Attitudes towards gestational diabetes among a multiethnic cohort in Australia

Improving women's experiences with gestational diabetes from culturally and linguistically diverse backgrounds in Australia: a qualitative study

Introduction

Gestational diabetes mellitus (GDM) is the fastest growing type of diabetes in many countries worldwide, including Australia. Although studies have explored the experiences of women with GDM from ethnic minority groups, few have compared their experiences with women from Anglosphere backgrounds.

Objective

To investigate the responses to diagnosis, the management of GDM, and the experiences of healthcare services among women with GDM from different culturally and linguistically diverse (CALD) backgrounds.

Methods

Participants were recruited via convenience sampling by advertisement posted around antenatal clinics of three hospitals in NSLHD: Royal North Shore, Hornsby, and Manly Hospitals. The interviews were semi-structured, one-on-one, and in-person conducted by a trained female volunteer. The interviews were audio-recorded, transcribed into text. The data was analyzed via an inductive and descriptive coding approach. The codes were then categorized into main themes and sub-themes.

Results

30 women (7 Australian-born, 11 Chinese, 8 Indians, and 4 Koreans) partook the semi-structured interviews and 5 themes were identified: (1) Reaction to diagnosis; (2) Management issues; (3) Roles of friends and family; (4) Information access; and (5) Experience with healthcare services. The lack of culturally tailored dietary information, social support and language barriers were the main factors underpinning the differences in GDM experiences among women from CALD backgrounds versus Australian-born.

Conclusion

Healthcare models should provide more emotional support upon diagnosis, culturally tailored guidelines for lifestyle modifications, and involve friends and family in care and management to enhance the experience of GDM for women from CALD backgrounds.

Perceptions of primiparous women diagnosed with gestational diabetes mellitus: A descriptive qualitative study

OBJECTIVE

To understand the perceptions of primiparous women recently diagnosed with Gestational Diabetes Mellitus (GDM) in Singapore.

DESIGN

A descriptive qualitative study design.

SETTING

An outpatient women's health clinic in a tertiary hospital in Singapore.

PARTICIPANTS

Twelve English-speaking primiparous women (aged 27-44 years old) who were diagnosed with GDM were recruited via purposive sampling to participate in this study.

METHODS

Face-to-face interviews were carried out with study participants in a private room at the outpatient clinic from December 2019 to May 2021. All interviews were audio-recorded and transcribed verbatim on the same day. Data analysis was guided by Braun and Clarke's thematic analysis framework.

FINDINGS

Four main themes were identified from this study's findings: (1) Life leading to GDM: A 'hint' that something was wrong, (2) Reactions to diagnosis: Shock or acceptance, (3) Learning to cope: Facing internal and external challenges, and (4) Living with GDM: A way forward.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Primiparous women with GDM require comprehensive informational, practical, and emotional support to help them manage and accept their condition. Healthcare providers are encouraged to provide individualised and holistic care to these women using a humanistic approach. Accessible online educational resources and peer support services could be considered. Public campaigns to increase the general public's awareness of GDM would also allow future women and their families to be more familiar with the condition and hence more prepared to cope with it.

The experiences of women from culturally and linguistically diverse backgrounds with gestational diabetes mellitus: A mixed methods systematic review

BACKGROUND

Gestational diabetes mellitus (GDM) is experienced at a higher rate in women from culturally and linguistically diverse (CALD) backgrounds. The aim of this systematic review is to describe the experiences of women with GDM from CALD backgrounds and compare their experiences to women with GDM from non-CALD backgrounds.

MATERIALS AND METHODS

MEDLINE, EMBASE, PsycINFO, Scopus, WOS and CINAHL databases were searched for qualitative and quantitative studies which included data on the experiences of CALD background women with GDM during all stages of pregnancy. Quality appraisal utilized checklists for analytical cross-sectional studies and qualitative research. Thematic analysis was performed using nVivo software.

RESULTS

Of the 3054 studies identified, 24 studies met the inclusion criteria. Data synthesis produced five key themes: (1) Response to diagnosis, (2) Experiences with self-management, (3) Interactions with the healthcare system, (4) Mental health challenges and (5) Facilitators and barriers to support. Women with GDM from CALD and non-CALD backgrounds similarly expressed mental health challenges, feeling burdened by recommendations, and challenges interacting with healthcare professionals (HCP). The major difference in experience was the cultural relevance of recommendations, especially related to diet recommendations.

CONCLUSION

Gestational diabetes mellitus is a burdensome diagnosis for CALD and non-CALD women, with CALD women uniquely experiencing a lack of culturally relevant recommendations for self-management. The similarities and differences in experience call for optimisation of GDM management and support for women with GDM.

