Lake Amelia J, Williams Amelia, Neven Adriana C H, Boyle Jacqueline A, Dunbar James A, Hendrieckx Christel, Morrison Melinda, O'Reilly Sharleen L, Teede Helena, Speight Jane
School of Psychology, Deakin University, Geelong, VIC, Australia.
The Australian Centre for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia.
Front Clin Diabetes Healthc. 2023 Feb 24;4:1086186. doi: 10.3389/fcdhc.2023.1086186. eCollection 2023.
Women with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content.
Semi-structured interviews with participants recruited via Australia's National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify 'important' domains which we then mapped to the Capability, Opportunity, Motivation-Behavior (COM-B) model.
Nineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: 'knowledge', 'memory, attention, and decision-making processes', 'environmental context and resources', 'social influences', 'emotion', 'beliefs about consequences', 'social role and identity', and 'beliefs about capabilities'. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample.
This study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM. .
既往患有妊娠期糖尿病（GDM）的女性患2型糖尿病（T2D）的风险增加。指南建议在产后6至12周进行产后糖尿病筛查（口服葡萄糖耐量试验或糖化血红蛋白），此后定期进行筛查。尽管如此，仍有大约一半的女性未接受筛查，这是早期识别糖尿病前期或2型糖尿病的一个关键错失机会。虽然政策和实践层面的建议很全面，但个人层面的建议主要侧重于提高筛查知识和风险认知，可能忽略了其他有影响力的行为决定因素。我们旨在确定影响澳大利亚既往患有妊娠期糖尿病的女性产后2型糖尿病筛查的可改变的个人层面因素，并推荐干预功能和行为改变技巧以支撑干预内容。
通过澳大利亚国家妊娠期糖尿病登记处招募参与者进行半结构化访谈，使用基于理论领域框架（TDF）的指南。采用归纳 - 演绎方法，我们将数据编码到TDF领域。我们使用既定标准确定“重要”领域，然后将其映射到能力、机会、动机 - 行为（COM - B）模型。
19名女性参与：年龄34±4岁，产后19±4个月，63%出生于澳大利亚，90%居住在大城市，58%按照指南进行了T2D筛查。确定了8个TDF领域：“知识”、“记忆、注意力和决策过程”、“环境背景和资源”、“社会影响”、“情绪”、“对后果的信念”、“社会角色和身份”以及“对能力的信念”。研究优势包括方法严谨的设计；局限性包括招募人数少和样本同质化。
本研究确定了既往患有GDM的女性产后T2D筛查存在众多可改变的障碍和促进因素。通过映射到COM - B，我们确定了干预功能和行为改变技巧以支撑干预内容。这些发现为制定针对最有可能优化既往患有GDM的女性T2D筛查接受率的行为决定因素的信息和干预措施提供了宝贵的证据基础。
