The Perspectives of Diabetes Educators and Dietitians on Diet and Lifestyle Management for Gestational Diabetes Mellitus: A Qualitative Study

Abstract

This study explores the knowledge and practice of diabetes educators and dietitians on diet and lifestyle management in women with gestational diabetes mellitus (GDM). Diabetes educators and dietitians were recruited from three maternity hospitals in Adelaide (Australia), through snowball and purposive sampling. Thirteen semistructured interviews were conducted, audio recorded, transcribed verbatim, and analysed for codes and themes. Four themes emerged: guidelines and resources, dietary intervention, management delivery, and communication. Diabetes educators and dietitians demonstrated consistent knowledge of nutritional management for GDM and uniform delivery methods. However, a lack of culturally diverse resources was highlighted, along with a lack of continuity of care across the multidisciplinary team. Barriers towards uptake of dietary intervention were reflected by diabetes educators and dietitians as women showing signs of guilt and stress and disengaging from the service. Further exploration on the knowledge and practice of diabetes educators and dietitians for GDM to best inform implementation strategies for knowledge translation of nutritional management is needed. The indication of language and cultural barriers and resources highlight an ongoing key priority area to support the care of women of ethnic minorities.

The Complexities of Managing Gestational Diabetes in Women of Culturally and Linguistically Diverse Backgrounds: A Qualitative Study of Women’s Experiences

“…Additionally, in Australia, the population is increasingly comprising more women of reproductive age who are of ethnic minority backgrounds [ 30 ]. We have recently highlighted the lack of cultural resources for nutritional management of GDM in women of ethnic minority backgrounds [ 8 ], which is consistent with other studies [ 12 , 31 , 32 ] and demonstrates the ongoing need to consult women of CALD backgrounds about their views, experiences and needs, so that appropriate, evidence-informed health education prevention and management resources, as well as culturally sensitive and appropriate interventions and support, can be offered. Co-developing nutritional management plans that are tailored to the cultural context and that are emphasized by trained diabetes educators and dietitians would enhance current GDM care for women of CALD backgrounds.…”

“…However, in our study and a study in local and immigrant women in Norway [ 23 ], women with an immigrant background did not report challenges in understanding and following advice. Despite this, health professionals have noted challenges when educating women of CALD backgrounds, attributed to language, culture and religion [ 12 ] or a lack of resources for CALD women [ 8 ]. Women in our study recommended one-on-one individualized education and advice that was culturally sensitive.…”

“…Current first-line clinical management of GDM is a healthy diet and exercise; however, there are no universal guidelines for its management [ 7 ]. Although diabetes educators and dietitians demonstrate consistent knowledge of nutritional management for GDM and uniform delivery methods, concerns exist that women with GDM struggle to follow nutritional advice and often disengage from services [ 8 ]. In a systematic review of 10 studies, He et al [ 9 ] noted that women with GDM had difficulty in changing their eating habits because the recommended eating plan differed significantly from their previous dietary habits.…”

Current practice, attitude and views of providing pregnancy care for women with type 1 diabetes in China: a qualitative study

“…Reducing the adverse outcomes among women with T1D requires enhancement of pregnancy-related care designated to their needs. Previous studies in other countries find that the uptake of pregnancy-related care in diabetes among patients with pregestational or gestational diabetes is associated with several sociopsychological risk factors, including patient knowledge levels, patients’ and healthcare professionals’ awareness of the disease, health service accessibility, and communication between patients and healthcare professionals 16–21. However, studies addressing the unmet sociopsychological needs of pregnant women with T1D are imperative in China.…”

“…Previous studies in other countries find that the uptake of pregnancy-related care in diabetes among patients with pregestational or gestational diabetes is associated with several sociopsychological risk factors, including patient knowledge levels, patients' and healthcare professionals' awareness of the disease, health service accessibility, and communication between patients and healthcare professionals. [16][17][18][19][20][21] However, studies addressing the unmet sociopsychological needs of pregnant women with T1D are imperative in China. Therefore, we conducted this qualitative study to investigate the attitude, views, needs and current practice of pregnancy care for women with T1D.…”