Barriers of Adherence and Possible Solutions to Nonadherence to Antidiabetic Therapy in Women with Diabetes in Pregnancy: Patients’ Perspective

Mukona, Doreen; Munjanja, Stephen; Zvinavashe, Mathilda; Stray-Pederson, Babil

doi:10.1155/2017/3578075

Cited by 33 publications

(43 citation statements)

References 35 publications

(44 reference statements)

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“…A US study among low-income mothers found that women who had diabetes in pregnancy (known diabetes and GDM) had nearly twice the risk of being diagnosed with depression during pregnancy or in the first year postpartum [41]. In our study, insulin administration, managing comorbidities and coping with other life stressors in addition to GDM were common sources of maternal distress associated with GDM, which have also been cited in other studies [37,38,42]. Having GDM was particularly burdensome for primigravidae women who felt 'robbed' of the joy of pregnancy.…”

Section: Discussionsupporting

confidence: 81%

Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

et al. 2020

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Background The diagnosis of gestational diabetes mellitus (GDM) may affect women’s mental wellbeing, functioning and quality of life, with potentially negative effects on treatment adherence. Identifying and addressing the psychological and emotional needs of women with GDM, could have benefits for sustainable long-term behavioural change following the affected pregnancy. This study explored the lived experiences of women with GDM and the impact of GDM on their experience of pregnancy and sense of well-being. Methods Purposive sampling was used to recruit women who had been diagnosed with GDM in their previous pregnancy and received antenatal care at a tertiary hospital in Cape Town, South Africa. This was a descriptive qualitative study using a combination of focus groups and in-depth interviews for an in- depth exploration of women’s lived experiences of GDM, their context and perceived needs. Data analysis followed an iterative thematic analysis approach. Results Thirty-five women participated in nine focus groups and five in-depth interviews. Women discussed the emotional and psychological burden of having GDM, highlighting (i) their initial emotional reactions to receiving a GDM diagnosis, (ii) their experience of adjusting to the constraints of living with GDM (iii) their feelings of apprehension about childbirth and their maternal role and (iv) their feelings of abandonment in the post-partum period once the intensive support from both health system and family ends. Conclusions The current biomedical model used in the management of GDM, is highly foetal-centric and fails to acknowledge important psychological factors that contribute to women’s overall wellbeing and experience of pregnancy. These results demonstrate the importance of incorporating mental health support in the management and care for women with GDM in public health services, along with facilitating emotional support from partners and family members. Based on our findings, we recommend routine mental health and psychosocial vulnerability screening and monitoring for women diagnosed with GDM throughout pregnancy and postpartum to improve prognoses.

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Section: Discussionsupporting

confidence: 81%

Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

et al. 2020

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“…Further barriers relate to distance to health facility; perceptions of female body size and weight gain/loss related to pregnancy; practices related to a pregnant women's diet; societal negligence of women's health; lack of decision‐making power among women regarding their own health; the role of women in society and expectations that the pregnant woman move to her maternal home for delivery; and lack of adherence to recommended postpartum screening and low continued lifestyle modifications (, & Stray‐Pederson, 2; Nielsen, Courten, & Kapur, ; Nielsen, Kapur, Damm, Courten, & Bygbjerg, ). Additionally, a recent delivery experience, baby's health issues, personal and family adjustment to the new baby, a negative experience of medical care and services and concerns about postpartum and future health (as in, for example, fear of being informed that they have diabetes) were specifically related to the barriers to postpartum follow‐up care (Bennett et al, ).…”

