Factors promoting diabetes self-care among low-income, minority pregnant women

The self-care situation analysis of reproductive-aged women in Tehran: a survey study

BACKGROUND

Along with a global increase in the prevalence of infectious and non-communicable diseases, self-care with an emphasis on reproductive health Self-care has received special attention. Given the importance of women's health, assessment of their self-care status using a valid and reliable tool seems to be necessary to determine the needs for future women's reproductive health promotion interventions. The present study aimed to assess the women's self-care at reproductive age in Tehran, to determine women's health needs based on global guidelines for women's health.

METHODS

This was a descriptive cross-sectional study on 1051 women of reproductive age, living in Tehran. The Subjects were recruited using a multi-stage sampling method. The women completed a socio-demographic and valid and reliable questionnaire to assess their self-care status. The data were analyzed using SPSS 24 and by Pearson, Spearman, ANOVA, and regression tests.

RESULTS

The mean score of self-care was 49.57 ± 23.50% in the reproductive-aged women. The lowest scores were related to psychosocial health (32.12 ± 29.93%) and reproductive-sexual health (49.74 ± 27.99%) respectively. There were significant positive correlations between the self-care and women's education level (r = 0.180; p < 0.01), and husband's education level (r = 0.272; p < 0.01), while there was a negative significant correlation between the self-care and the family size (r = - 0.135; p < 0.01).

CONCLUSION

The findings showed inadequate self-care among reproductive-aged women in Tehran. The most important challenge in their self-care behaviors was related to psychosocial and reproductive-sexual health. It seems to provide a package for promoting women's self-care in four areas of physical, psychosocial, reproductive-sexual health, and screening tests, with an emphasis on the first two priorities, namely psychosocial and reproductive health necessary in Tehran.

"A patient should not have to ask": Women's experiences of patient education about preconception care for type 2 diabetes

OBJECTIVES

To characterize perspectives and experiences regarding preconception care (PCC) patient education among women with type 2 diabetes.

METHOD

Descriptive, qualitative research design. Thirty-two English-speaking women with type 2 diabetes identifying as Black and/or Latina, ages 18-40 years old, participated. We conducted semi-structured interviews about PCC perspectives and experiences which we analyzed with conventional content analysis. To enhance rigor, we collected freelisting data from which we calculated salience scores. We triangulated our qualitative findings with salience scores.

RESULTS

We identified three themes. Our first theme concerned mismatch between women's desires for PCC counseling to be frequent in contrast with their experiences of its infrequency. Our second theme captured how women felt responsible for initiating care in the clinical encounter but uncertain about what they "should" be asking for. Our third theme characterized women's perspectives on receiving information about PCC and pregnancy planning.

CONCLUSIONS

Young adult women with type 2 diabetes who are Black and/or Latina welcome more education about how PCC can prevent obstetrical complications associated with diabetes, which disproportionately affect their communities.

PRACTICE IMPLICATIONS

Our findings provide actionable suggestions for improving acceptability and accessibility of PCC patient education in the United States where PCC awareness and uptake are low.

SweetMama: Usability Assessment of a Novel Mobile Application Among Low-Income Pregnant People to Assist With Diabetes Management and Support

Background

Mobile health tools may be effective strategies to improve engagement, education, and diabetes-related health during pregnancy. We developed SweetMama, a patient-centered, interactive mobile application (app) designed to support and educate low-income pregnant people with diabetes. Our objective was to evaluate the SweetMama user experience and acceptability.

Methods

SweetMama is a mobile app with static and dynamic features. Static features include a customized homepage and resource library. Dynamic features include delivery of a theory-driven diabetes-specific curriculum via 1) motivational, tip, and goal-setting messages aligning with treatment and gestational age; 2) appointment reminders; and 3) ability to mark content as "favorite." In this usability assessment, low-income pregnant people with gestational or type 2 diabetes used SweetMama for 2 weeks. Participants provided qualitative feedback (via interviews) and quantitative feedback (via validated usability/satisfaction measures) on their experience. User analytic data detailed the duration and type of interactions users had with SweetMama.

Results

Of 24 individuals enrolled, 23 used SweetMama and 22 completed exit interviews. Participants were mostly non-Hispanic Black (46%) or Hispanic (38%) individuals. Over the 14-day period, users accessed SweetMama frequently (median number of log-ins 8 [interquartile range 6-10]), for a median of 20.5 total minutes, and engaged all features. A majority (66.7%) rated SweetMama as having moderate or high usability. Participants emphasized design and technical strengths and beneficial effects on diabetes self-management and also identified limitations of the user experience.

