Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, Massachusetts.
Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.
J Midwifery Womens Health. 2020 Sep;65(5):681-687. doi: 10.1111/jmwh.13122. Epub 2020 Jun 22.
Women with gestational diabetes mellitus (GDM) have a marked increased risk of early onset type 2 diabetes, but less than half initiate postpartum glucose testing or connect with a primary care provider for continued follow-up after giving birth. This study analyzed women's narratives about their GDM-affected pregnancies to (1) identify different patterns (narrative archetypes) that capture the GDM experience; (2) explore how these patterns relate to awareness of ongoing risk after pregnancy and affect participation in self-care, monitoring, and preventive health care going forward; and (3) explore the use of identified patterns to tailor conversations with patients during prenatal and postpartum care to their actual perceptions and concerns about future risk.
Open-ended interviews elicited women's experiences and perspectives about GDM and its management. A narrative analysis first identified segments of text related to risk and behaviors and then applied Frank's narrative archetypes (restitution, chaos, quest) as an interpretive lens.
Interviews were completed in English (n = 15), Spanish (n = 7), and Haitian Creole (n = 7). We found distinct patterns: stories of restitution (n = 13), quest (n = 4), chaos (n = 4), and mixed narratives (n = 7). Using these archetypes, we found differences in how women respond to challenges related to disease complexity, treatment, and future risks. These patterns led to marked differences in the steps women took to prevent early onset type 2 diabetes.
Frank's narrative types provided insight into women's responses to clinical protocols, health care advice, and subsequent prevention actions. A restitution pattern may result in premature closure and lack of awareness of risk. Similarly, a chaos pattern may contribute to a sense of helplessness to implement follow-up recommendations, despite risk awareness. Understanding these patterns can help clinicians tailor individualized support as women transition from GDM with its focus on a healthy fetus and newborn to preventive self-care to protect their health.
患有妊娠糖尿病（GDM）的女性发生早发 2 型糖尿病的风险显著增加，但不到一半的人会在产后进行葡萄糖检测或与初级保健医生联系以进行持续随访。本研究分析了女性对其 GDM 妊娠的叙述，以（1）确定捕捉 GDM 经历的不同模式（叙述原型）；（2）探讨这些模式如何与产后持续风险意识相关，并影响未来自我保健、监测和预防保健的参与；（3）探讨使用已确定的模式在产前和产后护理期间与患者进行对话，以适应他们对未来风险的实际认知和关注点。
开放式访谈引出了女性对 GDM 及其管理的经验和观点。叙述分析首先确定了与风险和行为相关的文本片段，然后应用弗兰克的叙述原型（修复、混乱、探索）作为解释视角。
完成了英语（n=15）、西班牙语（n=7）和海地克里奥尔语（n=7）的访谈。我们发现了不同的模式：修复（n=13）、探索（n=4）、混乱（n=4）和混合叙述（n=7）的故事。使用这些原型，我们发现了女性对与疾病复杂性、治疗和未来风险相关的挑战的不同反应。这些模式导致了女性采取预防早发 2 型糖尿病的步骤的显著差异。
弗兰克的叙述类型深入了解了女性对临床方案、医疗保健建议以及随后的预防措施的反应。修复模式可能导致过早的封闭和缺乏风险意识。同样，混乱模式可能导致实施后续建议的无助感，尽管有风险意识。了解这些模式可以帮助临床医生在女性从以健康胎儿和新生儿为重点的 GDM 过渡到预防自我保健以保护自身健康时，为其提供个性化的支持。