Section: Discussionmentioning

confidence: 99%

Guidelines for the nursing management of gestational diabetes mellitus: An integrative literature review

et al. 2019

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Aims and objectivesAn integrative literature review searched for, selected, appraised, extracted and synthesized data from existing available guidelines on the nursing management of gestational diabetes mellitus as no such analysis has been found.BackgroundEarly screening, diagnosis and management of gestational diabetes mellitus are important to prevent or reduce complications during and postpregnancy for both mother and child. A variety of guidelines exists, which assist nurses and midwives in the screening, diagnosis and management of gestational diabetes mellitus.DesignAn integrative literature review.MethodsThe review was conducted in June 2018 following an extensive search of available guidelines according to an adaptation of the stages reported by Whittemore and Knafl (2005, Journal of Advanced Nursing, 52, 546). Thus, a five‐step process was used, namely formulation of the review question, literature search, critical appraisal of guidelines identified, data extraction and data analysis. All relevant guidelines were subsequently appraised for rigour and quality by two independent reviewers using the AGREE II tool. Content analysis was used analysing the extracted data.ResultsFollowing extraction and analysis of data, two major themes were identified from eighteen (N = 18) guidelines. These were the need for early screening and diagnosis of gestational diabetes mellitus and for nursing management of gestational diabetes mellitus (during pregnancy, intra‐ and postpartum management). Various guidelines on the nursing management of gestational diabetes mellitus were found; however, guidelines were not always comprehensive, sometimes differed in their recommended practices and did not consider a variety of contextual barriers to the implementation of the recommendations.ConclusionCritically, scrutiny of the guidelines is required, both in terms of the best evidence used in their development and in terms of the feasibility of implementation for its context.Relevance to clinical practiceThis study provides a summary of best practices regarding the diagnosis, screening and nursing management of gestational diabetes mellitus that provide guidance for nurse–midwives on maternal and postpartum follow‐up care for women at risk or diagnosed with gestational diabetes mellitus.

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“…The stages of thematic analysis followed were data organization, familiarization, transcription, coding, developing a thematic framework (searching for themes, reviewing, defining and naming them), indexing, displaying and reporting (interrelating and description of themes). Findings from the focus group discussions have already been published [13].…”

Section: Qualitative Phasementioning

confidence: 99%

Development of an Adherence Promotion Framework for Women with Diabetes in Pregnancy to Improve Adherence to Anti-Diabetic Therapy and Perinatal Outcomes

Mukona¹,

Munjanja²,

Zvinavashe³

et al. 2017

J Diabetes Metab

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Diabetes is now a major public health problem especially in developing countries. The purpose of this study was to develop an adherence promotion framework for diabetes in pregnancy. The study followed a mixed methods sequential dominant status design utilizing both quantitative and qualitative methods. Approval for the study was granted by the respective ethical review committees. All participants gave informed consent. The quantitative phase was conducted with a cohort of 157 pregnant women with a diagnosis of diabetes in pregnancy. The exposure was adherence to anti-diabetic therapy while the outcomes were perinatal outcomes. Data was collected using semi structured interviews and was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20 and STATA. A descriptive qualitative design was used in the qualitative phase where four focus group discussions (FGDs) were held with pregnant women with diabetes. Eight key informant interviews (KII) were conducted with health professionals. Thematic analysis was separately done for the FGDs and KIIs. Adherence to anti-diabetic therapy was suboptimal and the mean was 66.7%. The most common adverse perinatal outcomes were (34.4%), caesarean delivery (45.9%) and macrosomia (33.8%). There were significant associations between adherence and caesarean delivery (RR 1.90 CI 0.8 to 2.03 p>0.001), low Apgar score (RR 1.95 CI 1.03 to 3.69 p>0.039) and perinatal mortality (RR 3.08 CI 1.11 to 8.52 p>0.018). Some barriers to adherence identified in the qualitative phase were financial barriers and lack of social support. Contextual factors deduced from the study were used to develop the Adherence Promotion Framework. Chinn and Kramer's theory of knowledge development was used to guide development of the Framework.

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Barriers of Adherence and Possible Solutions to Nonadherence to Antidiabetic Therapy in Women with Diabetes in Pregnancy: Patients’ Perspective

Cited by 33 publications

References 35 publications

Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa

Guidelines for the nursing management of gestational diabetes mellitus: An integrative literature review

Development of an Adherence Promotion Framework for Women with Diabetes in Pregnancy to Improve Adherence to Anti-Diabetic Therapy and Perinatal Outcomes

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