Development and initial testing of a GDM information website for multi-ethnic women with GDM

BMC Pregnancy and Childbirth

Gillian Krenzin²  Cheryl Steele²  Mary Carolan-Olah¹ 

[1] Nursing and Midwifery, College of Health and Biomedicine, Victoria University, St Alban’s Campus, Melbourne 8001, Australia;Western Health, Diabetes Education Service, Western Hospital, Gordon St., Footscray 3011, VIC, Australia

关键词: Internet;    Intervention;    Knowledge;    Self-management;    Gestational diabetes;   

Others  :  1219960
DOI  :  10.1186/s12884-015-0578-0

 received in 2014-10-22, accepted in 2015-05-28,  发布年份 2015

【 摘 要 】

Background

Gestational diabetes mellitus (GDM) affects approximately 5–15 % of pregnant women in Australia. Highest rates are seen among women who are obese, from specific ethnic backgrounds and low socio-economic circumstance. These features also impact on uptake of self-management recommendations. GDM that is not well managed can give rise to serious pregnancy complications. The aim of this project was to develop and test an intervention to improve knowledge of GDM and GDM self-management principles.

Methods

A web-based intervention, consisting of resources aimed at a low level of literacy, was developed and tested among multi-ethnic women at a metropolitan hospital in Melbourne Australia. A basic one-group pre-test/post-test design was used to explore the impact of the intervention on knowledge, in 3 domains: (1) Knowledge of GDM; (2) food values, and;(3) GDM self-management principles. Questionnaire data was analysed using Statistical Package for the Social Sciences (SPSS), version 21.0. Fisher’s exact test was used to test for an improvement in each knowledge scale.

Results

Twenty-one women with GDM, from multi-ethnic backgrounds, participated in the testing of the intervention. Results indicated that the intervention was effective at improving knowledge scores and this effect was greatest in the first domain, knowledge of GDM. Although some improvement of knowledge scores occurred in the other two domains, food values and self-management principles, these improvements were less than expected. This finding may relate to a number of misunderstandings in the interpretation of the web resource and survey questions. These issues will need to be resolved prior to proceeding to a clinical trial.

Conclusion

Initial results from this study look promising and suggest that with some improvements, the intervention could prove a useful adjunct support for women with GDM from multi-ethnic and low socio-economic backgrounds. Conducting a randomised controlled trial is feasible in the future and will provide a useful means of examining efficacy of the intervention.

