Table 7.

A table summarising the results of the mixed-methods synthesis. The assessed strength of the evidence takes into account the number of relevant studies, their respective quality and the consistency of the evidence. The factors on the furthest left column are a summary of the factors found in the qualitative review and are listed in order of prevalence in the literature. The next column describes the extent to which the interventions addressed these themes and whether or not they were effective. Using this, an assessment was made about whether this factor represented a match, mismatch or gap. The confidence in that assessment was evaluated based on the number and quality of the relevant studies. Finally, recommendations for future interventions are provided.

Match: Factors are associated with effective interventions	Mismatch: Factors are associated with ineffective interventions	Gap: No association with effective or ineffective interventions	Inconclusive: Insufficient evidence to determine if a match, mismatch or gap.
Factors that influence physical activity (# qualitative studies that mentioned factor)	Extent to which addressed in interventions	Match, mismatch, gap?	Recommendations for future interventions
		Confidence in synthesis?
Lack of time and energy to be more active (7)	Eight interventions addressed these factors and ten did not. There was no discernible pattern of effective and ineffective interventions addressing lack of time or energy.	Gap	oIncorporate time-management strategies.
		Moderate confidence
Feeling guilty about taking time to oneself/putting others first (7)	One ineffective intervention assessed changes in “feeling you should put the needs of others in your family before yours” in a lifestyle survey. No other interventions addressed these factors.	Gap	oInclude strategies to reduce guilt for mothers to be active.
		Moderate-high confidence
Knowing about increased risk but not doing anything about it/putting off lifestyle change (6)	No interventions addressed women knowing about their increased risk of T2D but not acting on it, nor putting off lifestyle change into the future.	Gap	oPrioritisation of lifestyle change
		High confidence
Walking as a preferred form of physical activity (6)	One effective study used walking as a tool, whereas the other two significant studies did not use walking. All studies that used pedometers as motivation to increase walking/activity were either ineffective (N = 4) or of mixed effectiveness (N = 1).	Inconclusive	oWalking can be effective but pedometers alone may not be sufficient to promote walking.
		Moderate confidence
Lack of affordable childcare (6)	All three significant interventions provided access to childcare during the intervention. Two non-significant and one mixed-effectiveness studies also provided access to childcare, leaving 12 studies that did not address childcare at all.	Match	oAffordable or free childcare.
		Moderate confidence
Lack of support from healthcare professionals (5)	Two effective and two ineffective studies addressed this factor by holding the intervention at a hospital, having healthcare professionals lead the sessions or demonstrating that as a result of the intervention, women felt increased support and encouragement from doctors.	Gap	oCombine healthcare support with other forms of support (e.g. peer support).
		Moderate confidence
Lack of awareness or concern about T2D risk and how to reduce that risk (5)	All three effective physical activity interventions did not directly address this factor. The effective physical activity interventions were more generally focussed on changing lifestyle behaviours and the studies did not mention education about T2D risk and risk reduction techniques. The ineffective and mixed-effectiveness interventions primarily addressed education as a component of the programme (10 of 15).	Mismatch	oEducation about T2D may not be sufficient to change PA levels. There also may be a sense of helplessness or avoidance when made aware about T2D risk, without incorporating additional support (e.g. childcare, social support). oFuture research should explore this causal relationship further.
		Low-moderate confidence
Feeling helpless about getting T2D (5)	Three studies addressed this barrier by educating about how to prevent T2D after having GDM – two were ineffective and one was of mixed-effectiveness. The remainder of the studies (N = 15) did not address this barrier explicitly.	Gap	oFuture interventions should address this feeling of helplessness explicitly.
		Moderate confidence
Social and community support helps women to be more physically active (5)	All three interventions that effectively increased physical activity behaviour included social support as a component of the intervention. Four ineffective and two mixed-effectiveness interventions also aimed to address this using peer support. Two interventions attempted to provide social support through online message boards or inviting partners to attend, but these were not used by participants.	Match	oEffective social support techniques should be incorporated into future physical activity interventions for this target audience. Some methods of support may be more acceptable and effective than others.
		Moderate confidence
Importance of culturally sensitive interventions (4)	Two effective interventions and one mixed-effectiveness studies accounted for cultural factors in their studies.	Match	oFuture interventions should incorporate culture-specific components if relevant.
		Moderate-high confidence
Being a healthy role model for family (3)	No studies explicitly included this factor as part of their intervention.	Gap	oFuture research and interventions could emphasise being a role model as a motivator for behaviour change.
		High confidence
Reverting back to pre-GDM lifestyle (3)	No interventions explicitly addressed this factor.	Gap	oFuture interventions and research should aim to explicitly address this barrier to lifestyle change.
		High confidence
Difficulties in physical activity while breastfeeding (2)	One successful intervention addressed breastfeeding while considering exercise programme planning. Other studies educated about the importance of breastfeeding, but did not address it as a barrier to physical activity	Gap	oInterventions that suggest practical solutions to issues being physical activity while breastfeeding may increase effectiveness – future research should explore this.
		High confidence
Mental health difficulties (2)	Three studies addressed dealing difficulties in mental health during the intervention. One intervention was effective, another ineffective, and the final was of mixed-effectiveness.	Inconclusive	oFuture research should explore the effectiveness of addressing mental health issues in increasing physical activity behaviour.
		High confidence