[Effects of an integrated self-management program on self-management, glycemic control, and maternal identity in women with gestational diabetes mellitus]

Self-management and self-efficacy of women with gestational diabetes mellitus: a systematic review

BACKGROUND

Gestational diabetes mellitus (GDM) is a temporary form of diabetes induced by pregnancy and is potentially harmful to both the mother and fetus The impact of GDM diagnosis on pregnant women needs to be taken into account. This is related to the capacity for self-management of GDM, for which quality evidence is still lacking.

OBJECTIVE

to identify several aspects of self-management and self- efficacy for women with GDM.

METHOD

Electronic databases were searched for studies related to the self-management, self-efficacy, and glycemic control of women with GDM, from January 2012 to January 2021. The extraction of study features was based on study location, reported research aims, study design, methodology, and the analytical approach, using Endnote Version X7.7.1. The Critical Appraisal Skills Program Qualitative Checklist (CASP) was used to assess quality, as recommended by the Cochrane Qualitative Research Methods Group.

RESULTS

Ten out of 70 studies were identified as meeting the established criteria and including a diverse population. The synthesis revealed seven major themes: preliminary psychological impact, communicating the diagnosis, knowledge of GDM, self-efficacy and self-management of GDM, risk perception, the burden of GDM, and gaining control. The benefits of a diagnosis were behavioral and were mostly crystalized if a particular level of self-management and self-efficacy was reached and women were able to have specific control over their diet and body weight. On the other hand, women reported that the diagnosis increased their responsibility, as they had to take extra precautions regarding their dietary regimen.

CONCLUSION

Self-management and self-efficacy for GDM management are possible, despite the psychological hurdles that most women confront. There is still potential for improvement in terms of developing a healthy lifestyle that not only manages GDM for the best pregnancy result, but also prevents diabetes after pregnancy.

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.

The effects of health care programs for gestational diabetes mellitus in South Korea: a systematic review

Purpose

The purpose of this study was to investigate the effects and characteristics of health care programs for pregnant women with gestational diabetes mellitus (GDM) in Korea.

Methods

This study was conducted according to the Cochrane Collaboration's systematic literature review handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. We searched eight international and domestic electronic databases for relevant studies. Two reviewers independently selected the studies and extracted data. For each study, information on the research method, participants, characteristics of the program, and results were extracted using a previously established coding table. The National Evidence-based Healthcare Collaborating Agency's risk of bias assessment tool for non-randomized studies was used to assess the risk of bias of the included articles. A qualitative review of the selected studies was performed because the interventions differed considerably and the measured outcomes varied.

Results

Out of 128 initially identified papers, seven were included in the final analysis. The risk of bias was evaluated as generally low. Health care programs for pregnant women with GDM showed positive effects on blood glucose control. Anxiety and depression were reduced, and self-management and self-care behavior, self-efficacy, and maternal identity improved.

Conclusion

Our study provides clinical evidence for the effectiveness of health care programs for pregnant women with GDM, and its results can be used to support the development of health care programs for GDM. More well-designed research is needed on GDM, especially studies that deal with emotional stress and apply a family-oriented approach.

Theoretical evaluation of Cox's interaction model of client health behavior for health promotion in adult women

This study aimed to evaluate Cox's interaction model of client health behavior (IMCHB) as used in studies on women's health. Using keyword combinations of "women" and "IMCHB" or "interaction model of client health behavior," we searched the PubMed, MEDLINE, Embase, and RISS databases for studies on the promotion of women's health published from January 2009 to April 2019. Finally, 11 studies were selected and evaluated according to seven criteria for theory evaluation, which combined Fawcett's theory evaluation criteria and Chinn and Kramer's criteria. We found that the IMCHB corresponds to a verifiable practical level of a middle-range theory, although it may be partially abstract. It contains all four concepts of the metaparadigm of nursing, in terms of a holistic philosophical approach. A theoretical evaluation demonstrated that the IMCHB has significance, generality, testability, empirical adequacy, and pragmatic adequacy for nursing practice and research. However, the lack of clear conceptual definitions and the presence of complex relationships among concepts resulted in a lack of internal consistency and parsimony. According to an in-depth verification through a review of the literature, the IMCHB has been used as a health promotion intervention strategy for various populations of women and has led to useful results in nursing practice. The IMCHB was confirmed to be a suitable theory for experimental and clinical research. Future research can build on this middle-range theory for women's health research and practice.

[Effects of a supportive program on uncertainty, anxiety, and maternal-fetal attachment in women with high-risk pregnancy]

Purpose

The purpose of this study was to identify the effects of a supportive program on uncertainty, anxiety, and maternal-fetal attachment in high-risk pregnant women.

Methods

The participants were 59 high-risk pregnant women admitted to the maternal-fetal intensive care unit. The control group (n=30) received usual treatment and antenatal care, while the experimental group (n=29) received an additional supportive program. Uncertainty, anxiety, and maternal-fetal attachment were measured in both groups prior to the intervention and at 3 days and 10 days after the intervention (or at discharge). Data were analyzed with the t-test, chi-square test, repeated-measures analysis of covariance, and the Greenhouse-Geisser correction in SPSS version 23.0.

Results

A supportive program including information provision, nutritional care, emotional care, and exercise care was developed from the literature. All variables except women's length of stay were found to be homogeneous the between experimental and control groups in the pre-test. Length of stay was calculated as a covariate for testing hypotheses. There was a significant difference in state anxiety over time between the two groups, while there were no differences in uncertainty or maternal-fetal attachment.

