| Objective:The purpose of this study is to reduce the incidence of diabetes in high-risk pregnant women with gestational diabetes mellitus.Combined with qualitative and quantitative research results,this study fully analyzes the influencing factors and needs of diabetes-related knowledge,attitude and practice in high-risk pregnant women with gestational diabetes mellitus,so as to guide the construction of personalized intervention programs for high-risk pregnant women.And to evaluate the effects of nursing intervention based on interactive health behavior model on the pregnancy outcome,incidence of gestational diabetes,qualified rate of weight gain,diabetes-related knowledge and practice level and nursing satisfaction of high-risk pregnant women.Methods:This study consists of three parts:Part I: 276 pregnant women with high risk of gestational diabetes who received regular birth check-up in a third-class A hospital in Shanxi Province from May 2021 to September 2021 were selected by convenience sampling method,and the general information questionnaire of pregnant women and the Knowledge and practice questionnaire of pregnant women with high risk of gestational diabetes were used for investigation.To analyze the status quo of knowledge,practice and influencing factors related to diabetes in pregnant women at high risk of gestational diabetes.Part II: Objective sampling method was adopted to select 12 pregnant women with high risk of gestational diabetes and 4 medical staff with low scores of knowledge,belief and practice in the questionnaire survey as interview subjects,to deeply understand the impact of high-risk pregnant women on gestational diabetes awareness,and self-management status and needs.Colaizzi analysis method was used to analyze the data and extract the theme.Part III: From October 2021 to June 2022,130 high-risk pregnant women with gestational diabetes who were documented and regularly examined in the perinatal health clinic of a tertiary hospital in Shanxi Province were selected as the research objects.They were randomly divided into the experimental group and the control group according to the random number table method.The control group was given routine nursing,and the experimental group was given nursing program under the guidance of health behavior interaction mode.Before and after the intervention,pregnancy outcome,the incidence of gestational diabetes,qualified rate of weight gain,diabetes-related knowledge and practice level and nursing satisfaction level were compared between the two groups.To analyze the effect of nursing intervention based on interaction model of health behavior on pregnant women at high risk of gestational diabetes..Results:Part I: Pregnant women at high risk of gestational diabetes mellitus had scores ranging from 8 to 89.In this study,the total score of pregnant women at high risk was(58.70±3.673)points,knowledge(7.54±0.895)points,attitude(32.13±1.548)points and behavior(19.03±2.002)points,which were above the medium level.According to one-way analysis of variance,there were significant differences in the scores of knowledge and behavior questionnaire of pregnant women in education level,spouse occupation,residence type,number of pregnancies,per capita monthly family income and whether they had nutrition outpatient consultation(P < 0.05).Multivariate linear regression analysis showed that the education level of pregnant women,the occupation of spouses and the per capita monthly income of families were the main influencing factors.Part II: organizing and analyzing qualitative interviews,refining the lack of disease cognition(weak risk awareness,poor autonomous learning ability,slow behavior change);Inadequate social support(physical constraints,lack of family care,economic pressures);Pregnant women cope with deficiencies(information expectations,dietary preferences and desires,lack of individualized education);Challenges in providing nutrition advice(poor communication,lack of training,time constraints)4 themes and 12 sub-themes.Part III: In this study,4 cases of embryo stopped development were removed,3cases were not followed up,and 4 cases were not delivered in our hospital.The final effective samples were 119 cases.There were 59 cases in the experimental group and 60 cases in the control group,and there was no significant difference in baseline data(P >0.05).After intervention,the incidence of gestational diabetes and macrosomia in experimental groups was lower than that in control group,and the qualified rate of weight gain was higher than that in control group,the difference was statistically significant(P < 0.05).However,there were no significant differences in the incidence of premature delivery,cesarean section,premature rupture of membranes and neonatal hypoglycemia between the two groups(P > 0.05).Before intervention,there was no significant difference in diabetes related knowledge,practice and nursing satisfaction between the two groups(P > 0.05).After intervention,the level of knowledge and practice and nursing satisfaction of high-risk pregnant women in experimental group were significantly increased compared with control group(P < 0.05)..Conclusion:(1)The knowledge,attitude and practice related to diabetes among high-risk pregnant women in early pregnancy were at a medium level.The results show that education level of the pregnant women,spouse ’s occupation and family per capita monthly income are the main influencing factors.At the same time,in-depth interviews showed that pregnant women ’s lack of disease cognition,insufficient social support,coping defects and the challenges of medical staff providing nutritional advice also need to be solved.(2)Nursing intervention based on the interactive model of health behavior can improve the knowledge and practice level of diabetes in pregnant women at high risk of gestational diabetes,slow down pregnancy weight gain,reduce the incidence of gestational diabetes and macrosomia,and improve nursing satisfaction.However,the effects on premature delivery,cesarean section,premature rupture of membranes and neonatal hypoglycemia need further study. |
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