Feasibility and acceptability of a structured counselling approach to address lifestyle-related risk factors during pregnancy and postpartum care: an exploratory longitudinal pilot feasibility study

Background Lifestyle-related risk factors (LRRFs) are major contributors to adverse maternal and child outcomes. Despite clear international guidelines, counselling on these topics is inconsistently implemented in routine care. Structured tools may support comprehensive, consistent counselling, yet evidence for multi-domain approaches in maternal health is limited. Methods This exploratory longitudinal pilot feasibility study evaluated a structured counselling approach to support structured communication on five LRRFs (smoking, alcohol, nutrition, physical activity, and stress) in German outpatient midwifery and gynecological practice. Quantitative provider and session-level data were complemented by open-ended provider feedback collected at the end of the field phase. Ten providers participated (eight midwives, two gynecologists). Feasibility outcomes comprised provider recruitment and retention, the number and planned duration of documented counselling sessions, fidelity of delivery, and completeness of documentation. Provider acceptability was assessed using structured questionnaire items addressing perceived usefulness, usability and flexibility, complemented by open-ended feedback on barriers and facilitators. Quantitative data were analyzed descriptively; open-ended responses were reviewed manually and grouped into descriptive categories. Results The ten providers documented 256 counselling sessions. On average, providers addressed approximately two LRRF domains per session, most commonly nutrition, physical activity, and stress. High fidelity, defined as addressing ≥ 4 domains per session, remained below the predefined 75% threshold at all three measurement points (MPs) (coverage of four or more domains at MP1: 14.9%; MP2: 11.1%; MP3: 7.4%), suggesting selective rather than comprehensive application. Documentation completeness was high. Acceptability ratings were positive: clarity of materials (mean 6.9/10), efficiency (6.8/10), and perceived usefulness (5.8–6.9/10) were rated moderately high. Usability and flexibility were rated as moderate, reflecting time constraints and the need to adapt the structure to client needs. Qualitative feedback highlighted strengths in topic organization and communication flow, alongside barriers related to limited time and contextual fit. Conclusions Within this small, purposively recruited sample, the structured counselling approach could be applied during routine counselling encounters and provider acceptability was generally positive, although comprehensive coverage of LRRF domains was uncommon. These findings are specific to the present pilot setting and support further refinement and evaluation in larger and more diverse healthcare settings, including direct assessment of patient perspectives. Trial registration Not applicable.