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Guo S, Liu D, Bi X, Feng Y, Zhang K, Jiang J, Wang Y. Barriers and facilitators to self-management among women with gestational diabetes: A systematic review using the COM-B model. Midwifery 2024; 138:104141. [PMID: 39178483 DOI: 10.1016/j.midw.2024.104141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/24/2024] [Accepted: 08/07/2024] [Indexed: 08/25/2024]
Abstract
BACKGROUND Gestational diabetes mellitus is a common complication during pregnancy, and its prevalence rates have increased dramatically in recent years. Treatment of gestational diabetes requires the active self-management, however, this can be challenging. Understanding the barriers and facilitators of adherence to self-management recommendations is essential for designing effective interventions. AIM To identify and synthesize barriers and facilitators to self-management of gestational diabetes reported by pregnant women. METHODS This was a mixed-methods systematic review, including qualitative, quantitative, and mixed-methods studies. A literature search was conducted in four databases (PubMed, Embase, CINAHL, and the Web of Science). Eligible studies explored the barriers and/or facilitators, experiences and/or perceptions to engage in self-management in women with gestational diabetes. The Capability, Opportunity, Motivation, Behaviour model was used to classify barriers and facilitators affecting self-management. RESULTS Thirty-six studies (23 qualitative, 11 quantitative, and 2 mixed-methods) met the inclusion criteria. We identified barriers and facilitators relating to capability (e.g., physical discomforts and constraints; lack of knowledge of GDM and self-management behaviours; forgetfulness), opportunity (e.g., limited education and resources; social support from family, friends, and peer groups; conflict with existing lifestyles or cultural norms), and motivation (e.g., perceived negative consequence of self-management behaviours or not perceived benefits; negative emotion; concern the health of the baby). CONCLUSION In this study, we identified the barriers and facilitators of self-management in women with gestational diabetes, which were explained by relevant theoretical models. Interventions should be developed with full consideration of these findings to ensure that pregnant women have the correct knowledge and confidence to self-manage their complications.
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Affiliation(s)
- Shujie Guo
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China; Department of Clinical Nursing, School of Nursing, Air Force Medical University, Xi'an, China
| | - Dongmei Liu
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaoxuan Bi
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yuxuan Feng
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Ke Zhang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Jingjing Jiang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China
| | - Yanhong Wang
- School of Nursing, Lanzhou University, Lanzhou, Gansu, China.
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McGovern L, O'Toole L, Houshialsadat Z, O'Reilly SL. Women's perspectives on mHealth behavior change interventions for the management of overweight, obesity, or gestational diabetes: A qualitative meta-synthesis. Obes Rev 2024; 25:e13761. [PMID: 38733067 DOI: 10.1111/obr.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/13/2024]
Abstract
mHealth interventions play an increasingly important role in health behavior change for gestational diabetes or peripartum obesity management. This qualitative systematic review and meta-synthesis aims to explore women's perceptions of mHealth behavior change interventions for gestational diabetes and/or overweight/obesity management during pregnancy and the postpartum period. Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Psychological Information Database (PsycINFO) databases were searched using a Sample, Phenomenon of Interest, Design, Evaluation and Research type (SPIDER) concept framework through to February 2024. Included studies were quality assessed using the Critical Appraisal Skills Programme checklist. Study findings were evaluated using reflexive thematic analysis and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQual) checklist. We identified 29 studies, representing 604 women's views from one upper middle-income and nine high-income countries. Two themes were generated: mHealth as a supportive tool; and mHealth as a personalizable tool. Women highlighted the importance of self-monitoring, information trustworthiness, peer support, motivational tools (goal setting, risk awareness, and problem solving) and convenience in achieving behavior change using mHealth technology. They suggest mHealth programs incorporate these elements to support user engagement and improved health outcomes. Understanding what women want as mHealth users is particularly important for effective interventions in gestational diabetes, weight management, and chronic disease prevention. Creating a better, more woman-centered experience by addressing central engagement issues should result in improved maternal health outcomes.