Conclusion

Pregnant people with diabetes found SweetMama to be user-friendly, informative, and engaging. Future work must study its feasibility for use throughout pregnancy and its efficacy to improve perinatal outcomes.

Remote patient monitoring for management of diabetes mellitus in pregnancy is associated with improved maternal and neonatal outcomes

BACKGROUND

Diabetes mellitus is a common medical complication of pregnancy, and its treatment is complex. Recent years have seen an increase in the application of mobile health tools and advanced technologies, such as remote patient monitoring, with the aim of improving care for diabetes mellitus in pregnancy. Previous studies of these technologies for the treatment of diabetes in pregnancy have been small and have not clearly shown clinical benefit with implementation.

OBJECTIVE

Remote patient monitoring allows clinicians to monitor patients' health data (such as glucose values) in near real-time, between office visits, to make timely adjustments to care. Our objective was to determine if using remote patient monitoring for the management of diabetes in pregnancy leads to an improvement in maternal and neonatal outcomes.

STUDY DESIGN

This was a retrospective cohort study of pregnant patients with diabetes mellitus managed by the maternal-fetal medicine practice at one academic institution between October 2019 and April 2021. This practice transitioned from paper-based blood glucose logs to remote patient monitoring in February 2020. Remote patient monitoring options included (1) device integration with Bluetooth glucometers that automatically uploaded measured glucose values to the patient's Epic MyChart application or (2) manual entry in which patients manually logged their glucose readings into their MyChart application. Values in the MyChart application directly transferred to the patient's electronic health record for review and management by clinicians. In total, 533 patients were studied. We compared 173 patients managed with paper logs to 360 patients managed with remote patient monitoring (176 device integration and 184 manual entry). Our primary outcomes were composite maternal morbidity (which included third- and fourth-degree lacerations, chorioamnionitis, postpartum hemorrhage requiring transfusion, postpartum hysterectomy, wound infection or separation, venous thromboembolism, and maternal admission to the intensive care unit) and composite neonatal morbidity (which included umbilical cord pH <7.00, 5 minute Apgar score <7, respiratory morbidity, hyperbilirubinemia, meconium aspiration, intraventricular hemorrhage, necrotizing enterocolitis, sepsis, pneumonia, seizures, hypoxic ischemic encephalopathy, shoulder dystocia, trauma, brain or body cooling, and neonatal intensive care unit admission). Secondary outcomes were measures of glycemic control and the individual components of the primary composite outcomes. We also performed a secondary analysis in which the patients who used the two different remote patient monitoring options (device integration vs manual entry) were compared. Chi-square, Fisher's exact, 2-sample t, and Mann-Whitney tests were used to compare the groups. A result was considered statistically significant at P<.05.

RESULTS

Maternal baseline characteristics were not significantly different between the remote patient monitoring and paper groups aside from a slightly higher baseline rate of chronic hypertension in the remote patient monitoring group (6.1% vs 1.2%; P=.011). The primary outcomes of composite maternal and composite neonatal morbidity were not significantly different between the groups. However, remote patient monitoring patients submitted more glucose values (177 vs 146; P=.008), were more likely to achieve glycemic control in target range (79.2% vs 52.0%; P<.0001), and achieved the target range sooner (median, 3.3 vs 4.1 weeks; P=.025) than patients managed with paper logs. This was achieved without increasing in-person visits. Remote patient monitoring patients had lower rates of preeclampsia (5.8% vs 15.0%; P=.0006) and their infants had lower rates of neonatal hypoglycemia in the first 24 hours of life (29.8% vs 51.7%; P<.0001).

CONCLUSION

Remote patient monitoring for the management of diabetes mellitus in pregnancy is superior to a traditional paper-based approach in achieving glycemic control and is associated with improved maternal and neonatal outcomes.

Is self-management a burden? What are the experiences of women self-managing chronic conditions during pregnancy? A systematic review

OBJECTIVE

This systematic review examines the qualitative literature on women's experiences of self-managing chronic conditions in pregnancy.

DESIGN

Systematic review of qualitative literature. Searches were performed in PubMed and CINAHL from inception to February 2021. Critical interpretive synthesis informed the coding framework and the analysis of the data. The Burden of Treatment theory emerged during the initial analysis as having the most synergy with the included literature, themes were refined to consider key concepts from this theory.

