Table 2.

Barriers and Motivators with Exemplar Quotes

Barrier Codes	Code Description	Exemplar Quote
Dismissive Care	Care that was described as dismissive of women’s healthcare needs and priorities	“Sometimes that’s a challenging area for me. Advocating for myself with my doctors or just pushing them to keep looking for why something weird is happening. You know, ‘I noticed this in my body’ or noticed that, and it’s just like, ‘oh, well keep an eye on it.’ And sometimes it just gets a little brushed off.” (Participant #3; obesity group; white, non-Hispanic)
Fatalism	Statements that reflect feelings of fatalism and futility as a barrier to lifestyle change	“You have a baby, and then three years later you’re in good shape, and then you get pregnant again and you start all over again (laugh). So, part of me is like, just whip them out now … be unhealthy for six years, and then, now I can actually get in shape and stay in shape … And so, part of that is the challenge of, ‘is it even worth it?’ Cause it just starts over.” (Participant #4; pregnancy-complications group; white, non-Hispanic)
Focused on the Present, Not the Future	Descriptions of women being focused on the present (e.g., pregnancy and neonatal outcomes) rather than long-term health	“I was focused on how to keep my baby safe, not necessarily 10 years from now … Like I don’t really care about that right now, I care about keeping my baby safe.” (Participant #5; pregnancy-complications group; white, non-Hispanic)
General Knowledge of Risk	Statements reflecting a generalized knowledge of risk that highlight a lack of in-depth knowledge related to women’s specific risks based on their risk profile	“I feel like I never got information about why [high blood pressure is] important or why that matters. Just that it’s scary and that it’s a problem but no information about why or how it could affect other pregnancies or just my life in general after.” (Participant #1; pregnancy-complications group; white, non-Hispanic)
Lack of Education	Statements describing how a lack of education from healthcare providers acted as a barrier to lifestyle change	“So, I think the biggest issue is a lack of education. It’s not a lack of doctors caring, but it’s a lack of time to teach, and follow up regarding lifestyle changes.” (Participant #1; prediabetes group; white, non-Hispanic)
Cost	Statements about cost and finances as barriers to engagement in lifestyle change	“Diet and exercise programs, normally those kinds of things are really expensive. As a new mom, and you know, a young married couple, we just don’t really have it in the budget for a long, big-commitment kind of program.” (Participant #1; prediabetes group; white, non-Hispanic)
Unappealing Format	Statements about program format types and forms of delivery as barriers to participation in lifestyle change	“If it’s only presented in one way, if it’s only an in-person class, I’m not gonna be able to attend a class necessarily, nor would I want to, as a more introverted person. So, I think that if there were not other methods available, that would prevent me from participating.” (Participant #3; prediabetes group; Hispanic/Latino)
Exercise	Statements about barriers to engaging in exercise	“I don’t want to go to a personal trainer because I feel like that is for somebody who loves to work out … and I absolutely hate it (laughs). And it is very hard for me … physically it’s hard. I have asthma that’s induced by exercise, and a lot of back problems.” (Participant #4; pregnancy-complications group; white, non-Hispanic)
Food	Statements about food and access to food as a barrier to lifestyle change	“For me, my husband, he loves eating the Pakistani food, which is a lot of oil, and spices. So overnight, like he says, like, ‘we’ll go to the fitness center together, but I want that diet. I can’t stop that.’ So, I for sure, I will make that stuff for him. But when it comes to me, I will say okay, I don’t have energy to make something for my own self. I’ll eat that. So that actually, you know, that environment or like… He has actually had a big impact on my diet, also. That’s, I think, a factor which actually prevents me to eat healthy.” (Participant #3; obesity group; Asian)
Healthcare Inadequacy	Inadequacies in healthcare described by participants	“With my pre-eclampsia, I didn’t have a six-week checkup. They just sent me home with a blood pressure cuff to monitor my blood pressures. So, I just relied on searching for answers myself. I really haven’t been able to get my blood pressures down after that, and that’s really all I’ve ever been told.” (Participant #6; pregnancy-complications group; Native Hawaiian/Other Pacific Islander)
Childcare	Lack of childcare described as a barrier to participation in lifestyle change	“Whether it’s incorporating my children in these habit changes, which is probably a good thing, or finding childcare to watch my kids while I go and try and make these lifestyle changes … um, that way, they’re not 100% in the way. There’s no in-between, at least for my lifestyle, so I would have to get childcare.” (Participant #7; pregnancy-complications group; white, non-Hispanic)
Pregnancy and Postpartum	Statements about pregnancy and the postpartum period as barriers to participation in lifestyle change	“When the pregnancy started, I don’t have energy to move an inch. So, that, is actually putting a big barrier for me to continue exercising or eating healthy because when you are pregnant, then you can’t do whatever you try.” (Participant #2; obesity group; Asian)
