Background
Theoretical Domains | Generic Definitions | Constructs |
---|---|---|
Knowledge | An awareness of the existence of something | - Knowledge (including knowledge of condition/scientific rationale) - Procedural knowledge - Knowledge of task environment |
Skills | An ability or proficiency acquired through practice | - Skills - Skills development - Competence - Ability - Interpersonal skills - Practice - Skill assessment |
Social/Professional Role & Identity | A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting | - Professional identity - Professional role - Social identity - Identity - Professional boundaries - Professional confidence - Group identity - Leadership - Organisational commitment |
Beliefs about capabilities | Acceptance of the truth, reality or validity about an ability, talent, or facility that a person can put to constructive use | - Self-confidence - Perceived competence - Self-efficacy - Perceived behavioural control - Beliefs - Self-esteem - Empowerment - Professional confidence |
Optimism | The confidence that things will happen for the best or that desired goals will be attained | - Optimism - Pessimism - Unrealistic optimism - Identity |
Beliefs about consequences | Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation | - Beliefs - Outcome expectancies - Characteristics of outcome expectancies - Anticipated regret - Consequents |
Reinforcement | Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus | - Rewards (proximal/distal, valued/not valued, probable/improbable) - Incentives - Punishment - Consequents - Reinforcement - Contingencies - Sanctions |
Intentions | A conscious decision to perform a behavior or a resolve to act in a certain way | - Stability of intentions - Stages of change model - Transtheoretical model and stages of change |
Goals | Mental representations of outcomes or end states that an individual wants to achieve | - Goals (distal/proximal) - Goal priority - Goal/target setting - Goals (autonomous/controlled) - Action planning - Implementation intention |
Memory, attention, and decision processes | The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives | - Memory - Attention - Attention control - Decision making - Cognitive overload/tiredness |
Environmental context and resources | Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviour | - Environmental stressors - Resources/material resources - Organisational culture/climate - Salient events/critical incidents - Person × environment interaction - Barriers and facilitators |
Social influences | Those interpersonal processes that can cause individuals to change their thoughts, feelings or behaviours | - Social pressure - Social norms - Group conformity - Social comparisons - Group norms - Social support - Power - Intergroup conflict - Alienation - Group identity - Modelling |
Emotion | A complex reaction pattern, involving experiential, behavioural and physiological elements, by which the individual attempts to deal with a personally significant matter or event | - Fear - Anxiety - Affect - Stress - Depression - Positive/negative affect - Burn-out |
Behavioural regulation | Anything aimed at managing or changing objectively observed or measured actions | - Self-monitoring - Breaking habit - Action planning |
Methods
Study design and procedure
Study setting
Study participants
Study materials
The semi-structured interview
Data collection and analysis
Steps | Content |
---|---|
1. Familiarisation with the data | Reading and re-reading the data, to become immersed and intimately familiar with its content |
2. Coding | Generating succinct labels (codes) that identify important features of the data that might be relevant to answering the research question. It involves coding the entire dataset, and after that, collating all the codes and all relevant data extracts, together for later stages of analysis. |
3. Searching for themes | Examining the codes and collated data to identify significant broader patterns of meaning (potential themes). It then involves collating data relevant to each candidate theme, so that you can work with the data and review the viability of each candidate theme. |