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Affiliation(s)
- Liz McGovern
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
| | - Laura O'Toole
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | - Zeinab Houshialsadat
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
- Ecole Hautes Etudes en Santé Publique, Paris, France
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
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Yue SW, Zhou J, Li L, Guo JY, Xu J, Qiao J, Redding SR, Ouyang YQ. Effectiveness of remote monitoring for glycemic control on maternal-fetal outcomes in women with gestational diabetes mellitus: A meta-analysis. Birth 2024; 51:13-27. [PMID: 37789580 DOI: 10.1111/birt.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/07/2023] [Accepted: 08/11/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND The current pandemic and future public health emergencies highlight the importance of evaluating a telehealth care model. Previous studies have reached mixed conclusions about the effectiveness of remote monitoring on glycemic control and maternal and infant outcomes in women with gestational diabetes mellitus (GDM). OBJECTIVES This meta-analysis aimed to evaluate the effectiveness of remote blood glucose monitoring for women with gestational diabetes mellitus and to provide evidence-based guidance on the management of women with gestational diabetes mellitus for policymakers and healthcare providers during situations such as pandemics or natural disasters. METHODS The Cochrane Library, PubMed, Web of Science, EBSCO, Embase, Medline, CINAHL databases, and ClinicalTrials.gov were systematically searched from their inception to July 10, 2021. Randomized controlled trials (RCTs) published in English with respect to remote blood glucose monitoring in women with GDM were included in the meta-analysis. Two independent reviewers performed data extraction and assessed the quality of the studies. Risk ratios, mean differences, 95% confidence intervals, and heterogeneity were calculated. RESULTS A total of 1265 participants were included in the 11 RCTs. There were no significant differences in glycemic control and maternal-fetal outcomes between the remote monitoring group and a standard care group, which included glycosylated hemoglobin (HbA1c), fasting blood glucose, mean 2-h postprandial blood glucose, caesarean birth, gestational weight gain, shoulder dystocia, neonatal hypoglycemia, and other outcomes. CONCLUSION This meta-analysis reveals that it is unclear if remote glucose monitoring is preferable to standard of care glucose monitoring. To improve glycemic control and maternal-fetal outcomes during the current epidemic or other natural disasters, the implementation of double-blind RCTs in the context of simulating similar disasters remains to be studied in the future.
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Affiliation(s)
- Shu-Wen Yue
- School of Nursing, Wuhan University, Wuhan, China
| | - Jie Zhou
- School of Nursing, Wuhan University, Wuhan, China
| | - Lu Li
- School of Nursing, Wuhan University, Wuhan, China
| | - Jin-Yi Guo
- School of Nursing, Wuhan University, Wuhan, China
| | - Jing Xu
- School of Nursing, Wuhan University, Wuhan, China
| | - Jia Qiao
- School of Nursing, Wuhan University, Wuhan, China
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Luo X, Pan J, Jiang C, Li X, Li P. The influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus: A qualitative study. Int J Nurs Pract 2024; 30:e13234. [PMID: 38273651 DOI: 10.1111/ijn.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 12/04/2023] [Accepted: 12/12/2023] [Indexed: 01/27/2024]
Abstract
OBJECTIVE The study aimed to explore the influence of Chinese culture and customs on the beliefs and health-related behaviours of Chinese women with gestational diabetes mellitus (GDM). METHODS This descriptive qualitative study conducted semi-structured interviews with 15 Chinese women between November 2022 and January 2023. The interview data were analysed using thematic analysis. RESULTS Three major themes are found: (1) beliefs in health, (2) beliefs in illness and GDM and (3) beliefs in health-related behaviours. They worried about the negative effects of GDM on the infant and family, so they actively sought medical advice to maintain health. However, it is challenging for them to balance adhering to healthcare professionals' advice and avoiding practical difficulties in the impact of the Chinese sociocultural context. CONCLUSION This study emphasizes the influence of Chinese culture and customs on the beliefs and health-related behaviours of women with GDM. Healthcare providers should recognize the influence of Chinese culture, customs and beliefs on women with GDM and their families, in order to provide individualized education to help them maintain health-related behaviours.
