The Importance of Social Networks for Support and Health Beliefs throughout Pregnancy

Abstract

Pregnancy is a unique time when health care providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide physicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.

Physical activity is vital to mental and physical wellbeing throughout the lifespan.^1,2 However, as discussed by Stickford et. al., in this issue, ³ most women do not meet exercise guidelines during pregnancy.^4,5 Throughout their work, the authors found that pregnant women in rural areas may have a limited knowledge of safe exercise practices, misconceptions regarding physical activity during pregnancy, and several barriers to engaging in physical activity during this life stage. ³ Barriers to exercise found in their study were similar as those commonly reported by non-pregnant women (e.g., time, motivation, fatigue). ⁶ With these barriers noted, the healthcare provider is left with the difficult task of finding ways to encourage physical activity.

Social support has been shown to have an important influence on physical activity across the lifespan. ⁷ Specific to pregnancy, social support may be one of the more impactful behavioral strategies because pregnancy is a unique time in life in which social roles and group dynamics are often changing, particularly for first time parents. ⁸ Health and weight management interventions for pregnant individuals prominently feature social support or social network components. ⁹ Social networks are also important during pregnancy because health beliefs are commonly spread through social networks or social connections which could propagate misconceptions regarding physical activity during pregnancy.^10-12 Hence, understanding the social influences present during pregnancy is an important area of study and an important factor for clinicians to be aware of as a strategy to encourage patients who are pregnant to promote physical activity and exercise.

Understanding and supporting physical activity may require the healthcare provider to extend their outlook past social support as it is typically envisioned. For example, social capital also plays a critical role in the adoption of health behaviors. ¹³ Because health beliefs are important for behavior change, social influences on health beliefs are important to understand. Social network analysis provides one of the most granular approaches to evaluating specific connections between individuals. ¹⁰ Using a social network analysis approach, the emphasis is placed on understanding the connections between people and what they might mean for a person’s health belief and behavior. ¹⁰ For researchers, this may be evaluating the number or types of connections an individual has, the resources or support they have access to, or the density of their personal networks. ¹⁰ For providers, this may look like a conversation about specific roles or people in the patient’s life that they go to for support, health information, or advice during their pregnancy. ¹⁰

Social Network Analysis

Social networks foster supportive environments in which several forms of social support can be cultivated. ¹² Many times, these forms of social support are delineated into emotional, informational, appraisal, and instrumental social support.^14,15 For example, emotional, informational, and appraisal support during pregnancy was specifically linked to peers in prenatal care groups. ¹⁴ Pregnant women may have specific individuals within their network that provide specific forms of support more than others. Likewise, network structures such as the density of connections between individuals in one’s network have been linked to greater feelings of social support. ¹⁶ In contrast, the amount of “weak ties” (ties that are outside of the core network) has been associated with informational support and information sharing as these distant connections may provide information not present within the core network.^17,18

Further, networks can be extremely important reinforcement mechanisms for positive behavior change. ¹³ Not only is social support tied to physical activity, but social norms within a network also play a substantial roll in reinforcing behavior.^13,19 As previously mentioned, support groups can be great for information sharing but they can also provide reinforcing social norms of behavior to transition people more effectively from behavior to habit. ²⁰

Social Network Analysis and Social Capital

Social capital refers to the resources individuals can draw from their social networks to promote health. ²¹ From a social capital approach, understanding the diversity of connections within a pregnant women’s network would reveal the different types of resources they may have at their disposal. ²² Likewise, illuminating these connections for the individual may be a worthwhile activity to understand whom they go to for support and resources during difficult times. For example, while not directly physical activity related, women who were able to maintain group membership, social identity, and sense of connectedness with others were significantly more likely to report better mental health post-pregnancy. ²³

Social Network Analysis and Health Beliefs

In addition to providing accessible resources, social networks also have a substantial impact on the flow of health information and an individual’s health beliefs. Many individuals turn to those around them for information and in turn tend to hold similar health beliefs. This is particularly important when considering prenatal care. ²⁰ Indeed, the social influence these connections may have on behaviors and beliefs of pregnant women are vital to their physical activity habits and subsequently their wellbeing. If the connections are well informed, they can positively influence these women.^20,24 However, when social support sources are ill-informed, social influences can negatively influence health beliefs. For example, a study on communication norms found that pregnant women often turn to their friends and family for advice which in turned shapes their personal pregnancy-related beliefs and behaviors. ¹⁹

The Role of Healthcare Providers

Social influences on physical activity may seem daunting to address for many clinicians. However, health care professionals can plan an important role in helping promote healthy social influences on physical activity. Clinicians can become aware of and refer patients to local healthy support groups that can foster positive peer influence counteracting prior health misconceptions.^20,24 It is also important for clinicians to understand that prior misconceptions may be founded in, and subsequently reinforced by, social influence. Patient education in this area would do well to address how this information may be consciously or unconsciously diffused through these networks. Assessing patient’s social networks can be helpful to understand how patients have arrived at particular beliefs.

In the case of pregnancy and physical activity, misconceptions about it not being safe to exercise during pregnancy are common. ²⁵ It is important for clinicians to correct misconceptions without offending or discrediting important social supports. An easy way to do this is to acknowledge that many misconceptions are due to recommendations being changed over time. ²⁶ This can be helpful when sources of misconception include older family members who, for example, may have been told years ago when they were pregnant that exercise during pregnancy could be harmful. Similarly, clinicians are encouraged to focus on personalizing advice to each specific patient’s case. For example, exercise may have been counter-indicated for other individuals in the patients’ social network for specific health concerns. The role of the healthcare provider is to focus on what is best for each individual patient, and given there are no counter-indications, exercise is beneficial during pregnancy. Lastly, it may also be helpful for clinicians to provide training with regards to knowing when exercise is safe. Providing clear signs of what to typically expect with exercise during pregnancy can alleviate anxiety. Setting up realistic expectations and establishing supports may make exercise seem more approachable to patients who are nervous about it.

Conclusion

Pregnancy is a unique time when healthcare providers have more regular contact with women. Using this time to more fully understand the social influences at play can provide clinicians an opportunity to leverage networks to improve health and wellbeing while stemming the exposure to health misinformation. Advocating for supportive social networks or exercise groups/programs can provide additional support and behavioral reinforcement which is needed for sustained behavior change. In this manner, fostering these networks is likely more beneficial to supporting healthy exercise behavior during pregnancy than education alone.