English abstract
Background: With respect to advancement of the Gestational Diabetes Mellitus
(GDM) management plan, the prevalence rate of GDM-related pregnancy complications
continues to increase, most likely due to lack of adherence to the recommended GDM management plan. Previous studies have concluded that adherence to the GDM management
plan has significantly decreased the incidence of GDM complications. The latest studies on
GDM have focused on investigating new interventions to improve pregnancy outcomes;
however, evidence about the factors that influence adherence to the recommended GDM management plan is lacking.
Purpose: This study aimed to assess the predictors, the barriers, and the motivating
factors of adherence to the GDM management plan (i.e. healthy diet, physical activity, self monitoring of blood glucose level, oral hypoglycaemics, and insulin injection) among
Arabic-speaking pregnant Omani women with GDM.
Methods: A descriptive cross-sectional study was carried out among pregnant women
with GDM using a convenience sampling technique, for which 164 participants were
recruited from the Antenatal Clinics at Sultan Qaboos University Hospital (SQUH), Royal
Hospital (RH), and Khoula Hospital. The measurement scales included a summary of
diabetes self-care activities measure (SDSCA), diabetes management self-efficacy scales
(DMSES), and social support survey. Multiple-choice questions were used to assess barriers
to and motivators of adherence. Multiple linear regression was used to identify predictors of
adherence to the GDMmanagement plan among pregnant Omani women with GDM.
Descriptive statistics (frequency and percentages) were used to describe the barriers and the
motivating factors for adherence.
Results: The study included 164 Arabic speaking pregnant Omani women with
GDM. Findings from descriptive statistics showed that the study participants have an
acceptable level of adherence (M= 6.6 /10) to the GDM management plan, a medium level of
self-efficacy (M=121.58/160), and a moderate level of social support (M=78.58/100). In
addition, multiple linear regression analysis showed that none of the participants'
demographic characteristics (i.e. age, work status, working hours, educational level, income,
family history of T2DM, family history of GDM, health education, gravida, para, pre pregnancy weight, pre-pregnancy BMI, social support) is a significant predictor for
adherence to the GDM-management plan. However, the stepwise regression revealed three
models with three significant predictors, including self-efficacy, previous history of GDM,
and the type of GDM management. The major barriers to adherence to the GDM
management plan were family, especially kids' responsibilities, time constraints, home
responsibilities, and working status. Moreover, participants indicated their concern about
maternal and neonatal GDM-related complications and husband encouragement as the main
motivating factors for adherence to the recommended GDM-management plan.
Conclusion: Understanding among health care providers of the predictors, barriers,
and motivators of adherence to the GDM management plan is essential to plan and implement
health promotion interventions adapted to the women's personal needs, which will ultimately
improve their adherence and pregnancy outcomes.
Implications for practice and policy: The study results have implications for both
practice and policy. In practice, midwives and antenatal nurses should consider incorporating
self-efficacy enhancing strategies and family involvement in their health education
interventions to improve adherence to the recommended treatment plan. As for policy, the
study suggests collaboration between health policy makers in the Ministry of Health,
Consumer Protection Agency, and the Ministry of Municipality to ensure the availability of
healthy food choices in the public areas. Further, the Ministry of Manpower should provide
flexible working hours and a conducive working environment for pregnant women with
GDM to encourage a healthy and active lifestyle.
