Self-Management Behavior Of Women With Gestational Diabetes Mellitus:A Study Under Social Cognitive Theory

ObjectivesTo understand the status quo and influencing factors of GDM pregnant women’s self-management behavior based on social cognitive theory,so as to provide the basis for the development of self-management behavior intervention measures.Methods1.Study of status quo and related influencing factors of self-management behavior in pregnant women with gestational diabetesBy convenient sampling method,227 pregnant women with gestational diabetes were selected from three class A hospitals in Lanzhou City as research participants to understand the status quo of their self-management behavior and the relevant influencing factors based on social cognitive theory.Research tools include general data questionnaire,diabetes self-management attitude Scale,Perceived Social Support Scale(PSSS),Self-efficacy for Diabetes(SED)and The Summary of Diabetes Self-Care Activity(SDSCA).Descriptive statistical analysis,variance analysis/independent sample t test and multiple linear regression were used for statistical analysis.Structural equation model was constructed to analyze the relationship between variables.2.Qualitative study of poor self-management behavior in pregnant women with gestational diabetes mellitusEight GDM pregnant women with poor self-management behavior were selected through maximum difference sampling method for one-to-one semi-structured interview,so as to supplement quantitative data and further understand the generation experience of their poor self-management behaviors under the social cognitive theory.The interview data were analyzed using interpretative phenomenological analysis.Results1.Status quo and related influencing factors of self-management behavior of pregnant women with gestational diabetes mellitus(1)227 pregnant women with gestational diabetes mellitus were investigated,with an average age of 31.15±4.22 years.The average score of total self-management behavior was 3.83±1.11,and 68.72%of pregnant women with gestational diabetes were at a poor level of self-management behavior.The average score of dietary self-management behavior was 4.80±1.09,that of exercise self-management behavior was4.00±1.80.Among the 227 research participants,36 pregnant women required medication(including insulin),91.67%of them were rated as good at the medical self-management behavior.(2)Univariate analysis/independent sample t test showed that there were statistically significant differences in self-management behavior scores among GDM pregnant women with different educational level,per capita monthly family income,occupation,ethnicity,long-term residence,residence status,previous history of GDM and drug use(P<0.05).(3)Multiple linear regression analysis showed that diabetes self-efficacy score(β=0.421;95%CI:0.329,0.513,P<0.001)、whether medication was used(β=0.627;95%CI:0.301,0.953,P<0.001),occupation is worker/farmer(β=-0.688;95%CI:-1.270,10.107,P=0.021)was the influence factor of self-management behavior of pregnant women with gestational diabetes(Adjusted R~2=0.345).(4)The structural equation model showed that self-management attitude and self-efficacy had a direct positive effect on self-management behavior,the path coefficients were 0.322 and 0.563(P<0.05),respectively.Perceived social support can affect self-management behavior by influencing self-management attitude(path coefficient 0.400,P<0.05).2.Qualitative results of poor self-management behavior in pregnant women with gestational diabetes mellitusThrough the collation and analysis of the interview data of 8 GDM pregnant women with poor self-management behavior,the generation experience of their bad self-management behavior can be summarized into 3 themes and 7 sub-themes.Theme1:Insufficient understanding of self-management behavior,including insufficient understanding of the importance of self-management behavior,and treating blood glucose monitoring as outcome evaluation.Theme 2:Limited self-efficacy,including lack of self-management belief,dependence on authority;rich diet temptation,lack of willpower;easy to compromise,blame external environmental restrictions;the workload is heavy and the time is not free.Theme 3:Unbalanced social support:general life support is sufficient while GDM related support is relatively insufficient.Conclusion(1)The self-management behavior of GDM pregnant women was at a poor level,and the good rate of diet management was higher than exercise management than blood glucose monitoring;(2)Multiple linear regression showed that self-management efficacy,drug use and occupation is worker/farmer were factors affecting self-management behavior of pregnant women with GDM;(3)The structural equation model based on the theory of social cognition confirmed that self-management attitude and self-efficacy had a positive effect on self-management behavior;self-efficacy and perceived social support had a positive effect on self-management attitude;(4)The experiences of GDM pregnant women with poor self-management behavior can be summarized as:lack of cognition,lack of belief in self-management,lack of willpower to resist the temptation of eating,easy to compromise due to external environment restrictions,heavy work burden,and rich general life support but insufficient support related to GDM.