designed for the purpose of companionship of pairing with other moms nearby with providing goal-setting functions and giving valuable feedback and statistical analysis. On the home page, when the mom already starts walking outside, it will display the map on the main page, with other moms who are around, which allows you to see the greeting message from the other mom on the map directly, and the paired information is shown below the map on the page within one scrolling.
When the mom gets back home, the main page displays the route marked which has been accomplished today on the map. Other information could be seen as well such as goal completion level, duration and distance of the walk.
As the figure below shown as the goal setting page, the main function is to set a new goal through a floating button, the goals that have been set can be found in a to-do list on the current page as a reminder. When clicking on the floating button to set a new goal, there are options to choose to set a goal for day, week, month. It is simply done by clicking and scrolling the widget. On the statistics page, the daily record was displayed by distance and speed. Feedback follows behind the record.
The app and the stroller would work synchronically in order to provide social interaction between mothers. It can be also beneficial from both sides: connecting with other mothers through the app before a walk, and seeing a mother on the street with the lights on of the matching color on the stroller.
As indicated in previous sessions, goal-setting is a big topic to explore for promoting and maintaining the motivation of doing PA. Through different interfaces, it could result in a large difference from the length of engagement. Inspired by the fitbit clock faces, further design ideas could be explored for the App and the system. Related to the topic of goal-setting, rewards seem also a matter of promoting motivation.The impact of Incentive rewards and virtual rewards should be investigate further, whether they would benefit the user with the same result on engagement or one has a better effect, and how to make the experience sustainable, meaning that people would need increasing rewards to get desirable feelings, repeated success would make user feel less motivated(Konstanti, C., & Karapanos, E. 2018) is another point to dig deeper in the future works.
There’s another aspect to be pointed out is the cultural factor. In our research, we didn’t identify or categorize the postpartum women by cultural background. There would always be expat and immigrants in the country. Could imagine that for foreign mothers, they would encounter other issues such as language, culture shock or social isolation by other groups.Would our intervention still work for them, is another topic to discuss.
Furthermore, testing on the idea within postpartum women is necessary, whether the idea of the light and pairing would be accepted by its audience or not. Interviews, workshops, user scenarios should be built upon to evaluate the idea. Prototypes should be made in order to test for the real users, from the feasibility, viability, and desirability aspects to see the response from the users are needed.
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