4. Reviewing themes | Checking the candidate themes against the dataset, to determine that they tell a convincing story of the data, and one that answers the research question. In this phase, themes are typically refined, which sometimes involves them being split, combined, or discarded. |
5. Defining and naming themes | Developing a detailed analysis of each theme, working out the scope and focus of each theme, determining the ‘story’ of each. It also involves deciding on an informative name for each theme. |
6. Writing up | Weaving together the analytic narrative and data extracts and contextualising the analysis in relation to existing literature. |
Results
Characteristics | Women total n = 60 (%) |
---|---|
Age (years)a | 33 (±4.5) |
Primigravida (G1P0) | 27 (45) |
BMI category
b
| |
- Normal | 21 (35) |
- Overweight | 11 (18.3) |
- Obese (Class I) | 11 (18.3) |
- Obese (Class II) | 8 (13.3) |
- Obese (Class II) | 9 (15) |
- Total obese | 28 (46.6) |
Ethnicity
c
| |
- European | 24 (40) |
- Māori | 6 (10) |
- Asian | 22 (36.7) |
- Pacific Peoples | 7 (11.6) |
- MELAA | 1 (1.7) |
Highest educational qualifications after leaving school
d
| |
1. No qualification | 3 (5) |
2. Level 1 certificate | 2 (3.3) |
3. Level 2 certificate | 4 (6.7) |
4. Level 3 certificate | 6 (10) |
5. Level 4 certificate | 4 (6.7) |
6. Level 5 and level 6 Diploma | 13 (21.7) |
7. Bachelor degree and level 7 qualification | 25 (41.6) |
8. Post-graduate and honours degree | 1 (1.7) |
9. Master degree | 2 (3.3) |
New Zealand Deprivation indexe | |
- 1 (least deprived) | 8 (13.5) |
- 2 | 5 (8.4) |
- 3 | 5 (8.4) |
- 4 | 10 (16.7) |
- 5 | 7 (11.8) |
- 6 | 2 (3.4) |
- 7 | 5 (8.5) |
- 8 | 6 (10) |
- 9 | 5 (8.7) |
- 10 (most deprived) | 6 (10) |
Lead Maternity Carer (LMC)
f
| |
- Midwife | 55 (91.7) |
- Obstetrician | 1 (1.7) |
- Hospital Team | 4 (6.7) |
Health history
| |
Gestational age at GDM diagnosis (weeks)a | 27.8 (±2.0) |
Previous GDM | 10 (16.7) |
Previous hypertension | 2 (3.3) |
Current hypertension | 3 (5) |
Family history of hypertension | 24 (40) |
Family history of diabetes | 27 (45) |
Current smoker | 3 (15) |
Capillary blood glucose testing (CBG)
| |
Weeks of self-testing capillary blood glucose at interviewa | 6.8 (±2.3) |
Daily self-testing CBG: four times (Before breakfast, after breakfast, after lunch and after dinner) | 32 (53) |
Daily self-testing CBG: six times (Before and after breakfast, lunch and dinner) | 28 (47) |
Current treatment
| |
- Diet only | 18 (30) |
- Insulin and diet | 13 (21.7) |
- Metformin and diet | 17 (28.3) |
- Insulin, Metformin and diet | 12 (20) |
Interview type
| |
Face-to-face interview | 34 (57) |
Phone interview | 26 (43) |
Women’s initial response to being diagnosed with GDM
“Shocked, I don’t feel like I have diabetes, as I feel normal and okay” (Belle 19A).
“The initial gut reaction is like, oh my God, I did not expect this and what does this mean for my baby?” (Karen 09A).“I felt okay, because I know lots of Asian people, my friends around, they are pregnant. And a lot of Asian women they very, very easily get diabetes, pregnancy diabetes. So, I am prepared. I am okay” (Casey 01A).
“I think disappointing, because my diet’s pretty clean anyway. In that sense, it was disappointing” (Sian 11A).“Can’t be true, gutted, made them do another test, otherwise I would not do the treatment” (Larissa 01B).
Women’s response to living with GDM at the time of the interview
“It’s hard because we have to change our routine, we have to change our food patterns and all those sort of things, changing our life to be frank, but when it comes to the reality, that makes you know, a huge difference, in our life, so it’s a big change, a big challenge but we have to accept it, even though the numbers run my life but we have to do the things. The other good thing after my delivery, it will go away” (Anna 07).“It’s quite overwhelming in the beginning you kind of realise now that it’s not as big it kind of first seems. You just kind of adjust to it I guess and then its ok, always have to keep a look out for the numbers though” (Collette 09B).
