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Neven ACH, Lake AJ, Williams A, O'Reilly SL, Hendrieckx C, Morrison M, Dunbar JA, Speight J, Teede H, Boyle JA. Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework. Diabet Med 2022; 39:e14945. [PMID: 36004677 PMCID: PMC9826483 DOI: 10.1111/dme.14945] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
AIMS Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from diverse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior GDM and identify relevant intervention components. METHODS Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive-deductive model, themes were mapped to the TDF and COM-B model. RESULTS After screening 5148 citations and 139 full texts, we included 35 studies (N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence-based recommendations for communications to support behaviour change. CONCLUSIONS We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from diverse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.
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Affiliation(s)
- Adriana C. H. Neven
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Amelia J. Lake
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Amelia Williams
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Sharleen L. O'Reilly
- Centre for Physical Activity and Nutrition ResearchDeakin UniversityBurwoodVictoriaAustralia
- UCD Institute of Food and Health, School of Agriculture and Food Science, University CollegeDublin 4Ireland
| | - Christel Hendrieckx
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | | | - James A. Dunbar
- Deakin Rural Health, School of MedicineDeakin UniversityWarrnamboolVictoriaAustralia
| | - Jane Speight
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
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Bottemanne H, Charron M, Joly L. [Perinatal beliefs: Neurocognitive mechanisms and cultural specificities]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2022; 50:542-552. [PMID: 35288367 DOI: 10.1016/j.gofs.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
Perinatal beliefs contribute to the experience of pregnancy and the process of parenthood. Many of these perinatal beliefs have been perpetuated and evolved over time and throughout the world, exerting their influence on the behavior of pregnant women in interaction with medical recommendations. These beliefs generally offer explanations for gravidic and puerperal phenomena, helping to reduce the uncertainty of parents faced with the biological, psychological and social transitions of pregnancy. But certain beliefs can also be harmful, and alter the maternal experience of pregnancy and postpartum. In this paper, we provide an overview of the beliefs associated with the perinatal period. We successively detail the beliefs concerning fertility, pregnancy, childbirth, and postpartum, specifying the cultural beliefs from other cultures interacting with medical recommendations. Finally, we propose a neurocognitive model of perinatal beliefs generation, and we show the need to know these beliefs to improve care in midwifery, obstetrics, and fetal medicine.
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Affiliation(s)
- Hugo Bottemanne
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neurosciences, Sorbonne University/Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Brain Institute - Institut du Cerveau (ICM), UMR 7225/UMRS 1127, Sorbonne University/CNRS/INSERM, Paris, France; Sorbonne University, Department of Philosophy, SND Research Unit, UMR 8011, CNRS, Paris, France.
| | - Morgane Charron
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neurosciences, Sorbonne University/Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Lucie Joly
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neurosciences, Sorbonne University/Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Kainat K, Eskola EL, Widén G. Sociocultural barriers to information and integration of women refugees. JOURNAL OF DOCUMENTATION 2021. [DOI: 10.1108/jd-05-2021-0107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study focuses on specifically women refugees' experiences of accessing information and how sociocultural barriers impact these experiences aiming to broaden the LIS literature of women refugees' information problems from sociocultural aspects. The socioculturally formed roles of a woman can impact the information practices of women refugees or cause certain information problems during the integration process. Hence, the research questions that drive this study are: What kind of information problems might women refugees face in a new host country? What kind of sociocultural barriers influence their information problems? How do they react toward these information problems?Design/methodology/approachThe study is designed based on semi-structured in-depth interviews with eighteen refugee women living in Sweden. The study is a part of a larger study in which authors intend to explore the information practices and integration challenges of almost 20 or more refugee women living in Sweden.FindingsWomen refugees face information overload, difficulties in understanding new communication culture and lack of appropriate sources and networks in a new country. These information problems are influenced by sociocultural barriers such as the role of women, national culture of “collectivism”, small-world and lack of information literacy. Women react in certain ways such as, stressing, panicking, quitting the tasks, wasting time and making wrong decisions which negatively impact the integration process.Research limitations/implicationsThe research has its limitations as it is conducted with a small group of women refugees, belong to specific Middle Eastern culture and cannot be generalized. Another limitation is that the interviews are conducted in English language (with sufficient language skill). However, conducting interviews in their mother language would have been an advantage.Practical implicationsPractically, the study provides awareness for official and private organizations, volunteers and policymakers dealing with refugees. The stakeholders involved in the societal integration process of refugees, must consider that women refugees are more prone to information problems due to certain sociocultural influences (i.e. “being a woman” and national culture) and need a separate plan than the male refugees. For instance, by increasing and offering intercultural opportunities at workplaces or schools can encourage the wider social networking for women refugees. The programs aiming to reduce the sociocultural differences among women refugees and the Swedes are needed to be included in the integration policy.Social implicationsThe study intends to help the refugees society and the Swedish society overall by improving the integration plan.Originality/valueThe findings related to the information experiences of women refugees have potential implications for research where the value of information in the integration process is explored. The study meets the gap in previous literature by presenting the gender specific views on information problems from sociocultural aspects. The study also provides future directions to understand how women refugees deal with potential sociocultural barriers to information in a new country.