Gestational diabetes: changed health beliefs in migrant women from five Asian countries living in Sweden: a prospective qualitative study

Aim:

The aim of this study was to explore the temporal development of beliefs about health, illness and health care in migrant women with gestational diabetes (GD) born in Asia residing in Sweden, and the influence on health-related behaviour in terms of self-care and seeking care.

Background:

Migrant Asian women are a high-risk group for developing GD. Adapting to the culture in the new society and the healthcare system, being diagnosed with GD and becoming a mother is demanding. The question is whether Asian migrants’ patterns of beliefs and behaviour change over time, as no previous study has been revealed on this topic.

Method:

Qualitative prospective exploratory study. Semi-structured interviews were held on three occasions: during pregnancy and three and fourteen months after delivery, with women born in Asia, diagnosed with GD. Data were analysed with qualitative content analysis.

Findings:

There was a temporal change of beliefs influencing health-related behaviour, showing a rising curve in risk awareness. An increasing number of persons described developing a healthy diet/lifestyle based on initial advice and shifted focus from the child to worries about the woman’s health and risk of developing type 2 diabetes and being unable to care for the child/family. Also, the number of women perceiving GD as a transient condition decreased and more believed it would last forever. Beliefs about health care were unchanged, the healthcare model was perceived working well but information about GD and follow-ups was requested even after delivery, and competent staff was expected. Health professionals’ beliefs about the seriousness of GD influence patients’ beliefs and need to be considered. Migrant women need support with adequate information, based on their individual beliefs, to continue develop a sustainable healthy lifestyle even after giving birth, to promote health and prevent type 2 diabetes.

New Zealand women's experiences of managing gestational diabetes through diet: a qualitative study

Background

For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond.

Methods

Women diagnosed with GDM before 30 weeks’ gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women’s perceptions and experiences of dietary recommendations for the management of GDM.

Results

Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women’s perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term.

Conclusions

The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04297-0.

Psychosocial support interventions for women with gestational diabetes mellitus: a systematic review

PURPOSE

This study aimed to analyze the content and effectiveness of psychosocial support interventions for women with gestational diabetes mellitus (GDM).

METHODS

The following databases were searched with no limitation of the time period: Ovid-MEDLINE, Cochrane Library, Ovid-Embase, CINAHL, PsycINFO, NDSL, KoreaMed, RISS, and KISS. Two investigators independently reviewed and selected articles according to the predefined inclusion/exclusion criteria. ROB 2.0 and the RoBANS 2.0 checklist were used to evaluate study quality.

RESULTS

Based on the 14 selected studies, psychosocial support interventions were provided for the purpose of (1) informational support (including GDM and diabetes mellitus information; how to manage diet, exercise, stress, blood glucose, and weight; postpartum management; and prevention of type 2 diabetes mellitus); (2) self-management motivation (setting goals for diet and exercise management, glucose monitoring, and enhancing positive health behaviors); (3) relaxation (practicing breathing and/or meditation); and (4) emotional support (sharing opinions and support). Psychosocial supportive interventions to women with GDM lead to behavioral change, mostly in the form of self-care behavior; they also reduce depression, anxiety and stress, and have an impact on improving self-efficacy. These interventions contribute to lowering physiological parameters such as fasting plasma glucose, glycated hemoglobin, and 2-hour postprandial glucose levels.

CONCLUSION

Psychosocial supportive interventions can indeed positively affect self-care behaviors, lifestyle changes, and physiological parameters in women with GDM. Nurses can play a pivotal role in integrative management and can streamline the care for women with GDM during pregnancy and following birth, especially through psychosocial support interventions.

Women's experience with receiving advice on diet and Self-Monitoring of blood glucose for gestational diabetes mellitus: a qualitative study

OBJECTIVE

We aimed to explore how women with gestational diabetes mellitus (GDM) experience advice about diet and self-monitoring of blood glucose received in primary health care (PHC) and secondary health care (SHC) with a focus on how women perceived the care coordination and collaboration between healthcare professionals.

DESIGN, SETTING AND SUBJECTS

Individual interviews were conducted with 12 pregnant women diagnosed with GDM. Six women had immigrant backgrounds, and six were ethnic Norwegian. Women received GDM care in the area of Oslo, Norway. Interviews were analysed using thematic analysis.

RESULTS

Women described feeling shocked when they were diagnosed with GDM and feeling an immediate need for information about the consequences and management of GDM. Most of the women felt that their general practitioner (GP) had too little knowledge about GDM. Women with an immigrant background felt that the PHC midwives provided them with sufficient dietary advice related to GDM. Ethnic Norwegian women appreciated receiving more individually tailored dietary advice in SHC. Self-monitoring of blood glucose influenced women's daily lives; however, they perceived the training in PHC and SHC as adequate. The women experienced poor collaboration between healthcare professionals in PHC and SHC, which implied that they sometimes had to initiate follow-up steps in their GDM care by themselves.