Theoretical domains framework – Enablers and barriers
Domains and Definitions | Enablers | Barriers |
---|---|---|
Knowledge Refers to a woman knowing her glycaemic targets and procedural knowledge of how to test accurately | Glycaemic targets on: - sticker on the recording booklet - post-it notes on work computer - mobile phone notebook - visual step-by-step pamphlet - list how to perform CBG testing | - different glycaemic targets to previous pregnancy - unable to read the ‘how to do it list’ in first language - no visual images of how to perform CBG testing |
Skills Refers to a woman’s ability to perform the CBG testing, working the glucometer correctly and documenting results and completing a food diary | Techniques for CBG flow: - alternating warm fingers & hands - not using soap - pricking on side of finger pads Food diary documenting | - no apps available for recording CBG results - food diary writing space too small - food diary not in first language - not knowing how to go back on glucometer |
Beliefs about capabilities Refers to a woman’s beliefs about her capability to perform, control and monitor her CBG concentration | - can-do attitude - perceived control of GDM - in control of CBG testing - capable of interpreting CBG results and adjusting food intake | - can’t-do it attitude, too difficult - belief that it is not necessary to test regularly - perceived lack of control |
Beliefs about consequences Refers to a woman’s expectations about optimal CBG control | Anticipated positive consequences: - adhering to glycaemic targets will control GDM - secure healthy future for the baby - baby will be a normal size - belief future health will be better - belief family health will be better | Anticipated negative consequences: - fingerpicks damage finger pads, too difficult to play the piano or guitar - testing and controlling CBG did not work last time |
Memory, attention, and decision process Refers to a woman’s ability to remember when and decide where, to perform CBG testing | - mobile phone alarm reminder - setting timer on microwave - dedicated bag ready access to glucose testing equipment - able to decide where to do CBG testing | - forgetful - no reminder plan in place - unable to think outside the square - concern for doing CBG testing outside the home |
Environmental context and resources Refers to a woman’s access to equipment and to a health professional when unsure about results | - free resources for CBG testing - phone access to diabetes midwife - booklet fits into glucometer bag - pharmacist teaching CBG testing - group teaching sessions for learning CBG testing | - costs of resources needed for CBG testing - no phone access to diabetes health professionals - booklet too big for glucometer bag - health professional not believing results |
Social influences Refers to a woman’s social interactions for CBG monitoring and maintaining optimal CBG control | - supportive and engaged social interactions - do it wherever, no concern - work colleagues remind them - provide healthy food at work | - social pressure and loss of choice - worried about performing CBG testing in public, being judged - being told to leave restaurant for CBG testing - work demands, meetings, unable to stop work for CBG testing |
Emotion Refers to a woman’s reaction/feelings to monitoring and maintaining her CBG concentrations | - privilege to have been diagnosed - enabled learning a new skill that directed positive lifestyle changes - fun doing everyone’s CBG level - not as painful as anticipated | - anxiety, scared, needle phobia - stress to remember doing CBG testing, - feeling guilty when forgotten - focus on numbers not the woman - not enjoying reading |
Behavioural regulation Refers to a woman’s focus on self-monitoring effectively and planning how to incorporate this into her daily life | - action plan to monitor CBG - motivated by the baby to monitor CBG regularly - documenting honestly - sharing on social media glycaemic target achievements |
Domains and Definitions | Enablers | Barriers |
---|---|---|
Knowledge Refers to a woman’s understanding of what affects her CBG concentrations | - understanding the difference between carbohydrates, proteins, and fats - ability to read and comprehend food labels - able to understand how physical activity or inactivity affects their CBG concentrations | - lack of understanding which foods and exercises raise the CBG concentrations - not knowing how to read food labels - knowing how to increase insulin to eat favourite sweets |
Belief about consequences Refers to a woman’s expectations about what affects her CBG concentration | - eating the same food every day for optimal glycaemic control - using commercially available, pre-assembled ready for cooking, health food bags for optimal glycaemic control - hearing other women’s stories encourages anticipated regret - regular activities easy to incorporate into daily life and ensures healthy baby | - belief only medication controls CBG concentrations - belief that exercises have no effect on CBG concentrations - belief that physical activity can cause pre-term labour |