Conclusion

This supportive program was identified as an effective nursing intervention on state anxiety in high-risk pregnant women during their stay in the maternal-fetal intensive care unit. It is suggested that nurses could apply this program to alleviate high-risk pregnant women's state anxiety, and that this program could be modified to be more effective on uncertainty and maternal-fetal attachment in high-risk pregnant women.

[Effects of stress, depression, and spousal and familial support on maternal identity in pregnant women]

Purpose

The objective of this study was to identify the factors influencing maternal identity in pregnant women.

Methods

Using a descriptive research design, a cross-sectional survey was conducted. In total, 127 pregnant women were recruited from a tertiary hospital in Korea from January to April 2019. Measurements included maternal identity, stress, depression, spousal and familial support, and demographic and obstetric characteristics. Data were analyzed by descriptive statistics, the independent t-test, one-way ANOVA, Pearson correlation coefficients, and stepwise multiple regression using SPSS version 25.0.

Results

The mean score for maternal identity was 131.15 out of 160, and the mean scores for stress, depression, and spousal and familial support were 14.59 (out of 40), 6.82 (out of 30), and 109.04 (out of 132), respectively. Stress (r=-.38, p<.001), depression (r=-.37, p<.001), and spousal and familial support (r=.37, p<.001) were significantly correlated with maternal identity. In multiple regression analysis, stress (β=-0.27, p=.005) and spousal and familial support (β=0.23, p=.014) were found to be significant factors influencing maternal identity in pregnant women (F=14.19, p<.001).

Conclusion

It is necessary to develop effective strategies to mitigate stress and to encourage spousal and familial support in pregnant women. Such strategies could further enable pregnant women to enhance their maternal identity.

Relationship among Emotional Clarity, Maternal Identity, and Fetal Attachment in Pregnant Women with Gestational Diabetes Mellitus

PURPOSE

The purpose of this study was to examine the relationship among emotional clarity in emotional intelligence, maternal identity, and fetal attachment to measure how emotional clarity and maternal identity impact on fetal attachment and to determine mediating effects of maternal identity in pregnant women at the time of diagnosis with gestational diabetes mellitus (GDM).

METHODS

This study used a correlational survey design. 88 pregnant women with GDM completed a study questionnaire of emotional clarity, maternal identity, and fetal attachment immediately after the diagnosis of GDM. Data were analyzed Mann-Whitney U test, and ANOVA with Duncan test, Pearson correlation, three-step regressions to test mediating effect, and Sobel test.

RESULTS

The emotional clarity was positively related with maternal identity and fetal attachment. It affected maternal identity with 21.9% of explained variance. The emotional clarity and the maternal identity were significant predictors of fetal attachment by 57.7% of explained variance. The maternal identity mediated the relationship between emotional clarity and fetal attachment.

CONCLUSION

The results suggest that a nursing program to enhance the emotional clarity and the maternal identity needs to be developed as an effective strategy to improve fetal attachment.

Evaluation of information retention and adherence to treatment in patients with gestational diabetes mellitus after multidisciplinary group

OBJECTIVE

To evaluate the retention of information after participation in multidisciplinary group in patients with gestational diabetes mellitus (GDM) through a phone contact.

METHOD

122 pregnant women diagnosed with gestational diabetes were included. After diagnosis of gestational diabetes, the patients were referred to the multidisciplinary group where they received medical, nutrition and nursing guidelines related to the disease. After three days these patients received one telephone call from a nurse, who made the same questions regarding the information received. In the statistical analysis, results were presented as absolute and relative frequencies.

RESULTS

Most patients 119/122 patients (97.5%) were managing to do self glucose monitoring. Twenty-one patients (17.2%) reported having difficulty performing the blood glucose, especially finger pricking. When questioning whether the woman was following the proposed diet, 24/122 (19.7%) patients said they did not; the meal frequency was not reached by 23/122 (18.9%) of the women, and forty-seven (38.5%) of the women reported having ingested sugar in the days following the guidance in multidisciplinary group.

CONCLUSION

Regarding the proposed treatment, there was good adherence of patients, especially in relation to blood glucose monitoring. As for nutritional control, we observed greater difficulty in following the guidelines demonstrating the need for long-term monitoring, as well as further clarification to the patients about the importance of nutrition in diabetes management.

[Effects of a coaching program on comprehensive lifestyle modification for women with gestational diabetes mellitus]

PURPOSE

The purpose of this study was to investigate the effects of using a Coaching Program on Comprehensive Lifestyle Modification with pregnant women who have gestational diabetes.

METHODS

The research design for this study was a non-equivalent control group quasi-experimental study. Pregnant women with gestational diabetes were recruited from D women's hospital located in Gyeonggi Province from April to October, 2013. Participants in this study were 34 for the control group and 34 for the experimental group. The experimental group participated in the Coaching Program on Comprehensive Lifestyle Modification. The program consisted of education, small group coaching and telephone coaching over 4weeks. Statistical analysis was performed using the SPSS 21.0 program.

RESULTS

There were significant improvements in self-care behavior, and decreases in depression, fasting blood sugar and HbA1C in the experimental group compared to the control group. However, no significant differences were found between the two groups for knowledge of gestational diabetes mellitus.

CONCLUSION

The Coaching Program on Comprehensive Lifestyle Modification used in this study was found to be effective in improving self-care behavior and reducing depression, fasting blood sugar and HbA1C, and is recommended for use in clinical practice as an effective nursing intervention for pregnant women with gestational diabetes.