Program Overview

According to the American College of Obstetricians and Gynecologists (ACOG), it is recommended that pregnant women engage in at least 30 minutes of moderate intensity exercise most days of the week. Many pregnant women are not meeting the recommended levels of physical activity throughout their pregnancy. For that reason, we are creating a program with the purpose of encouraging and guiding pregnant women, specifically in Martin County, Florida, to be able to meet the recommended levels of physical activity. The program will consist of a short information session and prenatal yoga class for a total of 45 minutes twice a week, while educating and encouraging an additional 30 minutes of moderate intensity exercise the remaining days of the week.

Needs Assessment

The goal of our needs assessment is to assess how many pregnant women are reaching the recommended amount of physical activity. We would first look at secondary data sources to see if there is a need for physical activity programs for pregnant women. One study, done at the University of North Carolina Hospitals, concluded that only a small number of pregnant women reached the recommended amount of physical activity. Additionally, they found that the amount of physical activity in pregnant women generally decreased from the second to third trimester. After doing more research, we saw many similar studies, leading us to conclude that overall, there is a need for physical activity programs for pregnant women.

Our program will specifically be implemented in Martin County, located in Florida. For this reason, we will collect primary data to asses the need specific to Martin County. We want to see if pregnant women in Martin County are meeting the recommended amount of physical activity and if they have the means to do so. To do this, we will use questionnaires to have pregnant women self-report the amount of physical activity they engage in on average as well as what the activities are. Additionally, we will further interview individuals to gather more detailed information to help further clarify the health problem.

Some factors such as predisposing, reinforcing, and enabling factors, can have an impact on our program’s success so we will make sure to address those in our program. The first factor we would look at are predisposing factors which include an individual’s knowledge and perceptions that facilitate or hinder an individual’s motivation to change. An example of this could be that a pregnant woman simply doesn’t feel she has the skills to properly exercise because she never has before. A reinforcing factor is the feedback and rewards individuals receive that may encourage or discourage the behavior change. This could be friends and family members living a sedentary life and therefore not supporting the pregnant women’s efforts to exercise daily. Lastly, an enabling factor includes access or lack of access to health-related services. For instance, pregnant women may not have access to an environment that promotes physical activity or may not feel she has access to enough time to exercise. This program would address all three of these factors while focusing on providing pregnant women with the knowledge and skills to be able to implement physical activity in their daily routine and meet the recommended amount of physical activity. We would strive to have the whole needs assessment completed on the target population by October 2021.

A Rationale for a Comprehensive Exercise Program for Pregnant Women in Martin County, Florida

The National Institute of Health noted that a study showed that only a small proportion of pregnant women reached the recommended level of physical activity (Borodulin et al., 2012). Additionally, it was reported that physical activity of pregnant women generally decreased from the second to third trimester (Borodulin et al., 2012). A study at the University of North Carolina, Chapel Hill confirmed that “at most, 23% of pregnant women engaged in as much physical activity as is recommended by government and private health groups” (Boyles, 2010). To further stress this quantity, that is only one out of four pregnant women that are engaging in the recommended amount of physical activity.

As a result of a minority of women meeting the exercise goals, women have an increased risk for a variety of health problems. “Health benefits of physical activity during and immediately after pregnancy include possible prevention of gestational diabetes, preeclampsia and chronic musculoskeletal conditions, support of healthy weight, and improved mental health. Moreover, regular exercise helps maintain cardiorespiratory fitness levels throughout pregnancy and can facilitate postpartum recovery” (Borodulin et al., 2012).

For more information on exercise during pregnancy, watch this video from the March of Dimes website:

In addition to the problems listed above, some research suggests that mothers who are overweight, both during and after pregnancy, could increase the risk of their children being overweight. “The study researchers explained that a mother’s excessive weight gain during pregnancy may be tied to changes in her chemistry that make the child more likely to be overweight or obese. The mother’s weight gain after giving birth and the child’s subsequent weight gain probably reflect the family’s lifestyle and health behaviors” (Reinberg, 2015). Further research explains the dangers of being overweight by stating, “On average, overweight people lose about one year of life expectancy, and moderately obese people lose about three years of life expectancy…Severely obese people lose about 10 years of life expectancy” (Study: Obesity cuts life expectancy, 2016). Knowing that being overweight can reduce your life expectancy between one and ten years, we see how important it is that all individuals engage in physical activity, especially pregnant women who have a direct impact on their children’s lives.

