Abstract / Summary
Abstract Background Poorly managed gestational diabetes mellitus (GDM) has serious implications for mother and child and women diagnosed with GDM have increased risk of type 2 diabetes (T2D). Risk is greater for women from minority ethnic groups. There is a paucity of literature exploring factors influencing related lifestyle behaviour change for GDM self-management and T2D risk reduction, especially for women from these groups. This is necessary to inform the development of inclusive, theoretically informed interventions. Methods Interviews were conducted with a diverse sample of 35 women (66% from minority ethnicities) who had been diagnosed with GDM. The Capability-Opportunity-Motivation (COM-B) model of behaviour was used to identify how positive engagement with gestational diabetes self-management and type 2 diabetes prevention behaviours can be supported. Results Barriers to GDM self-management included variable knowledge and unclear, un-tailored guidance, challenges developing glucose management skills and a cognitive overload from continuous monitoring (Capability); women felt a loss of control over pregnancy decisions and cultural beliefs (such as the risks of exercise) and dietary habits made glucose management more challenging (Motivation). Barriers to T2D risk prevention choices were primarily driven by motivational factors, such as women not feeling they were at risk and appetite drivers associated with breast-feeding (Motivation) as well as lack of clear guidance and risk determination (Opportunity). Sociocultural influences included a cultural normalisation of diabetes, and contextual factors such as housing and the local environment not being conducive to lifestyle change (Opportunity). Recommendations include, improving the communication of guidance (e.g., BCT instruction how to perform behaviour ); fostering social interaction (e.g., BCT social support ); and addressing lack of intention postpartum, by consistent communication at discharge, adequate presentation of personalised risk and a concise provision of guidance (e.g., BCTs salience of health consequences ). Conclusions This study identifies the theoretical basis for inclusive intervention development and service design improvements to support women with GDM self-management and T2D risk reduction.