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Affiliation(s)
- Xiuwen Luo
- Master of Birmingham City University, Birmingham, UK
- Nursing Department, The Second People's Hospital of Foshan, Foshan, Guangdong Province, China
| | - Jie Pan
- Foshan University, Foshan, Guangdong Province, China
| | - Cailing Jiang
- Bachelor of Southern Medical University, Guangzhou, Guangdong Province, China
- Obstetrics Department of The Second People's Hospital of Foshan, Foshan, Guangdong Province, China
| | - Xiaoxiao Li
- Nursing Department, The Second People's Hospital of Foshan, Foshan, Guangdong Province, China
- Master of Jinan University, Guangzhou, Guangdong Province, China
| | - Peiling Li
- Bachelor of Guangdong Pharmaceutical University, Guangzhou, Guangdong Province, China
- Endocrinology Department of The Second People's Hospital of Foshan, Foshan, Guangdong Province, China
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Yu J, Kim O, Kang BS, Lee SU, Lee YJ, Hwang HS, Lee SM, Kim SC, Choi YH, Ko HS. Demand and Requirements for a Digital Healthcare System to Manage Gestational Diabetes in Patients and Healthcare Professionals: A Cross-sectional Survey. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241252569. [PMID: 38756007 PMCID: PMC11100378 DOI: 10.1177/00469580241252569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
This study aimed to assess the current status of gestational diabetes mellitus (GDM) diagnosis and management, and the demand for a digital healthcare system, in order to develop an optimal digital-based management model for GDM. An anonymous online survey was conducted targeting pregnant/postpartum women (Group W), internal medicine physicians (Group P), and obstetricians (group O) from September 6, 2022 to December 31, 2022. The survey assessed the women's knowledge of GDM and gathered information about healthcare professionals' (HCPs) current GDM management practices. All groups were asked about their acceptance of and demands for a digital healthcare system for GDM. Statistical comparisons between groups were conducted using the chi-square test or Fisher's exact test where appropriate. A total of 168 participants were in Group W, 185 in Group P, and 256 in Group O. Participants from all groups recognized the need for a digital healthcare system for GDM (Group W: 95.8%, Group P: 85.9%, Group O: 60%). However, HCPs showed less willingness to integrate these systems into their clinics than pregnant/postpartum women. Essential features identified were recording blood glucose levels and insulin, along with automatic data linkage from self-monitoring devices. Group W showed a higher preference for lab test access, search functionality, and fetal weight assessment than groups P and O (all P < .0001), while Groups P and O had a greater preference for recording insulin and maternal body weight compared to Group W (P = .0141 and .0023, respectively). Both pregnant/postpartum women and HCPs acknowledged the benefits of utilizing a digital healthcare system for managing GDM. However, there were differences in perspectives among these groups.
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Affiliation(s)
- Jin Yu
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Oyoung Kim
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung Soo Kang
- The Catholic University of Korea, Seoul, Republic of Korea
| | - Seon Ui Lee
- The Catholic University of Korea, Seoul, Republic of Korea
| | | | | | - Seung Mi Lee
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Chul Kim
- Pusan National University College of Medicine, Busan, Korea
| | - Yoon-Hee Choi
- The Catholic University of Korea, Seoul, Republic of Korea
- Medical Excellence Inc., Seoul, Korea
| | - Hyun Sun Ko
- The Catholic University of Korea, Seoul, Republic of Korea
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Safiee L, Rough D, George P, Mudenha R. Baseline Perceptions of Women With Gestational Diabetes Mellitus and Health Care Professionals About Digital Gestational Diabetes Mellitus Self-Management Health Care Technologies: Interview Study Among Patients and Health Care Professionals. JMIR Hum Factors 2023; 10:e51691. [PMID: 38113070 PMCID: PMC10762626 DOI: 10.2196/51691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a significant medical complication of pregnancy that requires close monitoring by a multidisciplinary health care team. The growing sophistication of mobile health (mHealth) technology could play a significant supporting role for women with GDM and health professionals (HPs) regarding GDM management. OBJECTIVE This study included 2 phases. The aim of phase 1 was to explore the perceptions of HPs and women with GDM regarding the use of mHealth for GDM self-management and to identify their needs from these technologies. The aim of phase 2 was to explore the perceptions of women with GDM about their experiences with a state-of-the-art app for managing GDM that was offered to them during the COVID-19 lockdown. This phase aimed to understand the impact that COVID-19 has had on women's perceptions about using technology to manage their GDM. By combining both phases, the overall aim was to establish how perceptions about GDM self-management technology have changed owing to the pandemic restrictions and experience of using such technology. METHODS In total, 26 semistructured interviews were conducted in 2 phases. In phase 1, overall, 62% (16/26) of the participants, including 44% (7/16) of HPs, 50% (8/16) of women with GDM, and 6% (1/16) of women in the postpartum period with GDM history participated in the interviews. In phase 2, overall, 38% (10/26) of women with GDM participated in the interviews. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. RESULTS Phase 1 identified 3 themes from the interviews with women with GDM: fitting with women's lifestyle constraints, technology's design not meeting women's needs, and optimizing the technology's design to meet women's needs. Overall, 3 themes were derived from the interviews with HPs: optimizing the technology's design to improve the quality of care, technology to support women's independence, and limitations in the care system and facilities. Analysis of phase-2 interviews identified 2 further themes: enhancing the information and functionalities and optimizing the interface design. In both phases, participants emphasized a simple and user-friendly interface design as the predominant positive influence on their use of technology for GDM management. CONCLUSIONS The combined findings underlined similar points. Poor usability, data visualization limitations, lack of personalization, limited information, and lack of communication facilities were the prime issues of current GDM self-management mHealth technology that need to be addressed. The analysis also revealed how women with GDM should play a vital role in gathering the requirements for GDM self-management technology; some needs were identified from in-depth discussion with women with GDM that would be missed without their involvement.