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Bagger S, Maindal HT, Nielsen KK, Vrå AG, Aagaard-Hansen J. Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark. Health Psychol Behav Med 2021; 9:761-777. [PMID: 34484976 PMCID: PMC8409963 DOI: 10.1080/21642850.2021.1969235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. Design Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman’s Explanatory Models. Data were analysed using qualitative content analysis. Results A diagnosis of GDM entailed great worry for the future. Participants’ fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women’s perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants’ challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours. Conclusion Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.
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Affiliation(s)
- Stine Bagger
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Helle Terkildsen Maindal
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Public Health, Section for Health Promotion, Aarhus University, Aarhus, Denmark
| | | | | | - Jens Aagaard-Hansen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Faculty of Health Sciences, SA MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Craig L, Sims R, Glasziou P, Thomas R. Women's experiences of a diagnosis of gestational diabetes mellitus: a systematic review. BMC Pregnancy Childbirth 2020; 20:76. [PMID: 32028931 PMCID: PMC7006162 DOI: 10.1186/s12884-020-2745-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/15/2020] [Indexed: 12/17/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) - a transitory form of diabetes induced by pregnancy - has potentially important short and long-term health consequences for both the mother and her baby. There is no globally agreed definition of GDM, but definition changes have increased the incidence in some countries in recent years, with some research suggesting minimal clinical improvement in outcomes. The aim of this qualitative systematic review was to identify the psychosocial experiences a diagnosis of GDM has on women during pregnancy and the postpartum period. Methods We searched CINAHL, EMBASE, MEDLINE and PsycINFO databases for studies that provided qualitative data on the psychosocial experiences of a diagnosis of GDM on women across any stage of pregnancy and/or the postpartum period. We appraised the methodological quality of the included studies using the Critical Appraisal Skills Programme Checklist for Qualitative Studies and used thematic analysis to synthesis the data. Results Of 840 studies identified, 41 studies of diverse populations met the selection criteria. The synthesis revealed eight key themes: initial psychological impact; communicating the diagnosis; knowledge of GDM; risk perception; management of GDM; burden of GDM; social support; and gaining control. The identified benefits of a GDM diagnosis were largely behavioural and included an opportunity to make healthy eating changes. The identified harms were emotional, financial and cultural. Women commented about the added responsibility (eating regimens, appointments), financial constraints (expensive food, medical bills) and conflicts with their cultural practices (alternative eating, lack of information about traditional food). Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves. Conclusion A diagnosis of GDM has wide reaching consequences that are common to a diverse group of women. Threshold cut-offs for blood glucose levels have been determined using the risk of physiological harms to mother and baby. It may also be advantageous to consider the harms and benefits from a psychosocial and a physiological perspective. This may avoid unnecessary burden to an already vulnerable population.
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Affiliation(s)
- Louise Craig
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Rebecca Sims
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia.
