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. 2018 Apr 11;18(1):91.
doi: 10.1186/s12884-018-1710-8.

Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control - a qualitative study using the theoretical domains framework

Ruth Martis  1 , Julie Brown  1 , Judith McAra-Couper  2 , Caroline A Crowther  3
Affiliations

Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control - a qualitative study using the theoretical domains framework

Ruth Martis et al. BMC Pregnancy Childbirth. .

Abstract

Background: Glycaemic target recommendations vary widely between international professional organisations for women with gestational diabetes mellitus (GDM). Some studies have reported women's experiences of having GDM, but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and barriers for women with GDM to achieve optimal glycaemic control.

Methods: Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework.

Results: Sixty women participated in the study. Women reported a shift from their initial negative response to accepting their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman's context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment, health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and food diaries in a woman's first language; long waiting times at clinic appointments; seeing a different health professional every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with their partners. This created social isolation.

Conclusion: Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for women with GDM and support them to achieve optimal glycaemic control.

Keywords: Dietary advice; Exercise; Gestational diabetes mellitus; Health literacy; Pregnant women; Self-management; Theoretical domains framework.

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Conflict of interest statement

Ethics approval and consent to participate

This qualitative study was nested within the TARGET Trial (a stepped wedge randomised controlled trial (Australian New Zealand Trial Registry: ACTRN12615000282583)) and approved by the New Zealand Health and Disability Ethics committee (HDEC) Ref. 14/NTA/163, research registration number 1965. Locality agreements were obtained from Canterbury and Counties Manukau District Health Boards. Eligible women who wished to participate signed a consent form for this study.

Consent for publication

Not applicable

Competing interests

None of the authors have any financial conflict of interests associated with this publication. CAC and JB are lead investigators for the TARGET Trial.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart of recruitment
See this image and copyright information in PMC

References

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