Further, the CDC recently released statistics on how often individuals in the US exercise. An article about this report explains that “southern states remain the least active in mainland US, with around a third of people inactive across the Southern belt from Kentucky to Florida to Texas” (Feder, 2020). Florida, with 28% of the state population self-reporting no physical activity, has a need for improving physical activity overall (Feder, 2020). By improving the number of pregnant women who are reaching the recommended exercise levels, we are working towards decreasing the trend that southern states are the least active in the US.

To reduce the prevalence of inactivity among pregnant women, we will implement a program in Martin County that has a comprehensive approach to teaching. This program will strive to improve the knowledge and skills of pregnant women by providing a prenatal yoga class that teaches them how to exercise. For 15 minutes before each class, the instructor will teach about the benefits of physical activity for both the mother and the baby as well as tips for implementing exercise into their daily lives. This will ensure that the pregnant women feel competent and confident when it comes to exercising.

A comprehensive exercise program for pregnant women has great potential for success in Martin County. Not only will exercise programs for pregnant women reduce stress for pregnant women, but they will also reduce some health risks for both mother and baby. This program is well planned and individualized for the residents of Martin County, setting this program up for great success. Let’s start now to invest in the health of pregnant women in Martin County. Just as Benjamin Franklin said, “Don’t put off until tomorrow what you can do today!”

Program Name: Moving Moms of Martin County

Mission Statement: Moving Moms of Martin County seeks to invest in the health of pregnant women by providing them with the knowledge, skills, and resources to improve the health of both themselves and their babies.

Program Goals

• Increase the number of pregnant women in Martin County that reach the recommended amount of physical activity.

• Reduce the incidence of gestational diabetes, preeclampsia, and chronic musculoskeletal conditions caused by a lack of physical activity in pregnant women.

• Eliminate the idea that there is not enough time in the day to exercise.

Program Objectives

• Process Objective: By April 2021, staff will have talked with at least 50 pregnant women to gather information about their levels of physical activity.

• Learning (Impact) Objective: During the 1-year program, 75% of participants will be able to demonstrate increased knowledge of implementing physical activity in their daily lives.

• Behavioral (Impact) Objective: By July 2021, 80% of participants will report an increase in their daily amount of physical activity.

• Environmental (Impact) Objective: By April 2022, there will be physical activity classes available daily for pregnant women to take part in.

• Outcome Objective: By April 2022, the overall number of pregnant women who reach the recommended amount of physical activity will increase by 50%.

This program will begin in April of 2021 and run for a full year. This is to ensure that the group of women that participate will be exercising throughout their pregnancy as well as after they have the baby. Our program will run twice a week, on Tuesdays and Thursdays. It will start around 6pm and last for 45-60 minutes. On Tuesdays, the class will meet outdoors at Hobe Sound Beach. On Thursdays, the class will meet indoors at a local church facility, Christ Fellowship. We chose two locations, one in Stuart and one in Hobe Sound, to try to provide access to the largest number of individuals possible. Additionally, if it rains, we will always have an indoor space to use as a plan B.

The class will begin with 15 minutes of educational content that will cover topics such as the benefits of exercising while pregnant, the risks of failing to meet the recommended amount of physical activity, and encouraging participants to exercise, even on the days the program doesn’t meet. We will also talk about incorporating physical activity into daily lives and the possibility of breaking up the 30-minute daily recommendation into 10 minute sections. This will help participants to realize that although they may not have 30 minutes all at once to exercise, they may have 5 minutes here or 10 minutes there, reducing the enabling factor that they don’t have access to time. The class will then transition to a time of prenatal yoga which will last 30 minutes. These first 45 minutes as a whole focus on eliminating any predisposing factors or fears that participants lack the skills and knowledge to properly exercise.

Once the yoga session is complete, instructors and staff will stick around for an additional 15 minutes to allow for questions and mingling. Because our program focuses on total health, including both physical and emotional health, we want to encourage friendships and connections among participants. This last 15 minutes, although optional, really focus on the reinforcing factor of having a support system and encouraging each other to stay active. In addition to this in-person aspect, we hope to create YouTube videos and host virtual classes specific for pregnant women. These extra resources will help our participants, and all pregnant women watching, to better achieve their physical activity goals.

