Feasibility of a Lifestyle Intervention Program for Prevention of Diabetes Among Women With Prior Gestational Diabetes Mellitus (LIVING Study) in South Asia: A Formative Research Study

Abstract

Aim: To refine and contextually adapt a postpartum lifestyle intervention for prevention of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM) in Bangladesh, India, and Sri Lanka.Materials and Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with women with current diagnosis of GDM, and health care professionals involved in their management, to understand relevant local contextual factors for intervention optimization and implementation. This paper describes facilitators and barriers as well as feedback from participants on how to improve the proposed intervention. These factors were grouped and interpreted along the axes of the three main determinants of behavior–capability, opportunity, and motivation. IDIs and FGDs were digitally recorded, transcribed, and translated. Data-driven inductive thematic analysis was undertaken to identify and analyze patterns and themes.Results: Two interrelated themes emerged from the IDIs and FGDs: (i) The lifestyle intervention was acceptable and considered to have the potential to improve the existing model of care for women with GDM; and (ii) Certain barriers such as reduced priority of self-care, and adverse societal influences postpartum need to be addressed for the improvement of GDM care. Based on the feedback, the intervention was optimized by including messages for family members in the content of the intervention, providing options for both text and voice messages as reminders, and finalizing the format of the intervention session delivery.Conclusion: This study highlights the importance of contextual factors in influencing postpartum care and support for women diagnosed with GDM in three South Asian countries. It indicates that although provision of postpartum care is complex, a group lifestyle intervention program is highly acceptable to women with GDM, as well as to health care professionals, at urban hospitals.

Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework

“…Unsafe or unfriendly (e.g. cultural, gender or physical) environments were barriers, especially in Indigenous communities 66,69,71,79,87 . Women were hindered by intimidating or unwelcoming environments ‘without Aboriginal or Torres Strait Islander staff’ 79 and ‘ dogmatic attitudes’ 71 .…”

“…Cultural expectations around food and social gatherings was a barrier to healthy dietary practices: ‘everything revolves around food’ 80 . Women felt that healthy eating went against the norm of family meals: ‘sitting down and eating the same thing at the dinner table’, 95 causing disruptions and tensions and reduced enjoyment of mealtimes 87,95 . Consequently, they felt bound to eat whatever was offered to them 85 : ‘because in our cooking you cannot just say … chicken curry on its own without rice or chapatti…’ 73 …”

“…cultural, gender or physical) environments were barriers, especially in Indigenous communities. 66 , 69 , 71 , 79 , 87 Women were hindered by intimidating or unwelcoming environments ‘without Aboriginal or Torres Strait Islander staff’ 79 and ‘ dogmatic attitudes’. 71 Some were deterred by the presence of ‘strong built people’ 66 in exercise facilities, preferring a ‘private place to exercise away from men’.…”

Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A systematic review update and qualitative synthesis applying the Theoretical Domains Framework

“…59 Consequently, the requirements of the OGTT were incompatible with the women's stage of life: 'I didn't have time to shower, how [do] I get a blood test?'. 44 Women expressed that they were reluctant to leave their young babies in someone else's care, 60 but lack of child-appropriate facilities also impeded screening uptake: 'there are no private rooms to feed the baby in the lab'. 61,62 Lack of time to complete type 2 diabetes screening was exacerbated once women returned to work: 'I couldn't really go to the doctor as much because of my [work] schedule.…”

Effects of a Lifestyle Intervention to Prevent Deterioration in Glycemic Status Among South Asian Women With Recent Gestational Diabetes

“…The LIVING intervention was based on previous approaches that were associated with decreases in body weight 14,15 but was modified through a careful process of formative research in participating countries to be scalable in the context of available resources and patient preferences. 16 This may have resulted in an intervention that was simply inadequate, particularly in terms of the personnel involved, given that staff expertise was identified as an implementation characteristic associated with the greatest postpartum weight decrease in a 2019 systematic review. 24 COVID-19 restrictions also impacted the mode of intervention delivery in our study, with a substantial proportion of face-to-face group sessions modified to remotely -delivered individual sessions.…”