PARTICIPANTS

Pregnant women who are self-managing a chronic condition.

RESULTS

A total of 2695 articles were screened and 25 were reviewed in detail. All 16 included studies concerned diabetes self-management in pregnancy. Common themes coalesced around motivations for, and barriers to, self-management. Women self-managed primarily for the health of their baby. Barriers identified were anxiety, lack of understanding and a lack of support from families and healthcare professionals.

CONCLUSIONS

Pregnant women have different motivating factors for self-management than the general population and further research on a range of self-management of chronic conditions in pregnancy is needed.

PROSPERO REGISTRATION NUMBER

CRD42019136681.

Effect of theory-based education on promoting a healthy lifestyle in pre-diabetic women: RCT

Background

Due to the fact that pre-diabetic people are at higher risk of developing diabetes, it is possible to reduce the risk by taking preventive measures. Therefore, the present study aimed to determine the effect of theory-based education on promoting a healthy lifestyle and fasting blood sugar (FBS) in pre-diabetic women.

Methods

This is a cluster‐randomized controlled trial that was performed on 71 pre-diabetic women referred to Arak Comprehensive Health Service Center. Thus, using cluster sampling method, one center was randomly assigned to the intervention group and one center to the control group. The data collection tool was a questionnaire based on the theory of planned behavior (TPB) and healthy lifestyle behavior that was completed before and at least 3 months after training and FBS test was performed. The experimental group received 3 training sessions of 60 to 90 min and finally the data were analyzed using statistical software.

Results

After the intervention, the mean scores of knowledge (P < 0.001), attitude (P = 0.047) and perceived behavioral control related to physical activity (P = 0.046) and dietary function (P = 0.01) increased significantly in the intervention group. In addition, fasting blood sugar in the intervention group (99.70 ± 11.06) improved significantly compared to the control group (110.94 ± 17.09) (P = 0.003).

Conclusion

Education based on the theory of planned behavior, by holding face-to-face meetings along with following up the samples after the educational intervention, can promote healthy lifestyle of pre-diabetic women. Therefore, designing and implementing similar interventions on all pre-diabetic individuals seem necessary.

Trial registration: The master's thesis in health education is approved by Arak University of Medical Sciences, Iran and is registered in the Iranian Registry of Clinical Trial (IRCT20190304042921N1). Prospectively registered 22/07/2019, https://en.irct.ir/trial/40596.

Patient and Provider Perspectives on a Novel Mobile Health Intervention for Low-Income Pregnant Women With Gestational or Type 2 Diabetes Mellitus

BACKGROUND

Management of diabetes mellitus (DM) during pregnancy is burdensome given the intensity of required patient engagement and skills, especially for women with greater social disadvantage. Mobile health (mHealth) technology is a promising avenue for DM health promotion, but few evidence-based mHealth tools exist for pregnancy. Thus, we designed a theory-driven mHealth tool called SweetMama, and planned a priori to gather usability and acceptability feedback from patients and providers to ensure a user-centered design.

METHODS

In this qualitative assessment, we solicited patient and provider feedback on this novel educational and motivational mobile application for low-income pregnant women with type 2 or gestational DM. Patients and providers participated in separate focus groups. Participants shared feedback regarding SweetMama's visual appeal, architecture, and content. SweetMama modifications were made in an iterative manner. Transcripts were analyzed using the constant comparative technique.

RESULTS

Patient (N = 16) and provider (N = 29) feedback was organized as positive feedback, negative feedback, or additional desired features. Within each category, themes addressed SweetMama visual features, information, or functional features. The majority of negative feedback was addressed and multiple desired features were implemented via iterative application development, resulting in a user-friendly, efficient, and potentially impactful mHealth app designed to support the unique needs of this population.

CONCLUSIONS

SweetMama users had largely positive feedback about the mHealth tool's appeal, content, and functionality. Suggested improvements were incorporated in preparation for further evaluation steps, which include longitudinal usability testing, feasibility trials, and larger trials to determine the efficacy of SweetMama use for improving perinatal outcomes.

Identifying Mobile Health Technology Experiences and Preferences of Low-Income Pregnant Women with Diabetes

BACKGROUND

Rapid expansion of mobile technology has resulted in the development of many mobile health ("mHealth") platforms for health monitoring and support. However, applicability, desirability, and extent of tailoring of these platforms for pregnant women, particularly in populations who experience the greatest health inequities-such as women with diabetes mellitus (DM) and/or those with greater socioeconomic barriers-remains unknown. The objective is to understand low-income pregnant women's experiences and preferences for mHealth tools to support DM health and improve DM self-management during pregnancy.