Community Engagement Plan

To begin to correct the issue of low exercise rates among pregnant women, we must take proper care in gaining entry into the community. Since we are entering from outside the community, it is important to enter with the gatekeepers of the community, the individuals who control, both formally and informally, the political climate of the community, to ensure we will have the support and engagement of community members to participate in our program. We plan to talk to the mayor of Stuart, Becky Bruner, to gain support our program. Because Stuart, a city in Martin County, is relatively small, we have the luxury of being able to talk with the mayor. The mayor is a valuable person to have a connection with because not only will they help us with the functionality of accomplishing tasks, they may also help spread our message that it is important to exercise when you are pregnant. It is not easy to get individuals to accept that change is needed and therefore, the support of the mayor will help us to spread our message and point individuals our way.

Once we have started to earn the trust of community members through the mayor, we must determine who stakeholders are, defined as any person, community, or organization with a vested interest in a program. For our program, our stakeholders will include pregnant women, family and friends of pregnant women, and the organizations we are working with such as Christ Fellowship Church, where we will hold our class, and Cleveland Clinic Martin Health, the local hospital.

We need support from community organizations because that will continue to help us earn the trust and support of the community members. We are partnering with Christ Fellowship Church and Cleveland Clinic Martin Health which are both large organizations that influence the community members in one way or another. This will greatly benefit us by helping to get the word out about the program. In addition, we need support from the Hobe Sound Chamber of Commerce. This is a non-profit organization located near Hobe Sound Beach, a second location for our program, that will specifically help us through a referral, further promoting our program.

Another way we will leverage our program for success is by utilizing the assets of Martin County. To better organize assets, they are categorized into building blocks. Primary building blocks, assets in the neighborhood and under the control of the neighborhood, include Christ Fellowship Church and Hobe Sound Chamber of Commerce. Christ Fellowship Church is providing us with a facility to hold our program and technological equipment and Hobe Sound Chamber of Commerce is promoting our program through a referral. Secondary building blocks, assets in the community largely controlled by outsiders, include Cleveland Clinic Martin Health Hospital and Hobe Sound Beach. Cleveland Clinic Martin Health is helping us to promote our program to their pregnant patients and Hobe Sound Beach is providing us a second facility to host our program. Lastly, potential building blocks, resources outside the neighborhood controlled by people outside, might include outsider information and other programs that were implemented outside of Martin County that we are utilizing to create Moving Moms of Martin County. With the use of these assets, we have a great team with many skills, resources, and knowledge that we can utilize to create a program that will make a difference in improving the lives of pregnant mothers and their babies.

Health Promotion Strategies

Two strategies we will use to help pregnant women meet the recommended levels of physical activity are heath communication strategies and behavior modification activities. We will use health communication strategies, such as posters, brochures, and other printed material to help spread the message that many pregnant women are not reaching the recommended amount of physical activity. Our hope is that when individuals become aware of this problem, pregnant women, as well as their family and friends, will be encouraged to increase their amount of physical activity. Furthermore, we will use behavior modification activities that will give pregnant women additional help to make the behavior change of increased amounts of physical activity.

A specific behavior modification activity we will use is to encourage the pregnant women who participate in the prenatal yoga program to keep a log of the days and times that they engage in physical activity from one class session to the next. From experience, I believe this will help to keep the individuals accountable and encourage them to try to meet the recommendation of 30 minutes of moderate intensity physical activity most days of the week. Since our program will meet on Tuesday and Thursday every week, we will be able to remind and encourage the individuals to keep up with their exercise log. Every Tuesday, during the 15 minutes of educational content at the beginning of class, time will be given for participants to set and log their personal physical activity goals for the week. Before and after class, participants will also have the opportunity to meet with instructors and staff to go over their logs and get extra tips and encouragement on how to meet their weekly physical activity goals.

Program Resources

In order to ensure our program will be successful, we will need to attain resources that will assist as we plan, implement, and evaluate our program. The first resource we need falls under the category of a ‘human’ resource. We know we will need an individual with expertise in teaching a prenatal yoga class. Without an instructor, we will have no way to guide our participants in a prenatal yoga class. This individual will most likely be external personnel and come from outside the planning agency. This resource might prove to be an extra challenge to find because the individual not only needs to know how to lead a yoga class but also must be knowledgeable about what is safe and unsafe for pregnant women to do regarding physical activity.