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Svensson L, Nielsen KK, Maindal HT. What is the postpartum experience of Danish women following gestational diabetes? A qualitative exploration. Scand J Caring Sci 2017; 32:756-764. [PMID: 28856697 DOI: 10.1111/scs.12506] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/19/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Women with gestational diabetes mellitus (GDM) receive acute but short-term care during pregnancy. There is less direct support during the postpartum period; women are offered general advice on how to follow a healthy lifestyle to avoid developing future type 2 diabetes. Observational studies suggest that a substantial proportion of women with prior GDM do not sustain recommended lifestyle changes postpartum. In a qualitative study, we examined how Danish women diagnosed with GDM experience the transition from a GDM-affected pregnancy to the postpartum period. METHODS Semistructured interviews with six women diagnosed with GDM. Data were analysed using qualitative content analysis. RESULTS A GDM diagnosis was accompanied by worries about the health of the woman's baby. This was also the driving force behind the women's motivation to engage in lifestyle changes during pregnancy. The outpatient treatment was perceived to be strict and associated with various challenges, including cravings and discomfort. After the delivery, taking care of the baby became the women's dominant focus. Social and emotional support from partners were needed to maintain motivation and prioritise a healthy lifestyle. The women's experience of the health system varied. However, in the postpartum period all the women experienced limited interaction and initiative from their healthcare providers in supporting them to engage in a healthy lifestyle. CONCLUSIONS This study identified barriers and facilitators to sustaining a healthy lifestyle postpartum. Efforts at multiple levels - including the individual, family and health system - are needed to facilitate and support a healthy lifestyle among women with prior GDM.
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Affiliation(s)
- Line Svensson
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Karoline Kragelund Nielsen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Terkildsen Maindal
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
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Artieta-Pinedo I, Paz-Pascual C, Grandes G, Espinosa M. Framework for the establishment of a feasible, tailored and effective perinatal education programme. BMC Pregnancy Childbirth 2017; 17:58. [PMID: 28178926 PMCID: PMC5299744 DOI: 10.1186/s12884-017-1234-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Antenatal education needs to be renewed and adapted to the needs of women. OBJECTIVES to assess women needs, identify factors that influence the desired outcomes, and propose a framework for developing new perinatal education based on the guidance published by the UK Medical Research Council for the development and evaluation of complex interventions in primary care. METHODS For this study: (a) four focus group sessions were held from October to November 2010 in Bizkaia (Spain) with 30 women exploring their needs during pregnancy and postpartum; (b) two literature reviews were conducted on women's needs at these times and theoretical models of healthcare education; and (c) seven discussion and consensus sessions were run with a group of experts composed of midwifes, gynaecologists, paediatricians, and paediatric and postpartum nurses. RESULTS Various areas for improvement were identified: needs assessment of each woman/family, consideration of pregnancy and childbirth as normal physiological processes, participation of fathers, establishment of social networks, continuity of postpartum care, better access to and training for midwives, and more flexible format and contents for the programme. We propose a woman-focused framework that includes three exploratory interviews during pregnancy, personalized interventions coordinated between professionals, empowerment to choose the type of birth, and postpartum activities. CONCLUSION New perinatal education should be on-going and focused on each woman. It is necessary to assess the feasibility of implementing this type of programme, depending on the context, professionals' readiness for change and characteristics of the proposed interventions. Then, its effectiveness and sustainability must be assessed.
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Affiliation(s)
- Isabel Artieta-Pinedo
- Primary Care Midwife Zuazo Health Centre, Barakaldo, (Bizkaia); and Associate Professor of the School of Nursing, University of the Basque Country, Leioa, Bizkaia, Spain.