METHODS

Low-income pregnant and postpartum women were included in individual interviews or focus groups; women with type 2 DM, gestational DM, or no DM were included. Analysis was performed with the constant comparison method.

RESULTS

In this population of 45 (N=37 with DM) low-income, largely minority, pregnant and postpartum women, 100% reported access to smartphones and prior experience with apps. Interest in mHealth to support health and engagement during pregnancy was high. Preferences for general mHealth features included education that reduces uncertainty, support communities, visualizing progress, convenient access to information, and support for better management of pregnancy-related tasks. Preferred design elements included personalization, interactive features, and integrated graphics. Women with DM expressed multiple additional DM-specific needs, including support tools for DM self-management and self-regulation tasks.

CONCLUSION

Pregnant and postpartum women, especially those with DM, desire mHealth technology to support engagement and to adapt lifestyle guidelines and treatment requirements for a healthy pregnancy. Further work to develop mHealth interventions tailored for target populations remains a key step in reducing health inequities and promoting access to evidence-based perinatal health interventions.

Health Care Providers' Utilization of and Perspectives on Mobile Health Technology for Diabetes and Pregnancy Support

OBJECTIVE

Mobile health (mHealth) technology can be an effective tool to deliver behavioral interventions to improve health outcomes for individuals with diabetes. However, there is limited evidence on mHealth for pregnant women managing diabetes or for the role of health care providers (HCPs) in delivering mHealth tools. To prepare for the development of a pregnancy-specific mHealth intervention for diabetes, we sought to understand HCPs' acceptance, utilization, and design recommendations for how mHealth technology can best be used to support the management of diabetes during pregnancy.

METHODS

Focus groups and individual interviews were conducted with clinical HCPs (obstetricians, nurses, diabetes educators, dietitians, and lactation counselors) who care for low-income pregnant women with diabetes. Data were analyzed using the constant comparative method.

RESULTS

Participants (n = 29) generated five themes and 14 subthemes. Knowledge and acceptance themes included utilization of mobile resources and barriers to HCPs' adoption. Knowledge of popular pregnancy applications (apps) dominated, while familiarity with and use of diabetes apps varied by profession and proximity to continued education. Technology adoption barriers included lack of credibility, dependence on Internet resources, and reliance on knowledge networks. Design themes addressed user-centered design, responsive and practical education, and clinical integration. Clinicians recommended patient-participatory design, customizable features, data-tracking features, motivational feedback, and bidirectional communication capabilities.

CONCLUSION

Although HCPs strongly embraced mHealth tools as an adjunct to obstetric care for women with diabetes, they also expressed limited knowledge and apprehension about patient engagement. HCP recommendations and concerns must critically inform the development of meaningful tools for this population.

What Are Patients Watching? A Quality and Content Evaluation of YouTube Videos About Gestational Diabetes. (Preprint)

BACKGROUND

People with gestational diabetes have enhanced learning requirements during pregnancy, and management of their disease often requires the translation of health information into new health behavior changes. Seeking information from the internet to augment learning from health professionals is becoming more common during pregnancy. YouTube is a popular free and accessible web-based resource, which may be particularly useful for individuals with low health literacy or other barriers to receiving high-quality health care; however, the quality and content of YouTube videos varies, and little is known about those covering gestational diabetes.

OBJECTIVE

We aimed to systematically evaluate the quality, content, and reliability of YouTube videos about gestational diabetes.

METHODS

A systematic search of YouTube videos was conducted over the course of 1 week in April 2020 using the following keywords: "gestational diabetes," "gestational diabetes management," "gestational diabetes treatment," and "pregnancy and diabetes." The search results were displayed by relevance, replicating a default YouTube search attempt. The first 60 results from each keyword were reviewed (n=240). Exclusion criteria were videos unrelated to gestational diabetes, videos not in English, and those for which the full video was not available at the time of review. For each unique video, a gestational diabetes content score was used to rate video comprehensiveness and accuracy, and the DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of information presented. Videos were further categorized by quality: videos with DISCERN scores lower than 3 (out of 5) or a content score less than 4 (out of 7) were categorized as low quality, and all others were designated high quality. We performed descriptive analysis and compared video characteristics by source and quality rating.

