A Convergent mixed methods study on exercise benefits, barriers, and self-efficacy in Chinese pregnant women: triangulating self-report scales with lived experience

Instruments like the Exercise Benefits/Barriers Scale (EBBS) and the Pregnancy Exercise Self-Efficacy Scale (P-ESES) are commonly employed to evaluate psychosocial factors influencing physical activity in pregnant individuals. However, whether these scales dequately capture the lived exercise experiences of Chinese pregnant women remains underexplored. This convergent parallel mixed methods study therefore assessed the alignment and discrepancies between questionnaire content and in-depth interview narratives. A total of 335 pregnant women from three provinces in China (Guangdong, Zhejiang, Shaanxi) completed the EBBS, P-ESES, and the Pregnancy Physical Activity Questionnaire (PPAQ). Concurrently, 30 participants purposively selected from the same quantitative pool participated in semi-structured interviews guided by the Health Belief Model.Thematic analysis was conducted on qualitative data using NVivo 12. Quantitative and qualitative datasets were integrated via a joint display table to examine convergence and divergence at the item level. Intercoder reliability was ensured through independent coding and consensus-based resolution. The quantitative strand showed generally low physical activity levels and moderate-to-high psychosocial scale scores (Table 2).Six qualitative themes emerged: (1) cognition of exercise during pregnancy, (2) motivations for exercise, (3) factors influencing exercise participation, (4) action inspiration and information sources, (5) post-exercise feelings, and (6) confidence in maintaining exercise. Triangulation revealed strong convergence for exercise benefits and most barrier/self-efficacy items under decision rules requiring endorsement by at least two participants. However, two critical divergences were identified: (i) lack of specific exercise advice from healthcare providers (7 qualitative mentions, no corresponding EBBS item), and (ii) weather/climate as a major environmental barrier (14 qualitative mentions, no corresponding EBBS item). Additionally, one P-ESES item regarding self-efficacy without gym access received zero qualitative endorsement. The findings provide qualitative support for the contextual relevance and construct coverage of the EBBS and P-ESES among Chinese pregnant women. Nevertheless, both scales contain notable blind spots concerning professional healthcare support and environmental/climatic barriers, and one P-ESES item (gym/facility access) received no experiential endorsement. Item-level mixed-methods triangulation is a feasible and informative complement to conventional psychometric evaluation when established instruments are used in new cultural contexts. Not applicable.