- Primary Care Research Unit of Bizkaia, Centro de Salud de Deusto, 4ª planta, 48014, Bilbao, Bizkaia, Spain.
| | - Carmen Paz-Pascual
- Primary Care Midwife in Sestao Health Centre, Bizkaia; and Lecturer in the Midwifery Training Unit of the Basque Country, Bilbao, Bizkaia, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Centro de Salud de Deusto, 4ª planta, 48014, Bilbao, Bizkaia, Spain
| | - Maite Espinosa
- Primary Care Research Unit of Bizkaia, Centro de Salud de Deusto, 4ª planta, 48014, Bilbao, Bizkaia, Spain
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Khooshehchin TE, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Perceived needs in women with gestational diabetes: A qualitative study. Electron Physician 2016; 8:3412-3420. [PMID: 28163857 PMCID: PMC5279975 DOI: 10.19082/3412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/13/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Diabetes is the most common medical complication of pregnancy. It can be associated with many complications for mother and fetus. Gestational diabetes is also one of the main health issues in Iran. Therefore, the present study is aimed at a deeper understanding of women’s experiences of gestational diabetes and their perceived needs to inform future lifestyle interventions. Methods This qualitative content analysis study was carried out in 2015. Participants were pregnant women diagnosed with gestational diabetes in the 24th to 36th week of pregnancy, who were referred to the clinics affiliated with Shahid Beheshti Medical Science University in Tehran, Iran. In-depth interviews were conducted with participants, using semi-structured questions. Interviews were audio taped and transcribed verbatim. Conventional content analysis was carried out for data analysis. Interviews continued until data saturation was obtained. Data were coded in MAXQDA software (version 11). Results Content analysis highlighted two themes; educational needs and need to support. The former was featured with five main categories: information sources, education process, unknown and known, weaknesses of public information system, and eagerness to learn. The latter was featured with two main categories: family support and social support. Conclusion Clarifying the needs of the mothers with gestational diabetes, leads to better and proper education planning and a program toward the improvement of health, self-care, and prevention of diabetes.
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Affiliation(s)
- Taraneh Emamgoli Khooshehchin
- Student Research Office, Ph.D. Candidate, Department of Reproductive Health, School of Nursing and Midwifery, International Branch, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohre Keshavarz
- Assistant Professor, Department of Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Afrakhteh
- Department of Obstetrics and Gynecology of Shohada Tajresh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Assistant Professor, Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Soghrat Faghihzadeh
- Department of Biostatistics, Zanjan University of Medical Sciences, Zanjan, Iran
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Viken B, Lyberg A, Severinsson E. Maternal health coping strategies of migrant women in norway. Nurs Res Pract 2015; 2015:878040. [PMID: 25866676 PMCID: PMC4381727 DOI: 10.1155/2015/878040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 02/03/2023] Open
Abstract
The aim of the study was to explore the maternal health coping strategies of migrant women in Norway. The ethnic and cultural background of the Norwegian population have become increasingly diverse. A challenge in practice is to adjust maternal health services to migrant women's specific needs. Previous studies have revealed that migrant women have difficulty achieving safe pregnancies and childbirths. Data were obtained by means of 17 semistructured interviews with women from South America, Europe, the Middle East, Asia, and Africa. Qualitative content analysis was employed. One overall theme is as follows: keeping original traditions while at the same time being willing to integrate into Norwegian society, and four themes emerged as follows: balancing their sense of belongingness; seeking information and support from healthcare professionals; being open to new opportunities and focusing on feeling safe in the new country. The results were interpreted in the light of Bronfenbrenner's ecological model. To provide quality care, healthcare professionals should focus on the development of migrant women's capabilities. Adaptation of maternal health services for culturally diverse migrant women also requires a culturally sensitive approach on the part of healthcare professionals.
