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Women Birth. 2018 Feb;31(1):e32-e41. doi: 10.1016/j.wombi.2017.06.011. Epub 2017 Jun 26.

Conceptions of pregnancy health and motivations for healthful behavior change among women in American Samoa.

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Sociology Department, Yale University, New Haven, CT, USA.
Development Studies Department, Brown University, Providence, RI, USA.
International Health Institute, Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
Division of Natural Science and Mathematics, Chaminade University, Honolulu, HI, USA.
Department of Obstetrics and Gynecology, Lyndon B Johnson Tropical Medical Center, Pago Pago, American Samoa.
Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT 06520-8034, USA. Electronic address:



American Samoan women are particularly at risk of obesity-related non-communicable disease (NCD), requiring efficacious interventions to protect their health and that of their infants. Prior studies have identified pregnancy as an ideal time for behavior change interventions related to NCD.


This study aimed to understand American Samoan women's conceptions of health during pregnancy, their motivations for pregnancy behavior change, and the role of their family in both enabling and preventing these changes.


Eighteen women (2-19 weeks post-partum) completed semi-structured interviews that explored their experiences of pregnancy-related behavior change and social support. A thematic analysis identified prominent themes. A stages of change framework was used to describe the sample's readiness for behavior change.


Participants expressed a Westernized conception of health during pregnancy that focused on eating a balanced diet and exercising regularly; behaviors that would usually be stigmatized outside of pregnancy. Many were in the contemplative/pre-contemplative stages of change, although some reported initiating healthful behaviors in pregnancy. Participants overwhelmingly described external motivations for adopting healthy behaviors, most notably the perceived benefit to their baby. During pregnancy, women reported protective treatment from their families as a result of communal ownership over the baby that is potentially limiting for women's agency over their health.


This study confirmed pregnancy as an opportune moment for health behavior intervention, especially within the context of Samoan culture. Future efforts should capitalize on external motivations for behavior change but also encourage the development of internal motivators to sustain changes initiated in pregnancy post-partum.


American Samoa; Behavior change; Motivation; Pregnancy; Stages of change

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