Women’s experiences of factors that facilitate or inhibit gestational diabetes self-management

BMC Pregnancy and Childbirth

Cheryl Steele¹  Gurjeet K Gill²  Mary Carolan³ 

[1] Western Health, Diabetes Education Service, Western Hospital, Gordon St. Footscray, Victoria, 3011, Victoria, Australia;Australian Community Centre for Diabetes (ACCD), Victoria University, St Alban’s Campus, PO Box 14228, Melbourne, 8001, Australia;School of Nursing and Midwifery, St Alban’s Campus, Victoria University, PO Box 14228, Melbourne, 8001, Australia

关键词: Self-management;    Barriers;    Disadvantaged;    Gestational diabetes;   

Others  :  1152330
DOI  :  10.1186/1471-2393-12-99

 received in 2012-03-19, accepted in 2012-09-10,  发布年份 2012

【 摘 要 】

Background

Gestational diabetes rates have increased dramatically in the past two decades and this pattern of increase appears to relate primarily to the obesity epidemic, older maternal age and migration from world areas of high GDM risk. Women from disadvantaged and migrant backgrounds are most at risk of developing and of mismanaging this condition. The aim of the study was to explore the factors that facilitated or inhibited gestational diabetes self-management among women in a socially deprived area.

Methods

Fifteen pregnant women, with a diagnosis of gestational diabetes, were purposively recruited for this study. Qualitative semi structured interviews and 1 focus group were conducted when participants were approximately 28–38 weeks gestation. The study’s theoretical framework was based on interpretative phenomenology and data was analysed using a thematic analysis approach.

Results

Women in this study identified a number of factors that complicated their task of GDM self-management. Barriers included: (1) time pressures; (2) physical constraints; (3) social constraints; (4) limited comprehension of requirements, and (5) insulin as an easier option. Factors facilitating GDM self-management included: thinking about the baby and psychological support from partners and families.

Conclusion

Women from low socio economic and migrant backgrounds often struggle to comprehend GDM self-management requirements. To improve adherence to management plans, these women require educational and supportive services that are culturally appropriate and aimed at a low level of literacy.