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Affiliation(s)
- Berit Viken
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
| | - Anne Lyberg
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
| | - Elisabeth Severinsson
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, Buskerud and Vestfold University College, P.O. Box 235, 3603 Kongsberg, Norway
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Lie MLS, Hayes L, Lewis-Barned NJ, May C, White M, Bell R. Preventing type 2 diabetes after gestational diabetes: women's experiences and implications for diabetes prevention interventions. Diabet Med 2013; 30:986-93. [PMID: 23534548 DOI: 10.1111/dme.12206] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 02/12/2013] [Accepted: 03/22/2013] [Indexed: 01/04/2023]
Abstract
AIMS To explore factors influencing post-natal health behaviours following the experience of gestational diabetes, and to elicit women's views about the feasibility of lifestyle intervention to prevent diabetes during the first 2 years after childbirth. METHODS Qualitative study using semi-structured interviews with women who had gestational diabetes. In phase 1 (31 women), interviews explored the experience of gestational diabetes, ideas about future risk of diabetes and factors influencing post-natal health-related behaviours. Statements were developed summarizing women's views of lifestyle change to prevent diabetes. In phase 2 (14 women), interviews explored how the passage of time had contributed to changes in health behaviour, and the statements were used to develop views about diabetes interventions. RESULTS Women were aware of their risk of developing diabetes, but did not always act on such knowledge. Pregnancy motivated behaviour changes to benefit the unborn child, but after delivery these changes were often not maintained. Tiredness, maternal attachment and childcare demands were prominent barriers in the early post-natal months. Later, work, family and child development became more significant barriers. Many women became more receptive to healthy eating messages around the time of weaning. Women were positive about long-term support for self-management to reduce their diabetes risk. CONCLUSIONS There is potential to reduce the risk of Type 2 diabetes post-natally among women with gestational diabetes. Interventions need to be developed that take into account contextual factors and competing demands, are flexible and respond to women's individual circumstances. Randomized trials of such interventions are warranted.
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Affiliation(s)
- M L S Lie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Molin KR, Mygind A, Nørgaard LS. Perceptions of disease aetiology and the effect of own behaviour on health among poly-pharmacy patients with non-Western backgrounds in Denmark. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2013; 21:386-92. [PMID: 23489599 DOI: 10.1111/ijpp.12023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 01/04/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the perceptions of disease aetiology and the effect of own behaviour on health among poly-pharmacy patients with non-Western backgrounds in Denmark. METHODS The study was based on 26 extended medication reviews with patients of non-Western backgrounds aged 50+ who use at least four prescription drugs regularly. The reviews were conducted by 12 pharmacists with the same mother-tongue background as the participants. The reviews included patient interviews on which the data in this article are based. In total, four open-ended questions from the patient interviews were analysed by the means of Giorgi's phenomenological method. KEY FINDINGS The analysis shows that stress was most commonly perceived as the cause of the participants' diseases for reasons that included (1) having left their country of origin and family, (2) worry over the political situation in their country of origin and (3) the problems involved in living as an immigrant in Denmark. Most of the participants perceived their own efforts as having little impact on their own health status, although some participants considered them as having considerable influence. CONCLUSIONS To a great extent, the explanations of the participants about possible disease aetiology are focused on stress, immigration and psychological well-being. Although many participants perceived that their own efforts did not have much impact on their health status, our study revealed a large diversity in the responses of non-Western immigrants, particularly regarding the importance of their own efforts on their health status.
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Affiliation(s)
- Katrine Rutkær Molin
- Section for Clinical and Social Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Devsam BU, Bogossian FE, Peacock AS. An interpretive review of women's experiences of gestational diabetes mellitus: proposing a framework to enhance midwifery assessment. Women Birth 2013; 26:e69-76. [PMID: 23333029 DOI: 10.1016/j.wombi.2012.12.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/16/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) affects almost 5% of pregnancies in Australia, and within 15 years, 25% of affected women will go on to develop Type 2 Diabetes Mellitus (T2DM). The adoption of preventive health behaviours may be influenced by women's experiences of GDM. QUESTION This review sought to understand women's beliefs, values, perceptions and experiences following diagnosis of GDM. METHODS Peer reviewed and professional journals were searched for primary research, published between January 1991 and December 2011 that explored the beliefs, values, perceptions and experiences of peripartum or postpartum women with a diagnosis or history of GDM. FINDINGS Nineteen studies met the inclusion criteria and the majority of these studies were qualitative (n=15). Each study was reviewed and synthesis revealed three emergent themes and core concepts related to each theme: Responses (initial reaction to GDM diagnosis, negative thoughts following diagnosis, struggle to manage GDM, feelings of 'loss of control', changes to identity and adapting to change), Focus of Concern (concern for baby's health, mother's concern for her own health, perceived seriousness of GDM, perceived fear of T2DM) and Influencing Factors (cultural roles and beliefs, social stigmas, social support, professional support, adequate and appropriate information, social roles and barriers to self-care). CONCLUSION The experiences of women with GDM are unique and personal however this review highlights common experiences evident in the existing research. The proposed framework may be used by midwives in clinical assessment and care of women diagnosed with GDM.