Environmental context and resources Refers to a woman’s access to food, exercise equipment and health professionals | - access to dietitian and group sessions - food diary and discussion - food costs are less (no fast foods) - vegetable garden - recipes on social media - identifying food in pantry which are suitable with stickers - being organised - appropriate food available when not at home - access to exercise equipment (home bicycle, tread mill) - family and children creating motivating resources | - dietetic service unavailable - transport and time issues - not documenting a food diary or not knowing about it - health professionals do not discuss content of food diary - food is more expensive (fruit, special bread) - no ethnic food options included - unavailable professional assessment for exercise/physical activities - easy access to sugary food and drinks |
Emotions Refers to a woman’s reaction/feelings to what affects her CBG concentrations | - excited to understand the link between food and exercise and CBG concentrations | - stressed about trying hard but not able to achieve optimal CBG concentrations - feeling hungry most of the time |
Behavioural regulation Refers to a woman’s focus on self-monitoring effective food intake and exercise and planning how to incorporate this into daily life | - self-monitoring with food diary - developing an activity diary - calling exercise physical activity - calling diet food intake, or what to eat - action plan for physical activities - creatively incorporating family exercises affecting CBG concentrations - family and children creating motivating resources together | - dislike of exercises - medication and food is enough to maintain CBG levels - stress or excitement increases CBG concentrations, too hard to control |
Domains and Definitions | Enablers | Barriers |
---|---|---|
Beliefs about consequences Refers to a woman’s expectation to sharing her diagnosis of GDM with others | - telling others about GDM diagnosis gains valuable support | Not telling others about GDM diagnosis because: - concern for other family members - being judged by family, friends and work colleagues - being told what and what not to eat |
Reinforcement Refers to a woman’s ability to reinforce skills and coping strategies for self-support in maintaining optimal glycaemic control | - continuing with food diary, feeling better - photos of food eaten instead of written food dairy - self-rewards with non-food items - documenting CBG results - activities connected with family fun | |
Environmental context and resources Refers to a woman’s ability to have access to learning resources and professional services for optimal glycaemic control | - written information in first language - visual information - informative websites - partner and extended family able to attend teaching or clinic sessions - work colleagues enquiring and providing healthy food options - efficient clinic appointment system - health professional phone support - free health shuttle for appointments - hospital crèche - stickers with healthy GDM messages encourages adherence to healthy food and exercises | - health professional impatient - health professionals inconsistent with advice - not seeing the same health professional twice - long waiting times at clinic - not taught in first language - unable to write the food dairy in first language - no visual information available - website information random and scary - poor parking facilities - no transport available - unable to pay for petrol - no child care support - restaurants unable provide an ingredients list for meals - partner and extended family provide unhealthy meals |
Social influences Refers to a woman’s access to social interaction to learning/reinforcing optimal glycaemic control | - social media (Facebook) - sharing recipes - group teaching - meeting other women with GDM - partner, family, and friend’s interest - work colleagues support | - unsupportive family members and workplaces - no social media groups or support groups in NZ - not knowing anyone with GDM - unable to perform testing in public - told what to eat by family members |
What is it like for a woman to monitor her CBG concentrations?
Knowledge
“I actually understood why I had to do this air tight control, so I do it. The sticker on the booklet reminds me of my numbers and the booklet in glucometer with pictures reminds me what to know” (Erin 04B).
“The consultant gave me something that I haven’t looked at, but it was ‘I quit sugar’ and I wouldn’t recommend that, as it sounded like sugar is poison and all this kind of stuff. Pictures would be so much better” (Alice 10A).“I think it’s important to give us something to take away, and some bullet points or pictures, now that you are diagnosed, these things you need to do, why we are doing it and in the right language” (Christina 15A).
Skills
“Just pressing your fingers firmly against the end of the pricky thing on the side, because no one wants to do it twice. Next time either side of the next finger and then keep going to the next finger, all makes it less painful and better blood drops” (Toni 03B).
“To be honest, the diabetes books are quite small to write in what you are eating and that can be off putting, for me I found anyway. It would so much better to have everything on my phone, like a phone app for the blood sugars and like a kind of electronic diary, everything else is on my phone, then I would do it more regularly I think” (Janet 07A).“I think they give you a lot of information that.... I mean it’s good to have. But then again, yeah, I’m probably not much of a reader. I just like to speak to thing, maybe give me a YouTube clip [link], and have picture that remind me how to, that would definitely help especially if it’s your first language” (Larissa 01B).
