Journal of Obstetric, Gynecologic & Neonatal Nursing
Clinical StudiesRelationships Between the Perceived Impact of Gestational Diabetes Mellitus and Treatment Adherence
Section snippets
Theoretical Framework
Many theoretical models have been proposed for the study of stressful life events similar to the diagnosis of gestational diabetes mellitus. However, most models examine only the relationship between an event and the stress response, or the event and a patient’s perception of the event. Investigation must go beyond these relationships to the consequences of the stressors. Therefore, the theoretical model chosen to guide this study is adapted from the report of the Institute of Medicine on
Literature Review
Maternal emotional factors have been shown to influence the course and outcome of pregnancy (Eliot & Eisdorfer, 1982). The treatment of gestational diabetes mellitus, which involves rigorous lifestyle changes for many women, has been documented to be stressful (Samson, Arnold, & Gibbons, 1986). The pregnant women surveyed by Samson and colleagues reported stress resulting from their health restoration program. Women’s greatest concern was controlling their glucose levels. The women surveyed
Method
The study was conducted in a large, urban, tertiary perinatal center in the northeast. Participants were 29 women with gestational diabetes mellitus who were enrolled in a larger study of early discharge and nurse specialist transitional care. All women in the convenience sample met the following criteria: English speaking, telephone access at home, primary diagnosis of gestational diabetes mellitus, and less than 36 weeks gestation. Patients were approached by the investigator and asked to
Results
Data were subjected to appropriate descriptive and correlational analysis. A generous alpha of .10 was used for significance testing. This alpha level, set before the data analysis, was used because of the exploratory nature of the study. Analysis of the scores on the Impact of Event Scale revealed a mean and standard deviation of 27.9 and 13.8, respectively. The mean score on the Impact of Event Scale in this sample, although lower than the mean score of 43.7 reported by Horowitz et al. (1979)
Discussion
Participants in this study were primarily low-income, unmarried, black women. A review of epidemiologic literature illustrates the disproportionate levels of infant morbidity and mortality, maternal death during pregnancy, and general illness in this population. Dutton (1986) describes the cycle of poverty and illness that includes low income, inadequate education, and hazardous occupations leading to poor environmental conditions, psychologic stress, and social isolation, which can, in turn,
Clinical Implications
The women enrolled in this study reported that gestational diabetes mellitus had a significant impact on their lives. The important consideration for health care providers when caring for women with this condition is, however, not only the specific reactions that women have to the stressor of gestational diabetes mellitus, but also the behavioral consequences of those reactions. Behavior has been documented to play an important role in health. Health care providers spend a lot of time trying to
Recommendations for Future Research
From this research, a profile emerged of a vulnerable population of women who are black, single, urban, lowincome, and experiencing a high-risk pregnancy. This population is already at high risk of poor birth outcomes because of minority status and social class. With the additional stressor of a high risk pregnancy that requires significant behavioral modification to optimize outcome, the coping behaviors of the women are tested. Further study is warranted of the reactions of women to the
Acknowledgments
A portion of this work was supported by a grant (P01-NR-01859) from the National Center for Nursing Research, National Institutes of Health. This article received Honorable Mention in the Clinical Research Paper category at the AWHONN 1994 Convention, Cincinnati, OH.
References (24)
- et al.
Management and outcome of class A diabetes
American Journal of Obstetrics and Gynecology
(1977) - et al.
The practice of nursing research
(1993) - et al.
- et al.
The relationship between the health belief model and compliance of persons with diabetes mellitus
Diabetes Care
(1980) Social class, health and illness
Multicenter survey of diabetic pregnancy in France
Diabetes Care
(1991)- et al.
Self care behaviors and glycemic control in Type I diabetes
Journal of Chronic Disease
(1987) - et al.
Impact of Event Scale: A measure of subjective stress
Psychosomatic Medicine
(1979) - et al.
Pregnancy and diabetes: A team approach
Archives of Internal Medicine
(1986)
Compliance and medicine
Facilitating treatment adherence: A practitioner’s guidebook
Cited by (12)
Women with diabetes in pregnancy: Different perceptions and expectations
2011, Best Practice and Research: Clinical Obstetrics and GynaecologyCitation Excerpt :Scores on the Impact of Event scale were higher for women with GDM when compared with normative population values for the scale. Women, who perceived that the diagnosis and treatment of GDM had more impact on their lives, were less likely to be adherent to blood glucose self-monitoring, but there was no association between the score and the global treatment adherence measure.62 While studies have reported on the lack of preparedness for pregnancy, poor glycaemic control at the time of conception and lack of intendedness of pregnancies among women with diabetes, few have explored the ‘diabetic pregnancy’ from the woman’s point of view, with most articles focussed on the viewpoint of health-care providers and/or researchers.
Development of macrosomia resulting from gestational diabetes mellitus: Physiology and social determinants of health
2010, Advances in Neonatal CarePregnancy and diabetes: A review of literature
2009, Psicologia della SaluteTreatment adherence in pregnancy
2006, Promoting Treatment Adherence: A Practical Handbook for Health Care ProvidersDiagnostic controversy: Gestational diabetes and the meaning of risk for Pima Indian women
2005, Medical Anthropology: Cross Cultural Studies in Health and Illness