Reviewer ’s report  
 
Title: Perspectives of pregnant and postpartum women and obstetric providers to promote 
healthy lifestyle in pregnancy and after delivery: A qualitative in -depth interview study  
 
Version: 0 Date: 21 Aug 2019  
 
Reviewer: Ellinor Olander  
 
Reviewer's report:  
 
BMWH -D-19-00409  
 
This manuscript presents findings from a qualitative interview study with pregnant and postnatal 
women as well as healthcare  professionals providing their care. Twenty -three interviews were 
conducted and analysis followed the PRECEDE -PROCEED framework. Below are a number of 
comments I invite the authors to consider with the aim of strengthening the manuscript.  
 
 
Major comments  
 
My main comment after reading your manuscript is that its novel contribution needs to be made 
more explicit; is it the use of the PRECEDE -PROCEED model, is it your participants, setting or 
findings?  This needs to be more explicit throughout the manuscript.  Related to this, to what 
extent do the findings relate to previous literature, there are a number of qualitative studies 
already conducted regarding behaviour change in pregnancy and postpartum.  
 
Linked to the above, the background and study aim needs cl arification - understanding factors 
that motivate pregnant women is not very convincing, what is it exactly your study sought to do? 
And why are you interviewing postpartum women when your focus is on pregnancy? This needs 
some more clarification.  
 
Clarifi cation could also be added to the interview guide, was this focused on pregnancy only? A 
considerable amount of your findings relate to the postpartum period (such as section on 
breastfeeding), so would the health coaching intervention span both pregnancy and postpartum?  
 
Regarding your analysis, did you analyse each participant group in turn or all together? 
Considering you have three groups of participants, more comparison of their views could be 
done.  
 
 
Minor comments  
 
* More information on the PRECEDE -PROCEED model is needed, you currently assume 
the reader knows what this model is, how it is used, and whether it has been used with 
this population before or not.  
* Pregnancy and postpartum are not two distinct phases where behaviour change is static, 
but how the pregnancy develops and then the development of the baby will impact on a 
woman's ability to engage in health behaviours, this should be acknowledged.   
 
* The abstract and keywords would benefit from being more specific to the behaviours 
your manus cript discusses such as physical activity and healthy eating, instead of 
'unhealthy lifestyle behaviours'.  
 
* Page 12, line 13, what behavioural changes is the participant referring to?  
 
* Please add the following information about the women participants - parity, trimester or 
weeks postpartum, pre -pregnancy BMI.  It is also not clear why owning a smart phone is 
relevant. For the healthcare professionals - I am not sure why gender is relevant? Please 
add information on years of experience and explain what a  health coach does.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include th e necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to asse ss any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this ma nuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, fees, funding, or salary 
from an  organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares  in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscrip t, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you recei ved reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer r eview policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included a s confidential comments 
to the editor s, which will not be published.  
 
I agree to the open peer review policy of the journal