Beliefs about capabilities
“The dietician and the doctor were very impressed with my numbers, and that made me feel amazing and proud, and chuffed with myself. I can do this” (Anneri 14B).“It’s too hard, I can’t do it” (Yoko 15B).
“I am good at this, do it always on time. I do it when I am commuting on the bus or when I am attending mass. Even though I am in the middle of kneeling and everyone is quiet, I will just quickly get out my kit and quickly prick myself even though it may make some noise” (Karroll 05B).
“Yes, I get frustrated with it and then the glucometer does not work. Yes, I have my days where I’m tired and I’m sick of it, and belief I can’t do it. I don’t do my blood tests then, and I don’t manage my food. It just runs my life” (Karrena 17B).
Beliefs about consequences
“They did tell us like that if mums are not taking care, there may be a chance for the baby to have the diabetes when the baby is a teenager or when it is little, that was a good thing, that is the one reason which I’m more careful, which I don’t want to give anything to my kids which is from me you know, whatever the life brings to them that’s their luck you know, but I don’t want to give anything from me to my next generation, so you know, if I can be more careful about that then I have to, totally changed everything and never forget to do blood sugars”(Anna 07).“Well, can I play the guitar with so many holes in my fingers? Who wants that? So, pricking only alternative days and not on my left hand is sort of ok, but if I have to play in church, I don’t do it the week before” (Yasmin 01).
Memory, attention, and decision process
“Yeah husband reminds me at night most of the time (Amali 16). I get my partner to ring me and then do it. A couple of times when I’ve been driving I did it while I was driving” (Angela 15). “I keep my alarm on the phone, as otherwise you know, I can’t remember the particular time” (Hana 11B). “Just put an alarm in my head and watch my clock every couple of hours” (Neethu 02).“I do it anywhere… And they will ask me what are you doing? And that is the time I start talking to them about gestational diabetes and I say, ‘you know I have gestational diabetes and I have to do this’. And then about at the same time I am like a tool for everybody to find out about diabetes and they learn about it” (Karroll 05B).I tend to stress about it for the first half an hour after a meal, that I’ve got to remember, and then it just slips your mind some days, so frustrating (Erin 18B).
Environmental context and resources
“It’s definitely more expensive … and then prescriptions fees for the testing bits. It all adds up and you want to be sure it’s worth it. Some weeks it is not” (Jean 16B).“Yeah, like insinuating that I eat overnight, because my levels are high in the morning, like no, I am busy sleeping actually, but yeah that I struggled with, not being believed by the diabetes consultant. Why should I continue testing then?” (Alice 10A).
Social influences
“Well, at work they gave me private corner to do it [CBG testing] and they are really interested what my levels are. My colleagues remind me. So helpful” (Yoko 15B).“I feel bad if I don’t do it, but yeah it’s usually as I’ve just been somewhere where I feel I couldn’t do it, or I can’t stop at work, especially now that I had the experience of being told to leave the restaurant and they think you are a druggie scum bag” (J.M.T.J.M.P. 14).
Emotion
“It’s been a good adjustment, kind of a joy, I learnt how to test blood sugars and I am living healthy, it’s kind of like a good stepping stone to continue that healthy life. It’s kind of giving you this mirror glass into the future that you could have diabetes in the future (Esther 07B). I'm brave, I never forget to do the pricks” (Raynia 09).
“Ah yes, I am scared, first of all ‘cause I hate needles. One thing, it should be different that putting like, when we test our diabetes, the needle we put in our fingers, it’s very painful, like all my fingers have holes, because every day I prick and then I stop. So, there should be different type of thing we can measure the diabetes” (Shairin 11).“Um, I guess, having had that experience before as part of my medical training, I kinda knew what it was like [being a doctor], but I think it’s the repetitiveness, focusing on numbers and having to do it so many times a day, I mean I wince at the lancet, when it goes off as its getting to the point where it’s actually getting, you know, traumatised by the pain that comes from the pricked fingers” (Christina 15A).
Behavioural regulation
“You just put yourself into a routine. You just have to, for the baby, and have all your gear in a bag, ready to be used anytime and anywhere” (Sabrina 05).“Yes, having it all planned helps. Every morning at 10.30 I have 30 minutes’ walk. And also after afternoon tea and dinner I have 30 minutes walking. It’s very good, and I feel I have more energy” (Casey 01A).