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Affiliation(s)
- Ladan Safiee
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Daniel Rough
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Priya George
- Ninewells Hospital, NHS Tayside, Dundee, United Kingdom
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Tanhapour M, Peimani M, Rostam Niakan Kalhori S, Nasli Esfahani E, Shakibian H, Mohammadzadeh N, Qorbani M. The effect of personalized intelligent digital systems for self-care training on type II diabetes: a systematic review and meta-analysis of clinical trials. Acta Diabetol 2023; 60:1599-1631. [PMID: 37542200 DOI: 10.1007/s00592-023-02133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 08/06/2023]
Abstract
AIMS Type 2 diabetes (T2D) is rising worldwide. Self-care prevents diabetic complications. Lack of knowledge is one reason patients fail at self-care. Intelligent digital health (IDH) solutions have a promising role in training self-care behaviors based on patients' needs. This study reviews the effects of RCTs offering individualized self-care training systems for T2D patients. METHODS PubMed, Web of Science, Scopus, Cochrane Library, and Science Direct databases were searched. The included RCTs provided data-driven, individualized self-care training advice for T2D patients. Due to the repeated studies measurements, an all-time-points meta-analysis was conducted to analyze the trends over time. The revised Cochrane risk-of-bias tool (RoB 2.0) was used for quality assessment. RESULTS In total, 22 trials met the inclusion criteria, and 19 studies with 3071 participants were included in the meta-analysis. IDH interventions led to a significant reduction of HbA1c level in the intervention group at short-term (in the third month: SMD = - 0.224 with 95% CI - 0.319 to - 0.129, p value < 0.0; in the sixth month: SMD = - 0.548 with 95% CI - 0.860 to - 0.237, p value < 0.05). The difference in HbA1c reduction between groups varied based on patients' age and technological forms of IDH services delivery. The descriptive results confirmed the impact of M-Health technologies in improving HbA1c levels. CONCLUSIONS IDH systems had significant and small effects on HbA1c reduction in T2D patients. IDH interventions' impact needs long-term RCTs. This review will help diabetic clinicians, self-care training system developers, and researchers interested in using IDH solutions to empower T2D patients.
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Affiliation(s)
- Mozhgan Tanhapour
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Peimani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sharareh Rostam Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Peter L. Reichertz Institute for Medical Informatics of TU Braunschweig and Hannover Medical School, 38106, Braunschweig, Germany
| | - Ensieh Nasli Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Science, Tehran, Iran
| | - Hadi Shakibian
- Department of Computer Engineering, Faculty of Engineering, Alzahra University, Tehran, Iran
| | - Niloofar Mohammadzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mostafa Qorbani
- Non-communicable Disease Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Moulaei K, Moulaei R, Bahaadinbeigy K. Barriers and facilitators of using health information technologies by women: a scoping review. BMC Med Inform Decis Mak 2023; 23:176. [PMID: 37670281 PMCID: PMC10478440 DOI: 10.1186/s12911-023-02280-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/31/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND AND AIM Health information technologies play a vital role in addressing diverse health needs among women, offering a wide array of services tailored to their specific requirements. Despite the potential benefits, the widespread utilization of these technologies by women faces numerous barriers and challenges. These barriers can cause women to either reduce their usage of health technologies or refrain from using them altogether. Therefore, this review was done with the aim of identifying and classifying barriers and facilitators. METHODS Some databases, including PubMed, Web of Sciences, and Scopus were searched using related keywords. Then, according to the inclusion and exclusion criteria, the articles were evaluated and selected. Finally, the barriers and facilitators were identified and classified. RESULTS Out of 14,399 articles, finally 35 articles were included in the review. In general, 375 barriers (232 items) and facilitators (143 items) were extracted from the studies. After merging similar items, 121 barriers (51 items) and facilitators (70 items) identified were organized into five main themes (management, technological, legal and regulatory, personal, and data and information management). The most important barriers were "privacy, confidentiality, and security concerns" (n = 24), "deficiencies and limitations of infrastructure, software, hardware, and network" (n = 19), "sociocultural challenges" (n = 15), and "poor economic status" (n = 15). Moreover, the most important facilitators were "increasing awareness, skills and continuous education of women" (n = 17, in personal theme), "providing training services" (n = 14, in management theme), "simple, usable, and user-friendly design of technologies" (n = 14, in technological theme), and "providing financial or non-financial incentives (motivation) for women" (n = 14, in personal theme). CONCLUSION This review showed that in order to use technologies, women face many barriers, either specific to women (such as gender inequality) or general (such as lack of technical skills). To overcome these barriers, policymakers, managers of organizations and medical centers, and designers of health systems can consider the facilitators identified in this review.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Reza Moulaei
- School of medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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