CONCLUSIONS

Ideally, women diagnosed with GDM should meet healthcare professionals with sufficient knowledge about GDM as soon as possible after being diagnosed. The collaboration between healthcare professionals involved in the care of women with GDM should be improved to avoid having women feel that they need to coordinate their own care.KEY POINTSCurrent awareness•The management of gestational diabetes mellitus requires appropriate follow-up by healthcare professionalsMain statements•Pregnant women's need for information about the consequences and management of gestational diabetes mellitus was highest immediately after diagnosis•Women perceived that they received more individually tailored information about diet and self-monitoring of blood glucose in secondary health care compared to primary health care•Women felt that general practitioners had insufficient knowledge about gestational diabetes mellitus•Based on our results, care coordination and collaboration between healthcare professionals involved in the care of women with gestational diabetes mellitus should be improved.

Impact of patient education on KAP, medication adherence and therapeutic outcomes of metformin versus insulin therapy in patients with gestational diabetes: A Hospital based pilot study in South India

BACKGROUND AND AIM

The study assessed the impact of continuous patient education on Knowledge, Attitude, Practice (KAP), medication adherence and extent of glycemic control in pregnant women with gestational diabetes on insulin or metformin therapy.

METHODS

81 women with gestational diabetes (37 on insulin and 44 on metformin) were assessed for KAP using a validated questionnaire and medication adherence using the 8-items Morisky medication adherence scale, fasting, and postprandial blood glucose levels at the baseline and after two education sessions on drug therapy at one and three months intervals. The difference in mean KAP, medication adherence scores, fasting, and postprandial blood glucose levels and the extent of glycemic control with insulin or metformin therapy were assessed statistically.

RESULTS

There was a highly significant difference in the mean KAP, medication adherence scores, fasting and postprandial blood glucose levels from baseline to follow-up after three months, (P < 0.0001) indicating that continuous patient education had a positive impact on their KAP, medication adherence, blood glucose levels.

CONCLUSION

The study identified that continuous patient education improved their knowledge and practice of medication adherence which reflected on lowered fasting and postprandial blood glucose levels. Glycemic control was found to be the same with metformin and insulin in gestational diabetes.

Multidisciplinary Group Education for Gestational Diabetes Mellitus: A Prospective Observational Cohort Study

The value of diabetes education, focusing on lifestyle measures, in women with gestational diabetes mellitus (GDM) is acknowledged, but requires intensive education and input of resources if done on an individual basis. Group education could be a valuable alternative to individual education. This study aims to investigate the impact of multidisciplinary group education on women’s knowledge about GDM, education, treatment satisfaction, and emotional status. Two hundred women with GDM were enrolled in a prospective observational study. Dutch speaking women were offered group education at their first visit after GDM diagnosis. Non-Dutch speaking women or women for whom group education was not possible received individual education. Individual follow-up with a dietitian was planned within two weeks for all women. Women receiving individual education (n = 100) were more often from an ethnic minority background compared to women in group education (n = 100) (32.0% (n = 31) vs. 15.3% (n = 15), p = 0.01). Knowledge about GDM significantly improved after education, with few differences between the two education settings. Both patients in group and individual education were equally satisfied with the content and duration of the initial and follow-up education. Of all group participants, 91.8% (n = 90) were satisfied with group size (on average three participants) and 76.5% (n = 75) found that group education fulfilled their expectations. In conclusion, women diagnosed with GDM were overall satisfied with the education session’s content leading to a better understanding of their condition, independent of the education setting. Group education is a valuable alternative to better manage the increasing workload and is perceived as an added value by GDM patients.

Going up, going down: the experience, control and management of gestational diabetes mellitus among Southeast Asian migrant women living in urban Australia