What affects a woman’s CBG concentration and how does she maintain optimal glycaemic control with this knowledge?
Knowledge
“You just fill it up with other stuff, like veggies, depends on what you eat regularly, it you eat KFC all the time then your buggered” (Danielle 06).“Yeah, so whenever I do my walking after meal, my blood sugar gets low right away, but if I snuggle in the bed after a meal, the blood sugar is high, that’s what I notice” (Belle 19A).
“I don’t really understand what these food labels mean. I eat the same stuff anyway, not much use knowing it” (Jisha 04).“So, I ask them, can I just have some insulin, and they say, "Okay". They give me the long-term insulin and now I can have sweets but my levels are ok” (Casey 01A).
Belief about consequences
“I focused on it’s a short period of time, eating the same every day, you can get through it, and after pregnancy it’s going to be so awesome that you can eat what you want to eat, you focus on the fact that it’s not forever, I always think of trying to push a baby out that is too big, that’s an incentive, they can dislocate if it’s too wide, so I just focus on every little bit, makes a difference, that’s what I picked up from the obstetrician, you might go “oh this biscuit won’t hurt” but yeah it makes a difference, no option but do it consistently. I know of women who so regretted that they did not do it properly” (Annie 16A).
“I’ve never tested after doing exercise, yeah, so I couldn’t say, I don’t belief it makes a difference, so don’t do it really” (Alice 10A).“I don’t want my baby to come before 35 weeks, you know, I’m scared it comes early, more exercise makes it too early, but I will walk or swim after that time if it makes a difference” (Anna 07).“I feel better now that I’m on the right medication. My sugars are well controlled and I don’t need to worry about eating and walking” (Erin 04B).
Environmental context and resources
“Walking through a personalised diet is really helpful, and not just a mass-produced ‘try these things’ and straight access to the dietitian via phone or email. I know what I can and can’t eat now. Keeping a food diary has been good” (Anneri 14B).“I bought a walker machine [treadmill] after being diagnosed with GDM to exercise. Every time I eat I do it. It is working well” (Belle 19A).
“Not sure if some food puts it up, it’s possible, if I did a food diary I guess I could look it up, but that’s a bit tedious” (Toni 03).“I didn’t read it, because it’s easier for him to read in English about what types of food you need to eat, it should be in colour and pictures. He doesn’t like to read either, but when you give me a colour picture, these are the things you need to eat a lot, and these are things you need to not eat in colour, that would make a difference, then I would understand” (Zeinab 12A).“I don’t do much exercise because I am working all the time. Don’t know how to fit it in. Maybe someone needs sit down with me and show me how and when?” [to exercise] (Fiona 02A).
Emotions
“There are days when I am so worried that I am eating the wrong food and might hurt my baby, where I have checked myself 12 times just to see where I am staying at because the strict diet does not make a difference [to CBG concentrations], maybe I should just stop altogether? If you don’t know, you don’t know” (Aroha 10B).“…but if I’m too hungry then I don’t care, which is quite often” (Elizabeth 08B).“I was kind of worried about what the dietician was going to say because I did have a few highs like in my first week of trying and I remember just feeling so overwhelmed and walking in she said, ‘are you OK?’ and I just burst into tears, it was just one of those things. She said: Oh my goodness, I’m not going to tell you off or anything, we'll work through it” (Collette 09B).
Behavioural regulation
“Oh, you will laugh, but I don’t try to vacuum the floor, I brush the floor every night time on my knees with a brush and shovel, because I can’t go out and I get cold. My levels are good when I do this. No good levels when I do not do it” (Jisha 04A).
“For the baby shower, I was so good with the food but my levels were still high, it’s not just stress but also excitement that puts it up. So, what use is that then not to feel happy. May as well not do the testing” (Raman 17B).
What support have women found helpful/not helpful in learning about and maintaining CBG control?
Beliefs about consequences
“It helps them to be more supportive if they know. I told them all. I don’t want them to bring sugary items when they visit” (Collette 09B).“Did not tell, as I am big and people will say, ah, yes, you are fat, that did it” (Jean 16B).“Did not tell parents and friends, as they get too worried, but a bit lonely and hard doing it without them” (Aliisa 02B).