RESULTS

For 115 unique videos, the mean content score (out of 7) was 3.5 (SD 2.0) , and the mean DISCERN score (out of 5) was 2.7 (SD 0.7), representing low to moderate information comprehensiveness and reliability respectively. Video sources were categorized as personal vlog (12/115, 10.4%), web-based education (37/115, 32.2%), medical (52/115, 45.2%), business or company (13/115, 11.3%), and media clip (1/115, 0.9%). DISCERN and content scores trended higher among medical and web-based education videos. The majority of videos (n=88) were categorized as low quality, while 27 videos were categorized as high quality. Video duration was longer for high-quality videos (P<.001); high- and low-quality videos otherwise had similar views and viewer interaction numbers.

CONCLUSIONS

Although high-quality videos about gestational diabetes exist, reliability, accuracy, and comprehensiveness were low overall, and higher quality was not associated with increased viewer interaction. It is important to acknowledge the limitations of this platform and to assist patients in accessing high quality content and differentiating the quality of information sources.

Evaluation of a Text Messaging Intervention to Support Self-Management of Diabetes During Pregnancy Among Low-Income, Minority Women: Qualitative Study

Background

Given the growing burden of diabetes in underserved communities and the complexity of diabetes self-management during pregnancy, the development of interventions to support low-income pregnant women with diabetes is urgently needed.

Objective

This study aims to develop and pilot test a theory-driven curriculum of SMS text messaging for diabetes support and education during pregnancy.

Methods

This was a prospective pilot investigation of a novel SMS text messaging intervention offered to pregnant women with pregestational or gestational diabetes mellitus and publicly funded prenatal care. Prior work yielded a conceptual model of diabetes self-management barriers and support factors in this population, which was used to guide curriculum development along with health behavior theories. Participants received three supportive or educational one-way text messages per week during pregnancy. In-depth semistructured interviews were performed at study exit to solicit feedback on the program. Narrative data were analyzed using the constant comparative technique to identify themes and subthemes.

Results

Participants (N=31 enrolled and n=26 completed both interviews) consistently reported that SMS text messaging provided enhanced motivation for diabetes self-care, reduced diabetes-related social isolation, increased perceived diabetes-associated knowledge, enhanced comfort with the health care team, and reduced logistical burdens of diabetes during pregnancy. Participants requested enhanced interactive and customizable features in future intervention iterations.

Conclusions

Pregnant women with diabetes who were enrolled in this pilot study of an SMS text messaging curriculum for diabetes support described enhanced motivation, knowledge, and comfort with diabetes self-care activities as a result of the health education intervention. The next steps include enriching the interactive features of the intervention and investigating the effect of the intervention on perinatal outcomes.

Barriers and facilitating factors in the prevention of diabetes type 2 and gestational diabetes in vulnerable groups: A scoping review

Aims

Type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM) are globally on the rise, accompanied by comorbidities and associated health costs. Increased physical activity, healthy nutrition, and weight loss have shown the potential to prevent T2DM/GDM. Despite this, reaching vulnerable groups remains a key challenge. The aim of this scoping review was to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups.

Methods

We conducted a systematic literature search in May 2018, updated in September 2019, in several databases (e.g. PubMed, Embase) to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Two reviewers independently screened the results. Extracted data was charted, categorized, and summarized.

Results

We included 125 articles. Ninety-eight studies were extracted, and eight categories of barriers and facilitating factors were formed. The most common categories of barriers were limited knowledge, family/friends, and economic factors, and the most common categories of facilitating factors were family/friends, social support, and knowledge.

Conclusion

This scoping review identified various barriers and facilitating factors in vulnerable groups. Preventive interventions should consider these barriers and facilitating factors in developing preventive interventions or in adapting existing ones.

"If I Don't Eat Enough, I Won't Be Healthy". Women's Experiences with Gestational Diabetes Mellitus Treatment in Rural and Urban South India

Gestational diabetes mellitus (GDM) is associated with a range of adverse pregnancy outcomes as well as increased risk of future type 2 diabetes and cardiovascular disease. In India, 10%–35% of pregnant women develop GDM. In this study, we investigated women’s experiences with the dietary and pharmaceutical treatment for GDM in rural and urban Tamil Nadu, India. Semi-structured interviews were conducted with 19 women diagnosed with GDM. Data were analyzed using qualitative content analysis. Three overall aspects were discovered with several sub-aspects characterizing women’s experiences: emotional challenges (fear and apprehension for the baby’ health and struggling to accept a treatment seen as counterintuitive to being safe and healthy), interpersonal challenges (managing treatment in the near social relations and social support, and coordinating treatment with work and social life), and health system-related challenges (availability and cost of treatment, interaction with health care providers). Some aspects acted as barriers. However, social support and positive, high-quality interactions with health care providers could mitigate some of these barriers and facilitate the treatment process. Greater efforts at awareness creation in the social environment and systemic adjustments in care delivery targeting the individual, family, community and health system levels are needed in order to ensure that women with GDM have the opportunity to access treatment and are enabled and motivated to follow it as well.