Issue addressed In many developed countries the rate of gestational diabetes mellitus (GDM) for Asian-born women is higher than other groups. Studies suggest that some women have limited knowledge of the disease and poor self-management leading to health problems for themselves and their baby. Few studies report the experience of GDM among Southeast Asian migrant women living in Australia and factors that influence their management of the disease. Methods A qualitative interpretive design was used to explore Southeast Asian migrant women's experience and management of GDM. Women diagnosed with the disease during pregnancy were recruited from an antenatal clinic at two Sydney metropolitan hospitals. Nineteen women were interviewed in their first language. Thematic analysis was used to analyse the data. Results A diagnosis of GDM conferred an unanticipated 'up and down' experience for this group of Southeast Asian women. Their experience of the disease, likened to an elevator ride, was modulated by 'insulin' and 'information' used to control the disease and manage blood glucose levels, dietary levels, exercise levels and anxiety levels. Conclusions Health promotion material that captures the fluctuating experience of GDM has the potential to help women, particularly at the time of diagnosis, to be better prepared, and health professionals to be better informed to control and manage the disease more effectively. So what? GDM is a serious problem. The model generated from our study has the potential to better inform health professionals to prepare women for the inevitable fluctuating physical and emotional effects of the disease. Culturally sensitive material and an educational strategy based on the model may also facilitate women's lifestyle changes and compliance, and improve migrant women's relationship with, and trust in, health professionals involved in their GDM care.

Nursing management of gestational diabetes mellitus in Ghana: Perspectives of nurse-midwives and women

BACKGROUND

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is observed in the beginning of, or first acknowledged during pregnancy. The prevalence of GDM is estimated to be approximately 15% globally and is expected to increase due to growing numbers of overweight and obesity in women in their reproductive age. The nursing management of GDM in terms of lifestyle modifications (exercise, diet and nutrition) and the taking of diabetes medication, if required, and adherence thereto is crucial to prevent maternal and neonatal-perinatal complications. This qualitative study therefore aimed to explore and describe the experiences of women regarding the nursing management they received after being diagnosed with GDM; and the perceptions of nurse-midwives on their nursing management of GDM in Ghana.

SETTING

This study was conducted in the military health institutions in Ghana, which includes one hospital and nine satellite clinics referred to as Medical Reception Stations providing antenatal and postnatal care to both military as well as civilian patients. Research on GDM in Ghana is extremely limited.

DESIGN

We used a descriptive phenomenological approach to conduct 15 unstructured individual interviews with women that have been diagnosed with GDM (n = 7) and nurse-midwives (n = 8) providing nursing management of GDM during a six months period (December 2014 to May 2015). Audio-recorded data was transcribed, coded and analyzed using an adapted version of Tesch's eight steps for coding.

PARTICIPANTS

Seven (n = 7) women between 28 and 45 years of age, with 1 to 3 offspring each, participated. Most women (n = 5) did not have a family history of diabetes. The eight (n = 8) nurse-midwives that participated were between 32 and 50 years old with between 2 and 12 years of experience.

FINDINGS

Participants in this study reported similar issues that could assist in better management of GDM. The majority of participants indicated the need for education on GDM, but both women and nurse-midwives acknowledged that this education is hugely lacking. Participants generally felt that emotional support for women is critical and it was included in the nursing management of GDM. Both groups of participants acknowledged that involving women and their significant others in the nursing management of GDM is important. Cultural and socio-economic issues, such as cultural beliefs that clashed with diabetic diets, lack of financial and social grants and limited nurse-midwifery staff were mentioned by both groups to affect the nursing management of GDM.

KEY CONCLUSIONS

The results demonstrate that, despite the reported challenges experienced by nurse-midwives and women, it was evident that the aim of nurse-midwives was to manage GDM as optimally as possible for women diagnosed with GDM, while considering the constraints established in the results. The challenges identified, specifically in terms of lack of education and cultural and socio-economic issues that affect the quality of and adherence to the nursing management of GDM, need to be addressed in order to optimize care for women diagnosed with GDM in Ghana.

IMPLICATIONS FOR PRACTICE

Based on our findings, recommendations are provided that can assist nurse-midwives and other health practitioners to provide comprehensive nursing management to women that have been diagnosed with GDM.

Differences in meconium stained amniotic fluid in an Australian population: A retrospective study

BACKGROUND

Meconium stained amniotic fluid commonly occurs postdates ( >40 weeks gestation) indicating fetal maturity. Previous literature indicates that different ethnicities mature at different rates.

AIM

To compare the rate of meconium stained amniotic fluid of Australian-born and non-Australian born women.

METHODS

A retrospective correlation study design was implemented, using data collected in the birth outcomes system at one tertiary hospital. Data was collected from all women who gave birth to a term (>/=37 weeks gestation), singleton, liveborn baby between January 1st to December 31st, 2014. Maternal country of birth was used for comparison. Categorical data was analyzed using Chi-Square test for Independence. Continuous variables were assessed for normality, and differences were compared using an Independent t-test or a Mann-Whitney U test. All tests were two-tailed and p<0.05 was considered statistically significant.

