Exploring Challenges and Co-Developing a Nutritional Resource for Antenatal Care: A Participatory Stakeholder Engagement Study With Midwives and Public Involvement.

backgroundIt is important that midwives discuss good nutrition and optimal weight during antenatal appointments, yet this rarely happens. Earlier research suggests that limited time, plus insufficient knowledge and skills are barriers to this.

aimTo engage antenatal midwives in stakeholder discussions to explore their perspectives on the design and delivery of a nutrition resource.

methodsThis qualitative study used a Participatory Action Research (PAR) approach. Twenty-six midwives (19 community-based; 7 hospital-based) were purposely recruited from four NHS sites in Northwest England. Four stakeholder workshops were co-designed and facilitated by researchers. In Phase 1, midwives reflected on current practice and challenges in delivering diet and weight advice. In Phase 2, they co-developed ideas for practical, acceptable nutrition resources. Data collection included participant-generated artefacts, post-it notes, visual maps, field notes, and verbatim reflections. Data were analysed inductively using Reflexive Thematic Analysis, and reflexivity was maintained throughout, recognising researchers' influence within this participatory design.

resultsTwo master themes were developed: (1) "We Want to Help, But We're Not Trained for This", highlighting systemic, professional, and emotional barriers to providing support and (2) "Make It Real and Make It Work", midwives' co-produced recommendations for inclusive tools and training that are realistic, culturally sensitive, and integrated into existing workflows. DISCUSSION AND

conclusionMidwives expressed a clear need for improved education and resource support. Despite systemic constraints, they co-produced practical and implementable solutions. Supporting midwives through evidence-based, context-specific tools and training may enhance nutrition conversations in antenatal care and improve maternal and infant health outcomes. PATIENT OR PUBLIC CONTRIBUTION: Three culturally diverse Patient and Public Involvement (PPI) representatives were recruited to assist with the validation of the analytical findings. One was a midwife working in antenatal care; the second was a recent service user (a postnatal woman) with an Eastern European background, and the third was a midwife (currently on maternity leave) with a South American background. Commentary from these PPI representatives was used to validate the analysis and support the interpretation of the data. Additionally, they were invited to provide commentary on the draft manuscript and have been included as co-authors.