Delayed Results	Statements about how a lack of results can act as a barrier to participation in lifestyle change	“I think that something that might prevent me from participating in a formal program is if I didn’t see the benefit right away, you know?” (Participant #4; obesity group; white, non-Hispanic)
Lack of Social Support	Descriptions of a lack of social support as a barrier to participation in lifestyle change	“Sometimes people don’t have support from their spouse or their family to help them to get into the exercising or watching a baby and your other kids or anything so that you can take care of yourself.” (Participant #4; pregnancy-complications group; white, non-Hispanic)
Time	Statements about how a lack of time and scheduling conflicts can act as barriers to participation in lifestyle change	“Sometimes those classes are at a hard time for me. My kids are all in school now, but all these classes that I’ve seen are like … right when I need to be dropping off or picking up kids from school.” (Participant #4; pregnancy-complications group; white, non-Hispanic)
Lack of Healthcare Coordination	Descriptions of a lack of coordination between OB and other healthcare providers following pregnancy and the postpartum	“Even like a referral to say, ‘hey, after [delivery] you should follow up with your general doctor about all of these and that you have this, and you need to keep an eye on that for the future.’ I know that I did not ever … I did not receive that. and I don’t know that I’ve ever had any women that I’ve been in contact with, um, get that information after.” (Participant #2; pregnancy-complications group; white, non-Hispanic)
Weight Stigma	Statements about weight stigma	“I felt like they made it more about statistics, that you’re statistically overweight, and they just kind of glanced over me as a person.” (Participant #7; pregnancy-complications group; white, non-Hispanic)
Mental Health	Mental health described as a barrier to participation in lifestyle change	“The postpartum blues, getting yourself out of the house … at that point, like, for me I don’t care about myself. I care about this baby.” (Participant #4; pregnancy-complications group; white, non-Hispanic)
Motivator Codes	Code Description	Exemplar Quote
Accountability	Accountability described as a motivator to participation in lifestyle change	“I think what would encourage me to participate in one is actually knowing it’s a commitment, and not just kind of casual … knowing that it is a commitment, that I will be meeting with those same people … these people you see every Wednesday night, and they’re there to encourage you and to help you.” (Participant #1; prediabetes group; white, non-Hispanic)
Competition	Competition described as a motivator to participation in lifestyle change	“I’m a really competitive person. So, any type of competition and I go, ‘Yeah, I’ll do that.’ And so, just like a motivator for me is just competition. Which, I don’t know if that’s a good thing (laugh), but yeah.” (Participant #4; pregnancy-complications group; white, non-Hispanic)
Kids	Statements about how children and parenting can serve as a motivator to participation in lifestyle change	“I wanna be around for my kids and I want to teach my kids that this is a healthy attribute.” (Participant #1; pregnancy-complications group; white, non-Hispanic)
Knowledge	Knowledge described as a motivator to participation in lifestyle change	“I think knowledge is power for me. So, like, I know something is important, then I’m gonna want to do it. Especially if it affects my kids or myself … if we have adequate information and we know how to make changes that would actually help me, even if it’s smaller, then it would be easier to start.” (Participant #1; pregnancy-complications group; white, non-Hispanic)
Family/Anecdotal Experience	Family/social history described as a motivator to participation in lifestyle change	“I have families and friends that are going through this process of diabetes, and it is not … something that I want to go through. So, I really want to do something about it.” (Participant #4; prediabetes group; no race/ethnicity selected)
Monetary Incentives	Monetary incentives described as motivators to participation in lifestyle change	“I think [monetary] incentives is another motivation if we’re looking at time and priority. When we have incentives, then that kind of bumps up priority for certain people.” (Participant #5; prediabetes group; Native Hawaiian/Other Pacific Islander)
Positive Healthcare Interaction	Statements about positive healthcare interactions as a motivator to participation in lifestyle change	“I was always very grateful for the first doctor that spoke to me about it, really educated me about it. And, you know, not only sent me home with pamphlets, but took time in that meeting.” (Participant #1; prediabetes group; white, non-Hispanic)
Personalization	Importance of personalization of programming described as a motivator to participation in lifestyle change	“So, I think if it was something that was personalized, if someone sat down … and came up with a plan that was gonna work for me personally with my interest, with my preferences … and it was like doable, because we’re all busy, as mothers. I think if it’s something that feels … doable and is um, not that all-or-nothing thinking, and maybe more personalized to … the individuals’ preferences.” (Participant #5; pregnancy-complications group; white, non-Hispanic)