RESULTS

3,041 women were included; 1131 Australian-born and 1910 non-Australian born. Meconium stained amniotic fluid occurred more frequently in non-Australian born women compared to Australian-born women (23.5% vs. 19.8 p=0.02). Their babies were significantly smaller (Mean=3265g, Standard Deviation 463.8 vs Mean=3442g, Standard Deviation 499.2, p<0.001), with no difference in gestational length (Mean=39.4, Standard Deviation 1.28 vs Mean=39.5, Standard Deviation 1.18, p=0.06). Increasing gestational age had the strongest association with meconium stained amniotic fluid; >/=42 weeks gestation occurring 3.52 (95% Confidence Interval: 2.00, 6.22, p=<0.001) more than <40 weeks gestation.

CONCLUSION

Maternity health services should record ethnicity and region of birth to provide individualised care as women born overseas often have poorer perinatal outcomes when compared to Australian-born women.

Policies and clinical practices relating to the management of gestational diabetes mellitus in the public health sector, South Africa - a qualitative study

BACKGROUND

Women with a prior gestational diabetes have an increased lifetime risk of developing type 2 diabetes. Although post-partum follow-up for GDM women is essential to prevent progression to type 2 diabetes, it is poorly attended. The need for health systems interventions to support postpartum follow-up for GDM women is evident, but there is little knowledge of actual current practice. The aim of this study was to explore current policies and clinical practices relating to antenatal and post-natal care for women with GDM in South Africa, as well as health sector stakeholders' perspectives on the barriers to -- and opportunities for -- delivering an integrated mother - baby health service that extends beyond the first week post-partum, to the infant's first year of life.

METHODS

Following a document review of policy and clinical practice guidelines, in-depth interviews were conducted with 11 key informants who were key policy makers, health service managers and clinicians working in the public health services in South Africa's two major cities (Johannesburg and Cape Town). Data were analysed using qualitative content analysis procedures.

RESULTS

The document review and interviews established that it is policy that health services adhere to international guidelines for GDM diagnosis and management, in addition to locally developed guidelines and protocols for clinical practice. All key informants confirmed that lack of postpartum follow-up for GDM women is a significant problem. Health systems barriers include fragmentation of care and the absence of standardised postnatal care for post-GDM women. Key informants also raised patient - related challenges including lack of perceived future risk of developing type 2 diabetes and non-attendance for postpartum follow up, as barriers to postnatal care for GDM women. All participants supported integrated primary health services but cautioned against overloading health workers.

CONCLUSION

Although there is alignment between international guidelines, local policy and reported clinical practice in the management of GDM, there is a gap in continuation of care in the postpartum period. Health systems interventions that support and facilitate active follow-up for women with prior GDM are needed if high rates of progression to type 2 diabetes are to be avoided.

A qualitative study of developing beliefs about health, illness and healthcare in migrant African women with gestational diabetes living in Sweden

Background

Gestational diabetes (GDM) is associated with health risks for both mother and child, and is particularly relevant to migrant women and women of African origin. With today’s extensive global migration, contact with the new society and health system confronts the migrant’s culture of origin with the culture of the host country. The question is whether immigrants’ patterns of beliefs about health, illness, and health-related behaviour change over time, as no previous studies have been found on this topic. The purpose was to explore development over time, during and after pregnancy, of beliefs about health, illness and healthcare in migrant women with GDM born in Africa living in Sweden, and study the influence on self-care and care seeking.

Methods

Qualitative prospective study. Semi-structured interviews, with 9 women (23–40 years), on three different occasions: during pregnancy (gestational weeks 34–38), and 3 and 14 months after delivery managed at an in-hospital diabetes specialist clinic in Sweden.

Results

Beliefs were rather stable over time and mainly related to individual and social factors. GDM was perceived as a transient condition as health professionals had informed about it, which made them calm. None, except one, expressed worries about relapse and the health of the baby. Instead women worried about being unable to live an ordinary life and being bound to lifestyle changes, particularly diet, developing diabetes and needing insulin injections. Over time knowledge of appropriate diet improved, although no advice was experienced given by the clinic after delivery. The healthcare model was perceived as well functioning with easy access but regular follow-ups were requested as many (decreasing over time) were unsure whether they still had GDM and lacked information about GDM and diet. During pregnancy information was also requested about the healthcare system before/after delivery.

Conclusions

Beliefs changed to a limited extent prospectively, indicated low risk awareness, limited knowledge of GDM, irrelevant worries about future health, and being unable to live a normal life, associated with problematic lifestyle changes. Beliefs about the seriousness of GDM in health professionals influenced patients’ beliefs and health-related behaviour. The healthcare organisation urgently needs to be improved to deliver appropriate and timely information through competent staff.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0518-z) contains supplementary material, which is available to authorized users.

Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study

OBJECTIVE

To explore the lived experience of women with gestational diabetes mellitus (GDM) living in China in order to add knowledge about how the Chinese women suffer from GDM.

DESIGN

A qualitative interpretive interview study. Data were collected with a snowball sampling technique. Phenomenological hermeneutics was used as the analysis method based on Ricoeur's phenomenological hermeneutical interpretation theory.

SETTING

The study was performed at the participants' work places, or at the obstetric clinics or wards at two provincial hospitals and one municipal hospital in the southeast of China.

PARTICIPANTS

Inclusion criteria were age ≥18 years, diagnosis of GDM without other pregnancy complications, in 34th gestational weeks-postpartum 4th weeks and speaking Mandarin Chinese without speech impediment. 62 women, who met the inclusion criteria, took part in the study.

RESULTS

The lived experience of the women with GDM living in China was formulated into a main theme: 'longing for caring care'. The main theme was derived from four themes: being stricken by GDM, wishing to receive caring GDM care, being left alone to struggle with GDM and trying to adjust and adapt to life with GDM.

CONCLUSION

The eagerness for caring care in China was highlighted. The lack of caring care could be one of the possible reasons why the professional-patient relations were deteriorating in China. It could be useful for health providers and health policymakers to receive education and training about caring care. Using the health metaphor of balance and 'patient participation' and 'patient-centred' approaches may benefit women with GDM and thus improve the quality of care in China.

Sources of information on Gestational Diabetes Mellitus, satisfaction with diagnostic process and information provision

Background

This study aimed to investigate the percentage of the needs and expectations of pregnant women with Gestational Diabetes Mellitus (GDM) about the best sources of information on GDM, their satisfaction with the diagnostic process and information provision.

Methods

Questionnaires were completed by 116 pregnant women aged 18–45 years, diagnosed with GDM and recruited from maternity diabetes clinic. Eligible women were invited to participate in the study and informed consent was obtained from each participant prior to enrolment. Descriptive statistics, Kruskal-Wallis test, t-test and chi-square test were used to analyse data.

Results

Most women (64.2 %) expected general practitioners (GPs) to be the best source of GDM information, following by diabetes educator nurses (45.9 %), diabetes support groups (33.9 %) and internet (32.1 %). However, women found that diabetes educator nurses were more helpful than GPs (32.6 and 20.2 %, respectively). Participants’ age and country of birth were statistically significant. For women aged over 30 years and women born overseas the internet was the most useful information source (68.9 and 77.1 % respectively). Overall, women were very satisfied (33.0 %) or satisfied (45.0 %) with how they were informed of the GDM diagnosis, although 26.0 % were informed by telephone and 16.0 % by text message. More than one-third (39.0 %) of women were not referred to sources of information by GPs at time of diagnosis of GDM (p <0.0001). Women who were referred reported that they were very satisfied (40.0 %) or satisfied (44.0 %) with information they received. Only 8.0 % of women reported dissatisfaction with the manner of health professionals.

Conclusion

The results suggest that health professionals should be aware of the needs and expectations of women who have been diagnosed with GDM, with most women expecting to receive information on GDM from their GPs and diabetes educator nurses. The findings suggest that there is scope for improving how women are informed of the GDM diagnosis and given information, and in clinicians’ manner.

'Is gestational diabetes a severe illness?' exploring beliefs and self-care behaviour among women with gestational diabetes living in a rural area of the south east of China

OBJECTIVE

This study explores beliefs about illness and health and self-care behaviour among women with gestational diabetes living in a rural area of the south east of China.

DESIGN

A qualitative exploratory study using semi-structured interviews and qualitative content analysis.

SETTING

A hospital located in the outskirts of a city in the south east of China.

PARTICIPANTS

Seventeen women with gestational diabetes in 34-38th pregnant weeks.

RESULTS

The beliefs about gestational diabetes among the women in the present study were found to be bidirectional. Some of them feared the illness and its negative influence on health, while others believed that it was not a severe illness and disbelieved the diagnosis of gestational diabetes. They related their illness and health to the individual, social and natural factors. They mainly sought help from the professional sector, but did not fully comply with the professionals' advice. Diet control and exercise were their main self-care measures, but none of them self-monitored their blood glucose. They demonstrated their misunderstanding about diet control and self-monitoring of blood glucose.

CONCLUSIONS

This study highlighted the serious lack of knowledge, lower level of risk awareness and poor self-care behaviour among women in this group. Health professionals were found to be the most important source of knowledge about gestational diabetes for these women. The influence of Chinese culture was demonstrated. Gestational diabetes among these women can most likely be improved by training the health professionals and by health education involving individuals, families and the rural communities.