The effect of education through mobile phone short message service on promoting self-care in pre-diabetic pregnant women: A randomized controlled trial

INTRODUCTION

Gestational diabetes is increasing in developed and developing countries. This study aimed to evaluate the effect of SMS messaging on the self-care among pre-diabetic pregnant women.

METHODS

This randomized controlled trial conducted on 100 pre-diabetic pregnant women referred to Ahvaz Health Centers, Iran, Sep to Dec, 2016. Women were randomly assigned into the face to face education group and short message systems in addition to the face to face education group. Self-care variables were compared between the groups. Data was analyzed using chi-square, independent and paired t-tests.

RESULTS

There was no difference regard to FBG and OGTT, but there was a significant difference between groups in physical activity level (P<0.001) and in all food groups except bread and cereals after the intervention (P<0.05).

CONCLUSION

The education through a short text message system seem couldn't control the blood sugar, but it could promote physical activity and food additives of pre-diabetic pregnant women.

Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicentre observational study

AIMS

To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population.

METHODS

A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension.

RESULTS

Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006).

CONCLUSIONS

Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.

Self-care behavior of type 2 diabetes mellitus patients in Bandar Abbas in 2015

Background

Diabetes self-care helps to control the blood sugar which, in turn, results in a better state of health. However, more than 50% of diabetic patients do not have self-care capabilities.

Objective

To determine type 2 diabetes self-care capabilities among patients visiting a Bandar Abbas diabetes clinic in 2016.

Methods

The present descriptive-analytical research was of a cross-sectional type. The sample was comprised of 120 patients afflicted with type 2 diabetes, who had been selected through the simple randomized sampling method. The data collection instrument was a questionnaire comprised of two sections: demographic information, and a summary of patients' diabetes self-care activities. A 7-point Likert scale was used for the rating. The final score would be interpreted as any of the three levels: good (acceptable) (75-100), moderate (50-74) and poor (below 50). The data entered SPSS version 18.0 for the required statistical analyses.

Results

The mean age of the sample was 51.88±10.12 years. Of the 120 subjects, 86 were female (71.7%) and 34 were male (28.3%). The findings revealed that the self-care capability of 83 subjects (69.2%) was poor; capability of 28 subjects was moderate (23.3%) and the same score of good/acceptable in 9 subjects (7.5%).

Conclusion

The results of the present research indicate that a large number of diabetic patients have a poor self-care capability. Due to the key role of such activities in a diabetic patient's life, it is suggested to include educational programs to increase the level of self-care capabilities among these patients.

Barriers of Adherence and Possible Solutions to Nonadherence to Antidiabetic Therapy in Women with Diabetes in Pregnancy: Patients' Perspective

Diabetes in pregnancy contributes to maternal mortality and morbidity though it receives little attention in developing countries. The purpose of the study was to explore the barriers to adherence and possible solutions to nonadherence to antidiabetic therapy in women with diabetes in pregnancy. Antidiabetic therapy referred to diet, physical activity, and medications. Four focus group discussions (FGDs), each with 7 participants, were held at a central hospital in Zimbabwe. Included were women with a diagnosis of diabetes in pregnancy, aged 18 to 49 years, and able to speak Shona or English. Approval was obtained from respective ethical review boards. FGDs followed a semistructured questionnaire. Detailed notes were taken during the interviews which were also being audiotaped. Data were analysed thematically and manually. Themes identified were barriers and possible solutions to nonadherence to therapy. Barriers were poor socioeconomic status, lack of family, peer and community support, effects of pregnancy, complicated therapeutic regimen, pathophysiology of diabetes, cultural and religious beliefs, and poor health care system. Possible solutions were fostering social support, financial support, and improvement of hospital services. Individualised care of women with diabetes is essential, and barriers and possible solutions identified can be utilised to improve care.