Reinforcement
“It’s kind of a fun time. My husband and my daughter guess what the number should be after I have done the pricking. If we are all right we reward us with going to the playground park with my daughter, she loves it and so do we” (BC 17A).
Environmental context and resources
“Yeah husband attending info sessions was good but next time not during office time, evenings or weekends would be better. The food plate was very helpful, but maybe more Asian food on it would help too” (Amali 16).
“Google was a bit scary. So, it’s better just to stay away from it and get your questions answered at the clinic. But that google information was in Russian, and that was good. Yeah, they need to tell me where to look on the internet. Same with menus from restaurants, their ingredients could be listed on-line” (Lilly 18A).“I saw a registrar who seemed very junior and gave me quite conflicting information to what everybody else had given me. So, I actually went back yesterday and saw a consultant, because I wasn’t happy. That improved things, but it took more time and to find a carpark is nearly impossible” (Erin 18B).“He says, “Just eat whatever you want”, because he likes sweet stuff. Hard not to give in” (Tara 19B).
Social influences
“So, I soon realised, after joining a [American] Facebook group, that most people struggle with cereals. So, I removed the cereal and just went to a two-egg breakfast, and that just evened it out. So, then I felt a bit better again” (Anneri 14B).“Yes, in the morning, if I want to sleep in then he will do for me the fingerpicks” (Shairin 11).
“…I guess that’s why I eat my chocolate with my yoghurt. I like chocolate, I’m going to have chocolate. You tell me I can’t, then I’m not going to listen. And I’m going to want it more and I’m going to binge eat it and don’t worry about my levels” (Aroha 10B).
Practice considerations | Research considerations |
---|---|
Monitoring for optimal glycaemic control | Monitoring for optimal glycaemic control |
• Enable women with GDM to attend group teaching for CBG testing and interpretation and include women who have had GDM to share their stories. • Discuss individual strategies for regular CBG monitoring, food intake and physical activity. • Encourage partner and family attendance at any clinic or teaching sessions (may need to be offered at evenings or weekends). • Provide information relating to GDM in a woman’s first language and/or more visually, including ethnic food suggestions. • Investigate the possibility of community pharmacists’ involvement in teaching CBG testing. | • Explore opportunities for companies to create phone Apps, e.g. for electronic food and activity diaries, recording of CBG results and medication intake. • Do phone apps have an impact on optimal glycaemic control for women with GDM? • Does a name change for GDM reduce anxiety in pregnant women? |
Dietary intake and exercise for glycaemic control | Dietary intake and exercise for glycaemic control |
• Enable easy access to a diabetes dietitian with diet recommendations tailored to an individual woman’s context (cultural, financial, and emotional). • Engage in meaningful discussions about the content in a food diary and provide multi-modal opportunity for the woman to record the food diary in her first language or enable mobile phone photo collection of food intake. • Regularly address hunger for women with GDM. • Encourage a physical activity diary alongside the food diary. • Consider engaging a physical (activity) therapist for clear in-depth assessment and guidance of exercise that women can incorporate into their daily life. | • Does keeping a physical activity diary impact on glycaemic control? • Does engaging a physical activity therapist contributes to the understanding and up-take of physical activity for women with GDM? • Why do women with GDM seem to be hungry despite quality dietary recommendations? • What affect has self-imposed dietary practices by women with GDM during their pregnancy on long term lifestyle behaviour? |
Support for optimal glycaemic control | Support for optimal glycaemic control |
• Provide free CBG monitoring equipment, health shuttles and child care when attending clinic appointments and reduce clinic waiting times. • Consider face-to-face support groups for women with GDM. • Consider setting up a social media group for women. With current GDM (e.g. Facebook). • Include regular mental health assessment for women with GDM. • Provide direct phone access to multi-disciplinary health professionals. | • Limited research available for regular mental health assessment for women with GDM. • Limited research about the effect of a GDM diagnosis on partners and family members. • Limited research on how partners and families can best support a woman with GDM in their context. • Does social media or face-face group support make a difference for women with GDM for maintaining optimal glycaemic control? |