| ObjectiveThe purpose of this study is to construct an intervention program for the dietary management of gestational diabetes mellitus patients by combining the health behavior process orientation theory and the nudge strategy,and to investigate the feasibility and intervention effects of the intervention program,so as to improve patients’ knowledge of gestational diabetes mellitus,and dietary compliance,improve blood glucose levels and pregnancy outcomes,and enable them to further achieve healthy dietary management.To provide a reference basis for further healthy diet management.Methods1.Construction of an intervention program for dietary management of gestational diabetes mellitus patients: The literature on dietary management of gestational diabetes mellitus was systematically searched,and the best evidence was refined to form the evidence-based basis for the intervention program.After group discussion,the first draft of the intervention plan for dietary management of gestational diabetic patients combining HAPA theory and boosting strategy was constructed;16 experts were selected to conduct two rounds of Delphi expert consultation on the first draft of the intervention plan,and 5gestational diabetic patients were selected for pre-experimentation to further optimize and revise the intervention plan,and finally the final draft of the intervention plan for dietary management of gestational diabetic patients was formed.2.Application of the dietary management intervention program for gestational diabetic patients: 96 gestational diabetic patients attending the obstetrics outpatient clinic of a tertiary hospital in Qingdao from May 21 st 2022 to Augst 31 st 2022 were selected as study subjects.The patients who went to gynecology and obstetrics clinics in two different hospitals were included in two different groups(48 cases with Shinan Hospital Control Group,48 cases Laoshan Hospital Intervention Group).Patients in the control group received 12 weeks of routine obstetric care and dietary management instructions;patients in the intervention group received a 12-week dietary management intervention program combining health behavior process orientation theory and nudge strategies.Glucose indexes and pregnancy outcomes were collected before and after the end of the intervention,Before the intervention,intervention Week 5 and intervention Week 12,scores of dietary adherence scale,and scores of gestational diabetes knowledge questionnaire were collected.The data were analyzed using SPSS26.0 software to compare the knowledge of gestational diabetes,dietary compliance,glucose control level and pregnancy outcome between the two groups.Results1.Construction of dietary management intervention programs for patients with gestational diabetes: the literature search finally included 11 papers,including 5 guidelines,4systematic reviews,1 evidence summary,and 1 expert consensus,and obtained 15 relevant pieces of evidence on 4 topics of nutritional assessment,dietary meal guidance,nutritional supplementation,and health education.The positive coefficients were 84% and 100%,and the proportion of experts who provide opinions is relatively high;The authority coefficients(Cr)of two rounds of correspondence with experts are 0.804 and 0.886;The Kendall’s W for two rounds were 0.226 and 0.261(P<0.05).Adjusted the programs based on patient feedback,and the final draft of the intervention protocol was finally formed.including 3 first level items,9 second level items,and 25 third level items.2.Application of the intervention program for dietary management of gestational diabetes mellitus patients: A total of 96 patients were participate in the study.Due to patient loss of follow-up,finally,44 patients in the intervention group and 46 patients in the control group completed the study,and the baseline data of the two groups were balanced and comparable.(1)Blood glucose level: after the intervention,fasting plasma glucose(FPG),1-hour postprandial plasma glucose(1h PG)and 2-hour postprandial plasma glucose(2h PG)of patients in the intervention group were lower than those in the control group,the difference is statistically significant(P<0.05).(2)Pregnancy outcomes: the overall incidence of cesarean delivery,gestational hypertension,postpartum hemorrhage,macrosomia,and neonatal hypoglycemia in the intervention group was slightly lower than that in the control group after the intervention,and the difference was not statistically significant(P>0.05).(3)Dietary compliance: intervention Week 5,intervention Week 12,the scores of patients in the intervention group were higher than those in the control group(P<0.05).(4)Knowledge mastery of gestational diabetes: intervention Week 5,intervention Week12,the scores of gestational diabetes knowledge questionnaire were significantly higher in the intervention group than in the control group(P<0.05)..Conclusion1.The intervention program for dietary management of GDM patients combined with HAPA theory and nudge strategy has a reliable evidence-based basis,a high expert authority,consensus of opinions,and a certain scientific and feasibility of the intervention program.2.The diet management intervention program combining the health behavior process orientation theory and the nudge strategy can promote the diet management behavior of pregnant diabetes patients,improve the blood sugar level of patients,reduce the incidence of adverse pregnancy outcomes to a certain extent,and improve the patients’ diet compliance,and knowledge of pregnancy diabetes. |
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