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Affiliation(s)
- Bianca U Devsam
- The University of Queensland, The School of Nursing and Midwifery, Building 12, Ipswich Campus, Ipswich, Queensland, Australia.
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Kaiser B, Razurel C. Determinants of postpartum physical activity, dietary habits and weight loss after gestational diabetes mellitus. J Nurs Manag 2012; 21:58-69. [PMID: 23339495 DOI: 10.1111/jonm.12006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2012] [Indexed: 11/30/2022]
Abstract
AIM To describe the most significant findings of the studies that examined the prevalence and determinants of postpartum health behaviours (physical activity, dietary habits and/or weight loss) in patients with gestational diabetes mellitus (GDM). BACKGROUND Patients with gestational diabetes have a high risk of developing type 2 diabetes in the months after delivery. For this reason, GDM patients are encouraged to practice specific health behaviours during the postpartum period. It is important to identify the factors that may impact the adherence to these behaviours. EVALUATION Eighteen published research articles that examined postpartum health behaviours and/or their potential determinants in women diagnosed with GDM were selected from electronic databases. KEY ISSUES Physical activity and diet rarely meet the recommendations. Risk perception, health beliefs, social support and self-efficacy are the main factors identified as having an impact on the adoption of health behaviours. However, the cross-sectional nature of the studies and the lack of social, geographical and/or ethnic variety in the populations studied do not allow us to generalize the conclusions. IMPLICATIONS FOR NURSING MANAGEMENT This literature review reports all the information currently available that can enable nurses and midwives to engage in the evaluation and optimization of their interventions in GDM patients. Motivational interventions based on Social Cognitive Theory are proposed.
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Affiliation(s)
- Barbara Kaiser
- University of Applied Sciences Western Switzerland, 47 Avenue de Champel, Geneva, Switzerland.
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Bennett WL, Ennen CS, Carrese JA, Hill-Briggs F, Levine DM, Nicholson WK, Clark JM. Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study. J Womens Health (Larchmt) 2011; 20:239-45. [PMID: 21265645 DOI: 10.1089/jwh.2010.2233] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. METHODS We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management. RESULTS Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9 kg/m(2) (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care. CONCLUSIONS Women with recent GDM report multiple barriers and facilitators of postpartum follow-up care. Our results will inform the development of interventions to improve care for these women to reduce subsequent diabetes risk.
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Affiliation(s)
- Wendy L Bennett
- Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
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Lawrence JM. Women with diabetes in pregnancy: different perceptions and expectations. Best Pract Res Clin Obstet Gynaecol 2010; 25:15-24. [PMID: 21115403 DOI: 10.1016/j.bpobgyn.2010.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/06/2010] [Indexed: 12/16/2022]
Abstract
Given the increasing incidence of type 1 diabetes, the recent emergence of type 2 diabetes as a condition that can begin during childhood, and the increasing prevalence of gestational diabetes mellitus, the number of women who have some form of diabetes during their pregnancies is increasing. The perceptions and expectations of women with diabetes during pregnancy may affect their psychological response to pregnancy as well as their behaviour during and after pregnancy. This article provides an overview of the epidemiology of diabetes in pregnancy, including diabetes diagnosed before pregnancy and gestational diabetes mellitus. Then, the limited number of studies about women's perceptions of diabetes and pregnancy, based on interviews conducted during or shortly after pregnancy, are reviewed. We present information about how health professionals may manage these perceptions and expectations, based on the findings of these studies, as well as areas for future research.
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Affiliation(s)
- Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, 91101, USA.
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