Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study
Abstract Introduction Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes. Research design and methods This paper desc...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Nursing |
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| Online Access: | https://doi.org/10.1186/s12912-023-01659-1 |
| _version_ | 1797363527661387776 |
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| author | Katelyn Sushko Patricia Strachan Michelle Butt Kara Nerenberg Diana Sherifali |
| author_facet | Katelyn Sushko Patricia Strachan Michelle Butt Kara Nerenberg Diana Sherifali |
| author_sort | Katelyn Sushko |
| collection | DOAJ |
| description | Abstract Introduction Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes. Research design and methods This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration. Results The quantitative results found that women achieved “at target” glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery. Conclusions The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women’s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences. |
| first_indexed | 2024-03-08T16:21:44Z |
| format | Article |
| id | doaj.art-b2da597e93d54b58beab32ab6ba3ecfa |
| institution | Directory Open Access Journal |
| issn | 1472-6955 |
| language | English |
| last_indexed | 2024-03-08T16:21:44Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nursing |
| spelling | doaj.art-b2da597e93d54b58beab32ab6ba3ecfa2024-01-07T12:18:26ZengBMCBMC Nursing1472-69552024-01-0123111110.1186/s12912-023-01659-1Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case studyKatelyn Sushko0Patricia Strachan1Michelle Butt2Kara Nerenberg3Diana Sherifali4Faculty of Health Sciences, School of Nursing, McMaster UniversityFaculty of Health Sciences, School of Nursing, McMaster UniversityFaculty of Health Sciences, School of Nursing, McMaster UniversityDepartments of Medicine and Obstetrics & Gynecology, University of CalgaryFaculty of Health Sciences, School of Nursing, McMaster UniversityAbstract Introduction Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes. Research design and methods This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration. Results The quantitative results found that women achieved “at target” glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery. Conclusions The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women’s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.https://doi.org/10.1186/s12912-023-01659-1Type 1 DiabetesType 2 DiabetesDiabetes in pregnancySelf-managementQualitative researchQuantitative research |
| spellingShingle | Katelyn Sushko Patricia Strachan Michelle Butt Kara Nerenberg Diana Sherifali Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study BMC Nursing Type 1 Diabetes Type 2 Diabetes Diabetes in pregnancy Self-management Qualitative research Quantitative research |
| title | Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study |
| title_full | Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study |
| title_fullStr | Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study |
| title_full_unstemmed | Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study |
| title_short | Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study |
| title_sort | supporting self management in women with pre existing diabetes in pregnancy a mixed methods sequential comparative case study |
| topic | Type 1 Diabetes Type 2 Diabetes Diabetes in pregnancy Self-management Qualitative research Quantitative research |
| url | https://doi.org/10.1186/s12912-023-01659-1 |
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