'What have I just eaten?' A qualitative exploration of awareness and use of ultra-processed food products during pregnancy and the post-partum period in line with the COM-B behaviour model.

Consumption of convenience/ultra-processed foods (UPFs) has been associated with a lower diet quality. However, it is unclear whether consumers are aware of what is classified as UPFs. Additionally, higher maternal diet quality is associated lower risk of adverse pregnancy and infant outcomes. Therefore, the aim was to explore awareness, perception, and usage of UPFs during pregnancy. Online focus group discussions with pregnant women and those who had experienced a pregnancy in the UK or ROI were conducted between February and April 2022. A thematic analysis was conducted, and themes were aligned to the COM-B behaviour model. Seven focus groups with ROI participants (n = 24) and six with UK participants (n = 28) were completed. Six themes were generated related to Capability - 1) 'What have I just eaten?' Awareness and understanding of UPF; 2) Education and learning; Opportunity - 3) Cheaper, more expensive, the price debate; 4) Time and balance; Motivation - 5) Healthiness - 'but in the grand scheme'; 6) Pregnancy and next generation. Findings highlight a lack of knowledge in relation to UPFs and therefore participants consumed more UPFs than they thought. The need for upskilling/re-learning cooking skills was emphasised as essential to be able to purchase alternatives to and reproduce UPFs. Generally cooking was considered cheaper, although an upfront ingredient cost was acknowledged. Convenience products and UPFs were seen as a way to negate participant time pressures. Health was not a strong driver to deter use of these products. Further education around convenience/UPF products alongside upskilling/re-learning cooking skills would empower individuals with the knowledge and skills for informed food choices. Wider environmental considerations such as fresh produce price and accessibility could be considered in policy to increase opportunities for cooking behaviours.