How breastfeeding behavior develops in women with gestational diabetes mellitus: A qualitative study based on health belief model in China

Abstract

BackgroundGestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide.ObjectiveTo explore the experience of disease among mothers with GDM and how they develop feeding behaviors.MethodsThis study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers’ experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.Results16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support.ConclusionTo promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

Decision-making process of breastfeeding behavior in mothers with gestational diabetes mellitus based on health belief model

“…The result was consistent with the previous studies [ 40 , 41 ]. Considering the fact that GDM resolves after delivery for the majority of women, GDM mothers mistakenly believed that GDM is merely related to pregnancy to underestimate the long-term consequences of GDM [ 26 ]. On the other hand, GDM patients formed their health beliefs and behaviors based on their contact with health professionals [ 42 ] and other patients [ 43 ].…”

“…Health professionals’ neglectful attitudes and practices may shape the patients’ regardless attitudes and practices toward GDM. This phenomenon is more likely to occur under the circumstance of excessive workload since physicians have insufficient time to interpret the relevant knowledge [ 26 ].…”

“…Considering the widespread advocacy of breastfeeding in society and the high level of social support from family, GDM mothers may be under high pressure to indicate the high benefit of breastfeeding, while the actual breastfeeding behavior is less adopted due to more perceived barriers. A previous study has shown that GDM mothers commonly perceived a high level of advocacy of breastfeeding from family and society, while the final breastfeeding behaviors were mainly determined by GDM mothers [ 26 ]. However, such an effect warranted further study.…”

“…Based on HBM, person’s perceived threat of an illness together with a person’s belief in the effectiveness of the recommended health behavior will predict the likelihood the person will adopt the behavior [ 25 ]. We modified the model based on our previous qualitative interviews (published elsewhere [ 26 ]). The model consists of 8 subdimensions:1) Knowledge of GDM; 2) Perceived susceptibility of GDM; 3) Perceived severity of GDM; 4) Perceived benefits of breastfeeding; 5) Perceived barriers of breastfeeding; 6) Self-efficacy in breastfeeding; 7) Social support; 8) Feeding behavior (Fig.…”

“…The GDM-related health belief, including the perceived threat of GDM and perceived value of breastfeeding, was measured using 27 items along a four-point Likert scale, with each subscale containing a minimum of four items. These items were developed and revised based on our qualitative interviews [ 26 ] and previous studies applying Health Belief Model [ 27 ]. The perceived threat of GDM was measured via perceived susceptibility and severity of GDM.…”