【 授权许可】

   
2012 Carolan et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Templeton M, Pieris-Caldwell I, AIHW: Gestational diabetes mellitus in Australia, 2005–06. Canberra: AIHW; 2008. [Diabetes series no. 10. Cat. no. CVD 44]
• [2]Ferrara A: Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 2007, 30(SUPPL. 2):S141-S146.
• [3]Metzger B: The global increase in diabetes: unique issues for mothers and children. International Journal of Diabetes in Developing Countries 2006, 26(2):57-62.
• [4]Anna V, Van Der Ploeg HP, Cheung NW, Huxley RR, Bauman AE: Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005. Diabetes Care 2008, 31(12):2288-93.
• [5]Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, Dietz PM: Maternal obesity and risk of gestational diabetes. Journal of Midwifery 2004, 20(3):281-9.
• [6]Hunt KJ, Schuller KL: The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin N Am 2007, 34(2):173-99.
• [7]Gagnon AJ, McDermott S, Rigol-Chachamovich J, Bandyopadhyay M, Stray-Pedersen B, Stewart D: International migration and gestational diabetes mellitus: A systematic review of the literature and meta-analysis. Paediatr Perinat Epidemiol 2011, 25(6):575-92.
• [8]Carolan M, Davey M-A, Biro MA, Kealy M: Maternal age, ethnicity and gestational diabetes mellitus. Midwifery 2011.
• [9]Coghill AE, Hansen S, Littman AJ: Risk factors for eclampsia: a population-based study in Washington State, 1987–2007. Am J Obstet Gynecol 2011, 205(6):553.e1-553.e7.
• [10]Langer O, Yogev Y, Xenakis E, Brustman L: Overweight and obese in gestational diabetes: the impact on pregnancy outcome. Am J Obstet Gynecol 2005, 192(6):1768-1776.
• [11]Bellamy L, Casas JP, Hingorani AD, Williams D: Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009, 373:1773-1779.
• [12]Cheung NW, Byth K: Population health significance of gestational diabetes. Diabetes Care 2003, 26(7):2005-2009.
• [13]Nolan CJ: Controversies in gestational diabetes. Best Practice and Research: Clinical Obstetrics and Gynaecology 2011, 25(1):37-49.
• [14]Mohsin M, Bauman AE, Jalaludin B: The influence of antenatal and maternal factors on stillbirths and neonatal deaths in New South Wales, Australia. J Biosoc Sci 2006, 38(5):643-657.
• [15]Alwan N, Tuffnell DJ, West J: Treatments for gestational diabetes. Cochrane Database Syst Rev 2009, 8(3):CD003395.
• [16]Phung H, Bauman A, Tran M, Young L, McDonald J, Michell L, et al.: Factors that influence special care nursery admissions to a district hospital in Southwestern Sydney. J Paediatr Child Health 2005, 41(3):119-124.
• [17]Cheung NW, Wasmer G, Al-Ali J: Risk factors for gestational diabetes among Asian women. Diabetes Care 2001, 24(5):955-956.
• [18]Link CL, McKinlay JB: Disparities in the prevalence of diabetes: is it race/ethnicity or socioeconomic status? Results from the Boston Area Community Health (BACH) survey. Ethnicity and Disease 2009, 19(3):288-292.
• [19]Carolan M, Steele C, Margetts H: Knowledge of gestational diabetes among a multi-ethnic cohort in Australia. Midwifery 2010, 26(6):579-588.
• [20]Carolan MC, Steele C, Margetts H: Attitudes towards gestational diabetes among a multi-ethnic cohort in Australia. J Clin Nurs 2010, 19(17–18):2446-2453.
• [21]Silva JK, Kaholokula JK, Ratner R, Mau M: Ethnic differences in perinatal outcome of gestational diabetes mellitus. Am J Obstet Gynecol 2006, 195(3):834-838.
• [22]Hoffman L, Nolan C, Wilson JD, Oats JJ, Simmons D: Gestational diabetes mellitus – management guidelines. Med J Aust 1998, 169:93-97.
• [23]Reader DM: Medical nutrition therapy and lifestyle interventions. Diabetes Care 2007, 30(SUPPL. 2):S188-S193.
• [24]Lemieux L, Ryan EA: The need for insulin in subjects with impaired glucose tolerance of pregnancy. Canadian Journal of Diabetes 2004, 28(3):196-200.
• [25]Crowther C, Hiller JE, Moss JR, et al.: Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005, 352(24):2477-2486.
• [26]Langer O: Maternal glycemic criteria for insulin therapy in gestational diabetes mellitus. Diabetes Care 1998, 21(SUPPL.2):B91-B98.
• [27]Lee-Parritz A: Contemporary management of gestational diabetes. Current Opinion in Endocrinology, Diabetes and Obesity 2011, 18(6):395-400.
• [28]Dalfrà MG, Lapolla A, Masin M, Giglia G, Dalla Barba B, Toniato R, et al.: Antepartum and early postpartum predictors of type 2 diabetes development in women with gestational diabetes mellitus. Diabetes and Metabolism 2001, 27(6):675-680.
• [29]Chodick G, Elchalal U, Sella T, Heymann AD, Porath A, Kokia E, et al.: The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study. Diabet Med 2010, 27(7):779-785.
• [30]Lee AJ, Hiscock RJ, Wein P, Walker SP, Permezel M: Gestational diabetes mellitus: clinical predictors and long-term risk of developing type 2 Diabetes - a retrospective cohort study using survival analysis. Diabetes Care 2007, 30(4):878-883.
• [31]Smith J, Osborn M: Interpretative phenomenological analysis. In Qualitative psychology: A practical guide to research methods. Edited by Smith J. London: Sage; 2008:51-80.
• [32]Chan GK, Brykczski KA, Malone RE, Benner P: Interpretative phenomenology in health care research. Indianapolis: Sigma Theta Tau International; 2010.
