Engagement

Questionnaire-based postintervention retention was high at 91%. Early pregnancy hospital information and lifestyle advice received high initial engagement. Departments were classified as highly engaged when both vitality and connectedness were above their medians. Engagement was calculated from employee survey items measuring vitality and connectedness. Participants engaged with the guide, but engagement declined as pregnancy progressed. Later pregnancy and birth-related content was among the least viewed material. Sustained engagement was identified as important for any later effectiveness trial. Treatment acceptability ratings were much stronger among participants who completed the intervention. Attendance followed a U-shaped pattern in which some parents disengaged early while others completed the course. Attendance was a major feasibility challenge, with only half of randomised participants completing at least five sessions. Future work should test strategies that support early engagement by addressing practical and psychological barriers.