A study exploring the association of attitude and treatment satisfaction with glycaemic level among gestational diabetes mellitus patients

AIMS

The aim of this study was to evaluate attitude and treatment satisfaction of women suffering from GDM and their association with glycaemic level.

METHODS

A cross sectional study was conducted in antenatal clinic of Hospital Pulau Pinang, Malaysia from June to December 2013 on the sample of 175 patients. Data was collected through modified version of Diabetes Integration Scale (ATT-19) and Diabetes Treatment Satisfaction Questionnaires (DSTQs). Glycaemic level was evaluated in terms of Fasting Plasma Glucose (FPG). Three most recent values of FPG (mmol/l) were taken from patients medical profiles and their mean was calculated. Descriptive and inferential statistics were used for data analysis.

RESULTS

A total of 166 patients were included in final analysis. Only 35 (21.1%) patients had positive attitude and 122 (73.5%) of patients had adequate treatment satisfaction. There was no significant association of total mean ATT-19 score with age, ethnicity, educational level, occupational status, family history and type of therapy. For treatment satisfaction statistically significant association was present only between total mean treatment satisfaction score and educational level. Patients with negative attitude and inadequate treatment satisfaction had higher mean glycaemic level.

CONCLUSIONS

It is concluded that more than two folds of patients were satisfied with their ongoing treatment but majority of the patients were feeling difficulty in active coping measures for the management of GDM.

Barriers and coping strategies of women with gestational diabetes to follow dietary advice

OBJECTIVE

To understand barriers and coping strategies of women with gestational diabetes (GDM) to follow dietary advice.

DESIGN

Qualitative study.

PARTICIPANTS

Thirty women with GDM from the Winnipeg area participated. Each participant completed a Food Choice Map (FCM) semi-structured interview and a demographic questionnaire.

MAJOR OUTCOME MEASURES

Underlying beliefs of women with GDM and factors that hinder following dietary advice.

ANALYSIS

Qualitative data analyzed using constant comparative method to identify emergent themes of factors and beliefs that affected following dietary advice. Themes were categorized within the Integrative Model of Behavioral Prediction.

RESULTS

GDM women faced challenges and barriers when (1) personal food preference conflicted with dietary advice; (2) eating in different social environments where food choice and portions were out of control and food choice decisions were affected by social norms; (3) lack of knowledge and skills in dietary management and lack of a tailored dietary plan.

CONCLUSIONS AND IMPLICATIONS

Quick adaptation to dietary management in a short time period created challenges for women with GDM. Stress and anxiety were reported when women talked about following dietary advice. Tailored educational and mental health consultation with consideration of the barriers may promote dietary compliance and overall better health.

Diabetes care and service access among elderly Vietnamese with type 2 diabetes

BACKGROUND

Vietnamese patients are disproportionately represented in type 2 diabetes mellitus statistics and also incur high rates of diabetes complications. This situation is compounded by limited access to health care. The aim of this project was to gain a deeper understanding of the difficulties Vietnamese patients experience when accessing services and managing their type 2 diabetes mellitus, and to identify factors that are important in promoting health service use.

METHODS

Three focus groups with 15 Vietnamese participants with type 2 diabetes mellitus, 60 to >70 years of age, were conducted in Vietnamese. Open-ended questions were used and focussed on experiences of living with diabetes and access to healthcare services in the Inner Northwest Melbourne region. Audio recordings were transcribed and then translated into English. Data were analysed using a thematic analysis framework.

RESULTS

Findings indicate four main themes, which together provide some insight into the experiences of living with diabetes and accessing ongoing care and support, for elderly Vietnamese with type 2 diabetes. Themes included: (1) the value of being healthy; (2) controlling diabetes; (3) staying healthy; and (4) improving services and information access.

CONCLUSIONS

Participants in this study were encouraged to adhere to diabetes self-management principles, based largely on a fear of medical complications. Important aspects of healthcare access were identified as; being treated with respect, having their questions answered and having access to interpreters and information in Vietnamese. Attention to these details is likely to lead to improved access to healthcare services and ultimately to improve glycemic control and overall health status for this community.

Expectant fathers' knowledge of maternal morbidity: a Sri Lankan experience

Background: Male partners play an important and vital role in the decision-making process regarding pregnant women’s health. The purpose of the present study was to assess the knowledge and awareness of expectant fathers about Gestational Diabetes Mellitus (GDM), Pregnancy Induced Hypertension (PIH), and anaemia during pregnancy.