• [33]Kierkegaard S: Fear and trembling. New York Penguin: Translated by Hanney A; 1985.
• [34]Carolan M: Women's experiences of gestational diabetes self-management: a qualitative study. Midwifery
• [35]Victorian Government Department of Health: North and West Metropolitan Region health status profile 2011. Victoria: Melbourne; 2012. available at :http://docs.health.vic.gov.au/docs/doc/7E4C404D336E0677CA2579F800123DB8/$FILE/NWMR%20Regional%20Health%20Profile%202011.pdf webcite
• [36]Key Centre for Women's Health: VicLanes: local environments, physical activity and diet - a research translation project with local government. Melbourne: Department of Human Services and Victorian Local Government Association and University of Melbourne; 2006.
• [37]Ben Haroush A, Yogev Y, Chen R, Hadar E, Hod M: Maternal obesity is the major risk factor for large-for-gestational -age infants in pregnancies complicated by gestational diabetes. Am J Obstet Gynecol 2006, 195(6):S159.
• [38]Hadar E, Oats J, Hod M: Towards new diagnostic criteria for diagnosing GDM - The HAPO study. J Perinat Med 2009, 37(5):447-449.
• [39]Bradbury-Jones C, Sambrook S, Irvine F: The phenomenological focus group: an oxymoron? J Adv Nurs 2009, 65(3):663-671.
• [40]Webb C, Kevern J: Focus groups as a research method: a critique of some aspects of their use in nursing research. J Adv Nurs 2001, 33(6):798-805.
• [41]Cote-Arsenault D, Morrison-Beedy D: Women’s voices reflecting changed expectations for pregnancy after perinatal loss. J Nurs Scholarsh 2001, 33(3):239-244.
• [42]Jasper M: The first year as a staff nurse: the experiences of a first cohort of Project 2000 nurses in a demonstration district. J Adv Nurs 1996, 24:779-790.
• [43]Van Kelst L, Spitz B, Seremeus W, Thomson AM: Student midwives’ views on maternity care just before their graduation. J Adv Nurs 2012.
• [44]Plank A, Mazzoni V, Cavada L: Becoming a caregiver: new family carers' experience during the transition from hospital to home. J Clin Nurs 2012, 21(13):2072-2082.
• [45]Rosenbek Minet LK, Lønvig E-M, Henriksen JE, Wagner L: The experience of living with diabetes following a self-management program based on motivational interviewing. Qual Health Res 2011.
• [46]Burnard MP: A method of analysing interview transcripts in qualitative research. Nurse Educ Today 1991, 11(4):461-466.
• [47]Davey M-A, Taylor O, Oats JJN, Riley M: Births in Victoria 2005 and 2006. Melbourne: Victorian Perinatal Data Collection Unit, Department of Human Services Statewide Quality Branch Department of Human Services; 2008.
• [48]ABS: Australian Bureau of Statistics: 4102.0 - Australian Social Trends. Education Canberra; 2008. Available at http://www.ausstats.abs.gov.au/Ausstats/subscriber.nsf/0/DE5DE30C9CF6E5E3CA25748E00126A25/$File/41020_2008.pdf webcite
• [49]Metzger B, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al.: HAPO study cooperative research group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008, 358(19):1991-2002.
• [50]Balas-Nakash M, Rodríguez-Cano A, Muñoz-Manrique C, Vásquez-Peña P, Perichart-Perera O: Adherence to a medical nutrition therapy program in pregnant women with diabetes, measured by three methods, and its association with glycemic control. Rev Investig Clin 2010, 62(3):235-243.
• [51]Kapur K, Kapur A, Ramachandran S, Mohan VE, Aravind SR, Badgandi M, Srishyla MV: Barriers to changing dietary behavior. Journal of Association of Physicians of India 2008, 56:27-32.
• [52]Schrauwers C, Dekker G: Maternal and perinatal outcome in obese pregnant patients. Journal of Maternal-Fetal and Neonatal Medicine 2009, 22(3):218-226.
• [53]Rhoads-Baeza ME, Reis J: An exploratory mixed method assessment of low income, pregnant Hispanic women's understanding of gestational diabetes and dietary change. Heal Educ J 2012, 71(1):80-89.
• [54]Bandyopadhyay M, Small R, Davey MA, Oats JJN, Forster DA, Aylward A: Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. Aust N Z J Obstet Gynaecol 2011, 51(4):360-364.
• [55]Hoppichler F, Lechleitner M: Counseling programs and the outcome of gestational diabetes in Austrian and Mediterranean Turkish women. Patient Educ Couns 2001, 45(4):271-274.
• [56]Alhusen JL, Gross D, Hayat MJ, Woods AB, Sharps PW: The influence of maternal-fetal attachment and health practices on neonatal outcomes in low-income, urban women. Res Nurs Heal 2012, 35:112-120.
• [57]Berg M, Sparud-Lundin C: Experiences of professional support during pregnancy and childbirth - A qualitative study of women with type 1 diabetes. BMC Pregnancy Childbirth 2009, 9:27-35. BioMed Central Full Text
• [58]Levy-Shiff R, Lerman M, Har-Even D, Hod M: Maternal adjustment and Infant outcome in medically defined high-risk pregnancy. Dev Psychol 2002, 38(1):93-103.
• [59]Downs DS, Ulbrecht JS: Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus. Diabetes Care 2006, 29(2):236-240.
• [60]Miles MB, Huberman AM: An expanded sourcebook: Qualitative data analysis. 2nd edition. London: Sage; 1994.
• [61]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. J Obstet Gynecol Neonatal Nurs 2008, 37(4):415-425.