A second resource we need for our program is the material resource of a facility with sufficient space to hold our program. Without a facility, our program will have nowhere to take place. We plan to use both a local church, Christ Fellowship Church, and the local beach, Hobe Sound Beach as our program’s location. Both locations are free for us to use and have water fountains and bathrooms, all of which benefit our program greatly. We chose to meet at a location in Stuart one day and a location in Hobe Sound the other day with the hope of allowing more participants to have access to our program. Christ Fellowship Church additionally offered to provide us with some other necessary equipment such as a speaker system for our yoga instructor to use on both of the days that our program meets.

A third resource we need to address is financial resources. We do not want to require our participants to pay a fee for this program, so we want to keep our spending as low as possible. However, we know that we will need to spend money on things such as hiring an expert to teach the class to ensure our program is successful. One way we are combating this financial issue is by using a cooperative agreement with the local church we are meeting at. They are offering our program use of their facility for free as well as offering some technological equipment as mentioned above. Additionally, they are boosting our program by using their platform to promote our program and inviting their members to attend and volunteer for our program. To cover any other fees we may have, we will try to get sponsors from local agencies such as gyms, pregnancy centers, and health clinics.

Evaluation Plan

To evaluate if our program is effective and worth continuing, we must assess the quality of our program development, implementation, and evaluation. Detailed below is how we will evaluate each of our program objectives to see if they were met and if our program is successful.

Process Objective: By April 2021, staff will have talked with at least 50 pregnant women to gather information about their levels of physical activity.

Do we have data on file from 50 pregnant women regarding their levels of physical activity?

To measure if we met this objective, we simply must see if we have data on file from at least 50 individuals. It is important to gather this information to evaluate if our program is being implemented as planned. The data we get from these individuals will help us to emphasize the point that many individuals are not meeting the recommended daily requirement for physical activity. We will know this objective was successfully met if those individuals continue to improve their levels of physical activity from what was measured the first time.

Learning (Impact) Objective: During the 1-year program, 75% of participants will be able to demonstrate increased knowledge of implementing physical activity in their daily lives.

Did the program participants learn ways to increase physical activity throughout their daily lives?

To measure this, during the educational portion of the program, the program instructors and staff will ask participants to explain how they are implementing physical activity throughout their daily lives. If most participants (about 75%) are able to give at least one clear example of how they are being physically active in the midst of a busy day, we will consider that objective to be successfully met. On the other hand, if less than 50% of the participants are able to give clear examples, we will consider that objective to be failed and must improve the educational portion of our program to give better information on how to implement physical activity in daily lives.

Behavioral (Impact) Objective: By July 2021, 80% of participants will report an increase in their daily amount of physical activity.

Has the daily amount of physical activity for participants increased?

To measure this, program instructors and staff will look over participants’ activity logs with the participants during the Tuesday morning educational session. Activity logs will help us to see if participants are, on average, increasing their daily amount of physical activity. If 80% of the participants logged an increase in physical activity from their first log entry, we will consider that objective met and the program successful. If less than 50% show this increase, we will consider that objective failed and make an effort to give more examples of physical activity opportunities as well as a variety of options of physical activity throughout our Tuesday/Thursday program.

Environmental (Impact) Objective: By April 2022, there will be physical activity classes available daily for pregnant women to take part in.

Are physical activity classes available daily that target pregnant women?

This can be assessed by looking at the dates and times of classes that our program offers. Our program will have classes available online via YouTube for pregnant women to take part in as well as have virtual classes, which will all be taken into account when assessing how often classes are offered. We will consider this objective met only when we have an in person or virtual class offered each day in addition to the various YouTube videos. This objective will be considered failed if we do not have at least one class offered each day.

Outcome Objective: By April 2022, the overall number of pregnant women who reach the recommended amount of physical activity will increase by 50%.

Are our participants achieving the recommended amount of daily physical activity?

By utilizing the activity logs of our participants, program instructors and staff will be able to see if participants are reaching the recommended amount of daily physical activity. If program instructors and staff see that at least half of the participants are reaching the recommended amount of daily physical activity, this objective will be met and we will be able to confidently say our program is worth continuing. On the other hand, if less than 50% of our participants are able to meet the recommended amount, we must make adjustments to our program so that more classes that offer structured physical activity will be available for our participants.