Background: Living Well during Pregnancy (LWdP) is a telephone-based antenatal health behaviour intervention shown to improve healthy eating behaviours and physical activity levels in pregnancy. However, one third of eligible, referred women did not engage with or dropped out of the service.

Aims: Explore the experiences and perceptions of women who were referred but did not engage or complete the LWdP program to inform service improvements and adaptations required for scale and spread, and to improve the delivery of patient-centred antenatal care.

Methods: Semi-structured telephone interviews were undertaken with women who attended ≤2 LWdP appointments after referral. Interviews were thematically analysed and mapped to the Theoretical Domains Framework and Behaviour Change Wheel/COM-B Model, to identify barriers and enablers to program engagement and determine evidence-based interventions to improve service engagement and patient-centred antenatal care. 

Results: Three key themes were identified: 1) program content not meeting women’s expectations and goals; 2) a need for flexible, multimodal health care; and 3) information sharing throughout antenatal care not meeting women’s information needs. Interventions to improve women’s engagement with LWdP and patient-centred antenatal care were categorized as 1) adaptations to LWdP, 2) training and support for program dietitians and antenatal healthcare professionals, and 3) increased advertisement of positive health behaviours in pregnancy.

Conclusions: Women require flexible and personalised delivery of the LWdP aligned to their individual goals and expectations. The use of digital technology has the potential to provide flexible, on demand access to, and engagement with, the LWdP program, healthcare professionals, and reliable health information. All healthcare professionals are vital to the promotion of positive health behaviours in pregnancy, with ongoing training and support necessary to maintain clinician confidence and knowledge on healthy eating, physical activity, and weight gain during pregnancy.