| Objective:Based on the theoretical framework of the PRECEDE-PROCEED Model,the thesis investigated the status of disease knowledge,self-management behavior and quality of life of pregnant women with gestational diabetes mellitus(GDM)and analyzed the influencing factors of self-management behavior.According to the influencing factors,a health intervention program was developed,and the intervention results were evaluated and analyzed in order to promote the self-management level of pregnant women with GDM and improve their quality of life and pregnancy outcomes.Methods:Based on the theoretical framework of the PRECEDE-PROCEED Model,this study was divided into two parts.Part I:In the evaluation and diagnosis stage,by using general data questionnaire,GDM knowledge questionnaire,Self-management Scale for Chinese Gestational Diabetes Mellitus(SMSGDM),the Medical Outcomes Study Short Form-36(SF-36),a cross-sectional survey was conducted on 218 pregnant women with GDM in the obstetrical outpatient department of two tertiary general hospitals in Nanchong City,who were in compliance with the admission criteria,from May 2020 to October 2020.The survey aimed at understanding the disease knowledge,self-management behavior and quality of life of pregnant women,and analyzing the influencing factors of self-management behavior.(2)Part II:In the health intervention stage,a clinical randomized controlled study was conducted.96 pregnant women with GDM,who visited the obstetrical outpatient department of the tertiary general hospital in Nanchong City and chose delivery in the hospital,from February 2021 to July 2021,were selected as the research subjects.They were randomly divided into the intervention group and the control group by SPSS 26.0 random number generator,with 48 participants in each group.The routine health guidance was offered to the control group while for the intervention group,besides the routine health guidance,PRECEDE-PROCEED-Model-based health intervention was also provided.The total weight gain,fasting and 2h postprandial blood glucose,scores of GDM knowledge questionnaire,SMSGDM and SF-36 of pregnant women in the two groups were observed before the intervention,4 weeks and 12 weeks after the intervention.Methods of delivery,Apgar score,premature delivery,macrosomia,pregnancy-induced hypertension and hydramnios were recorded within 1 week after delivery.(3)SPSS 26.0 software was used for data processing and statistical analysis,which included descriptive statistical analysis,independent sample t-test,Chi-square test,Fisher’s exact probability test,one-way ANOVA,multiple stepwise regression analysis,Pearson correlation analysis and repeated measure ANOVA,etc.Results:(1)The results of cross-sectional survey showed that the general mean score of GDM knowledge of 218 pregnant women with GDM was 9.56±3.09.The general mean standard score of self-management behavior was 62.71 ±5.56,which was at the medium level.The two dimensions,whose scores were lower than the standard score,were resource utilization 58.07±12.27 and blood glucose management 55.23±11.62.The general mean standard score of quality of life was 46.32±7.81,which was at the middle level.The three dimensions,whose scores were lower than the standard score,were physiological function 26.76±14.94,vitality 41.68±12.69 and general health status 46.17±8.44.(2)The results of the univariate analysis showed that pregnancy BMI,education level,living conditions,per capita monthly income of the family,types of medical expenses paid,family history of diabetes,GDM knowledge training,GDM knowledge acquisition channel,peer support during pregnancy,hospital telephone follow-up during pregnancy,GDM knowledge score had an influence on the self-management behavior of pregnant women with GDM(P<0.05).The multiple stepwise regression analysis results indicated that peer support during pregnancy,per capita monthly income of the family,GDM knowledge score,GDM knowledge acquisition channel,education leveland GDM knowledge training were the main influencing factors of the self-management behavior of pregnant women with GDM(R2=0.445).Pearson correlation analysis showed a positive correlation between self-management and quality of life in pregnant women with GDM(r=0.868,P<0.01).(3)Before the intervention,there were no significant differences in general information,scores of GDM knowledge,SMSGDM scale and SF-36 scale,total weight gain during pregnancy,fasting and 2h postprandial blood glucose between the two groups(P>0.05).(4)After the intervention,the comparison of scores of GDM knowledge,SMSGDM scale and SF-36 scale between the two groups was shown as following.There were differences in scores of GDM knowledge,SMSGDM scale and SF-36 scale between the two groups at different time points(P<0.01).The scores of GDM knowledge,SMSGDM scale and SF-36 scale of the intervention group were significantly higher than those of the control group(P<0.05).The scores of the three aspects in the two groups were on the rise throughout the study,but the increase was more significant in the intervention group.As time went on,the differences of scores of GDM knowledge,SMSGDM scale and SF-36 scale between the two groups continued to enlarge,and there was an interaction between intervention ×time(P<0.01).After 4 and 12 weeks of intervention,the scores of GDM knowledge,SMSGDM scale and SF-36 scale in the intervention group were significantly higher than those of the control group(P<0.01).(5)After the intervention,the comparison of total gestational weight gain,fasting and 2h postprandial blood glucose between the two groups was shown as following.There were significant differences in total gestational weight gain,fasting and 2h postprandial blood glucose between the two groups at different time points(P<0.01).The total gestational weight gain,fasting and 2h postprandial blood glucose in the intervention group were significantly lower than those in the control group(P<0.05).The total gestational weight gain in the two groups was on the rise throughout the study,but the increase was more significant in the control group;fasting and 2h postprandial blood glucose showed a downtrend throughout the study,but the decreasing was more significant in the intervention group.As time went on,the differences in total gestational weight gain,fasting and 2h postprandial blood glucose between the two groups continued to increase,and there was an interaction between intervention × time(P<0.01).After 4 and 12 weeks of intervention,the total gestational weight gain,fasting and 2h postprandial blood glucose in the intervention group were significantly lower than those in the control group(P<0.01);the standard rates of total gestational weight gain,fasting and 2h postprandial blood glucose levelcontrol in the intervention group were significantly higher than those in the control group(P<0.01).(6)The comparison in the pregnancy outcomes showed that the incidence of caesarean section and macrosomia in pregnant women with GDM in the intervention group was lower than that in the control group,and the difference was statistically significant(P<0.05).The incidence of abnormal Apgar score,premature delivery,pregnancy-induced hypertension and hydramnios in the intervention group was lower than that in the control group,but the difference was not statistically significant(P>0.05).Conclusion:(1)The self-management behavior and quality of life of pregnant women with GDM was at the medium level,and the peer support during pregnancy,per capita monthly income of the family,GDM knowledge score,GDM knowledge acquisition channel,education leveland GDM knowledge training were the main influencing factors of the self-management behavior of pregnant women with GDM.(2)Health intervention based on PRECEDE-PROCEED Model can effectively improve the self-management level and quality of life of pregnant women with GDM,control the total weight gain and blood glucose level during pregnancy,reduce the incidence of Caesarean section and macrocosm,and promote maternal and infant health. |
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