Methods: A cross sectional descriptive study was carried out among expectant fathers whose partners were attending antenatal clinics at the Anuradhapura Teaching Hospital, Sri Lanka. All consenting participants were interviewed by investigators using an interviewer administered questionnaire to collect data on knowledge of risk factors, symptoms, complications and their control. Statistical analysis was performed using the Kruskal Wallis test. 

Results: Of the 246 expectant fathers studied, 192 (78%) were aware of GDM, 183 (74.4%) and 154 (62.6%) were aware of PIH and anaemia during pregnancy, respectively. The total number of answers provided by expectant fathers ranged from 0 to 33 (of 41 questions). There were 44 fathers who could not answer even a single question. For GDM, anaemia, and PIH, the percentages of expectant fathers who failed to provide at least a single correct answer were 24.8%, 40.2%, and 31.3%, respectively. The median number of total correct answers provided increased steadily along with the average income (chi-square 31.24, p<0.001) and educational level (chi-square 33.57, p<0.001). Expectant fathers in the 25-34 age group had significantly higher scores, compared to younger and older fathers (chi-square 15.11, p=0.001). Fathers experiencing the second pregnancy of their spouses also had higher scores.

Conclusions: Expectant father’s knowledge of the selected morbidities was limited. To improve maternal health, any health promotional programmes should include expectant fathers.

Gestational diabetes: prospective interview-study of the developing beliefs about health, illness and health care in migrant women

AIMS AND OBJECTIVES

To explore the development over time of beliefs about health, illness and health care in migrant women with gestational diabetes mellitus born in the Middle East and living in Sweden and to study the influence on self-care and care seeking.

BACKGROUND

With today's extensive global migration, contact with the new society/health care confronts the migrant's culture of origin with the culture of the host country. The question is whether immigrants' patterns of beliefs about health, illness and health-related behaviour change over time, as no previous studies have been found on this topic.

DESIGN

A qualitative prospective exploratory study.

METHODS

Semi-structured interviews, with 14 women (28-44 years), on three occasions: during pregnancy in gestational weeks 34-38 and three and 14 months after delivery.

RESULTS

  There was a U-shaped development of beliefs, from focusing on worries about the baby's health during pregnancy and trying to comply with advice from health professionals, particularly a healthy diet, through regression to dietary habits (more sugar, less fibre) and lifestyle held before being diagnosed with gestational diabetes mellitus three months after delivery, back to a healthy diet/lifestyle and worries 14 months after delivery but then focusing on their own risk, as mothers, of developing type 2 diabetes and being unable to care for the child. Over time, the number of persons perceiving gestational diabetes mellitus as a transient condition decreased. Respondents lacked information about gestational diabetes mellitus, diet and follow-ups.

CONCLUSION

Beliefs changed over time and influenced health-related behaviour. Beliefs about the seriousness of gestational diabetes mellitus among healthcare staff/care organisation influence the development of patients' beliefs and need to be considered in planning care.

RELEVANCE TO CLINICAL PRACTICE

Pregnancy should be used as an opportunity to provide complete information about gestational diabetes mellitus and future health risks. This should continue after delivery and wishes for regular follow-ups should be met.

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

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.

Women's experiences of gestational diabetes self-management: a qualitative study

OBJECTIVE

to explore women's experiences of self-managing their gestational diabetes.

DESIGN AND PARTICIPANTS

the study design was informed by interpretive phenomenological analysis. Data was collected using semi-structured interviews and one focus group. Participants included 15 women with a diagnosis of gestational diabetes who had experienced self-management of their condition.

RESULTS

incremental adjustment occurred over 4 discrete themes, including: (1) the shock of diagnosis; (2) coming to terms with GDM; (3) working it out/learning new strategies; (4) looking to the future. Each adjustment phase was underpinned by the fifth theme (5) having a supportive environment. Throughout, participants reported that thinking about the baby was a powerful motivator for adherence to gestational diabetes management regimens.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

this study has shown that women undergo a process of adjustment following GDM diagnosis as they learn to self-manage their condition. The process is largely facilitated by the women's interest in maximising fetal health which may make them receptive to interventions to improve GDM control and to prevent type 2 diabetes in the future.

A Transaction Cost Assessment of a Pervasive Technology Solution for Gestational Diabetes

Diabetes is one of the leading chronic diseases affecting Australians and its prevalence continues to rise. It is becoming a serious challenge for both the quality of healthcare and expenditure in the Australian healthcare system. The goal of this study is to investigate the development and application of a pervasive wireless technology solution to facilitate the effective management of diabetes in the context of women with gestational diabetes. Gestational diabetes is a form of diabetes that affects up to 8% of pregnant women. A transactions cost assessment of this solution is also provided. Integral to the success of this solution is the pervasive technology solution which serves to support and facilitate superior diabetes self-management.