【 授权许可】

   
2015 Carolan-Olah et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Diabetes in pregnancy: its impact on Australian women and their babies. AIHW, Canberra; 2010.
• [2]Carolan M. Gestational diabetes mellitus among women born in South East Asia: A review of the evidence. Midwifery. 2013; 29(9):1019-26.
• [3]Carolan M, Davey MA, Biro MA, Kealy M. Maternal age, ethnicity and gestational diabetes mellitus. Midwifery. 2012; 28(6):778-83.
• [4]Cheung NW. The management of gestational diabetes. Vasc Health Risk Manag. 2009; 5:153-64.
• [5]Yogev Y, Visser GHA. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med. 2009; 14(2):77-84.
• [6]Glastras S, Fulcher G. Guidelines for the management of gestational diabetes in pregnancy. Clin Pract. 2012; 9(2):161-70.
• [7]Persson M, Winkvist A, Mogren I. 'From stun to gradual balance'- women's experiences of living with gestational diabetes mellitus. Scand J Caring Sci. 2010; 24(3):454-62.
• [8]Carolan M. Women's experiences of gestational diabetes self-management: A qualitative study. Midwifery. 2013; 29(6):637-45.
• [9]Hui AL, Sevenhuysen G, Harvey D, Salamon E. Food choice decision-making by women with gestational diabetes. Can J Diabetes. 2014; 38(1):26-31.
• [10]Carolan M, Gill GK, Steele C. Women's experiences of factors that facilitate or inhibit gestational diabetes self-management. BMC Pregnancy Childbirth. 2012; 12:99. BioMed Central Full Text
• [11]Evans MK, O'Brien B. Gestational diabetes: the meaning of an at-risk pregnancy. Qual Health Res. 2005; 15(1):66-81.
• [12]Chung JH, Voss KJ, Caughey AB, Wing DA, Henderson EJ, Major CA. Role of patient education level in predicting macrosomia among women with gestational diabetes mellitus. J Perinatol. 2006; 26(6):328-32.
• [13]Zanchetta MS, Poureslami IM. Health literacy within the reality of immigrants’ culture and language. Can J Public Health. 2006; 97 Suppl 2:S26-30.
• [14]Pope C. Addressing limited English proficiency and disparities for hispanic postpartum women. J Obstet Gynecol Neonatal Nurs. 2005; 34(4):512-20.
• [15]Mendelson S, McNeese-Smith D, Koniak-Griffin D, Nyamathi A, Lu MC. A community-based parish nurse intervention program for Mexican American women with gestational diabetes. JOGNN/NAACOG. 2008; 37(4):415-25.
• [16]Hoppichler F, Lechleitner M. Counseling programs and the outcome of gestational diabetes in Austrian and Mediterranean Turkish women. Patient Educ Couns. 2001; 45(4):271-4.
• [17]Rosal MC, Goins KV, Carbone ET, Cortes DE. Views and preferences of low-literate hispanics regarding diabetes education: Results of formative research. Health Educ Behav. 2004; 31(3):388-405.
• [18]Negarandeh R, Mahmoodi H, Noktehdan H, Heshmat R, Shakibazadeh E. Teach back and pictorial image educational strategies on knowledge about diabetes and medication/dietary adherence among low health literate patients with type 2 diabetes. Prim Care Diabetes. 2013; 7(2):111-8.
• [19]Rosal MC, Ockene IS, Restrepo A, White MJ, Borg A, Olendzki B et al.. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos: Latinos en control. Diabetes Care. 2011; 34(4):838-44.
• [20]ABS: Australian Bureau of Statistics. 2033.0.55.001 - Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA). Canberra: Australian Bureau of Statistics; 2006.
• [21]Department of Human Services. Well being and lifestyle - the evidence 2006, North West Region. Melbourne, Victoria: Department of Human Services; 2008.
• [22]Inner North West Melbourne Medicare Local. Inner North West Melbourne Medicare Local Whole of Region Needs Assessment. 2012.
• [23]Department of Human Services. Western Metropolitan Region Health and Social Wellbeing Profile. Public Health and Strategic Melbourne 2002 [cited 2013 25 February 2013]; Available from:. http://www. health.vic.gov.au/archive/archive2014/nphp/publications/phpractice/phpractice_project/findingsandrecs.pdf webcite
• [24]Homko CJ, Sivan E, Reece EA. The impact of self-monitoring of blood glucose on self-efficacy and pregnancy outcomes in women with diet-controlled gestational diabetes. Diabetes Educat. 2002; 28(3):435-43.
• [25]Murphy A, Guilar A, Donat D. Nutrition education for women with newly diagnosed gestational diabetes mellitus: small-group vs. individual counselling. Can J Diabetes. 2004; 28(2):147-51.
• [26]Speck M. Best practice in professional development for sustained educational change. ERS Spectrum, Spring; 1996.
• [27]Knowles MS. Andragogy, not pedagogy. Adult Leader. 1968; 16(10):350-2.
• [28]Leventhal H, Meyer D, Nerenz D. The common-sense representation of illness danger. Contributions to medical psychology. 2nd ed. Pergamon, New York; 1980.
• [29]Hagger MS, Orbell S. A meta-analytic review of the common-sense model of illness representations. Psychol Health. 2003; 18(2):141-84.
• [30]Polit DF, Beck CT. Nursing Research: Generating and Assessing Evidence for Nursing Practice . 9th ed. Wolters Kluwer/ Lippincott, Philadelphia; 2012.
• [31]Wallström A, Frisman GH. Facilitating early recovery of bowel motility after colorectal surgery: A systematic review. J Clin Nurs. 2014; 23(1–2):24-44.
• [32]Wilkinson A, Whitehead L, Ritchie L. Factors influencing the ability to self-manage diabetes for adults living with type 1 or 2 diabetes. Int J Nurs Stud. 2014; 51(1):111-22.
• [33]Carolan M, Steele C, Margetts H. Knowledge of gestational diabetes among a multi-ethnic cohort in Australia. Midwifery. 2010; 26(6):579-88.
• [34]Dunn SM, Bryson JM, Hoskins PL, Alford JB, Handelsman DJ, Turtle JR. Development of the diabetes knowledge (DKN) scales: forms DKNA, DKNB, and DKNC. Diabetes Care. 1984; 7(1):36-41.
• [35]Gastrich MD, Peck S, Janevic T, Bachmann G, Lotwala N, Siyam A. Gestational diabetes mellitus: An educational opportunity. J Diabetes Nurs. 2013; 17(6):220-4.
• [36]Nicolas-Rocca TS, Schooley B, Joo SJ. Design and development of a patient-centered e-health system to improve patient understanding at discharge. Comm Assoc Inform Syst. 2014; 34(1):453-76.
• [37]Yin HS, Gupta RS, Tomopoulos S, Wolf MS, Mendelsohn AL, Antler L. Readability, suitability, and characteristics of asthma action plans: Examination of factors that may impair understanding. Pediatrics. 2013; 131(1):e116-26.
• [38]Preacher KJ, Briggs, NE. Calculation for Fisher's Exact Test: An interactive calculation tool for Fisher's exact probability test for 2 × 2 tables. Available from: http://www.quantpsy.org/fisher/fisher.htm. 2001.
• [39]Porcheret M, Main C, Croft P, McKinley R, Hassell A, Dziedzic K. Development of a behaviour change intervention: A case study on the practical application of theory. Implement Sci. 2014;9(1):42.
• [40]Heuberger R. Increasing empathy, knowledge, and skills regarding gestational diabetes. Top Clin Nutr. 2010; 25(3):250-5.
• [41]Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int. 2000; 15(3):259-67.
• [42]Morahan-Martin JM. How internet users find, evaluate, and Use online health information: a cross-cultural review. CyberPsychology and Behavior. 2004; 7(5):497-510.
• [43]Ryan P. Integrated theory of health behavior change: background and intervention development. Clinical nurse specialist CNS. 2009; 23(3):161-70.
• [44]Bassett-Gunter RL, Levy-Milne R, Naylor PJ, Symons Downs D, Benoit C, Warburton DER. Oh baby! Motivation for healthy eating during parenthood transitions: A longitudinal examination with a theory of planned behavior perspective. Int J Behav Nutr Phys Act. 2013; 10:88. BioMed Central Full Text
• [45]Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy and Childbirth. 2014;14(1).
• [46]Worsley A. Nutrition knowledge and food consumption: can nutrition knowledge change food behaviour? Asia Pac J Clin Nutr. 2002; 11 Suppl 3:S579-85.
• [47]Wardle J, Parmenter K, Waller J. Nutrition knowledge and food intake. Appetite. 2002; 34:269-75.
• [48]Rutherford L, Reid S. Knowledge, attitudes and motivations to health: A module of the Scottish Health Survey 2008–2011. Edinburgh: NHS Health Scotland; 2013.