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Table 4 Enablers and Barriers for women with GDM to monitor their CBG concentration

From: Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control – a qualitative study using the theoretical domains framework

Domains and Definitions Enablers Barriers
Knowledge
Refers to a woman knowing her glycaemic targets and procedural knowledge of how to test accurately
Glycaemic targets on:
- sticker on the recording booklet
- post-it notes on work computer
- mobile phone notebook
- visual step-by-step pamphlet
- list how to perform CBG testing
- different glycaemic targets to previous pregnancy
- unable to read the ‘how to do it list’ in first language
- no visual images of how to perform CBG testing
Skills
Refers to a woman’s ability to perform the CBG testing, working the glucometer correctly and documenting results and completing a food diary
Techniques for CBG flow:
- alternating warm fingers & hands
- not using soap
- pricking on side of finger pads
Food diary documenting
- no apps available for recording CBG results
- food diary writing space too small
- food diary not in first language
- not knowing how to go back on glucometer
Beliefs about capabilities
Refers to a woman’s beliefs about her capability to perform, control and monitor her CBG concentration
- can-do attitude
- perceived control of GDM
- in control of CBG testing
- capable of interpreting CBG results and adjusting food intake
- can’t-do it attitude, too difficult
- belief that it is not necessary to test regularly
- perceived lack of control
Beliefs about consequences
Refers to a woman’s expectations about optimal CBG control
Anticipated positive consequences:
- adhering to glycaemic targets will control GDM
- secure healthy future for the baby
- baby will be a normal size
- belief future health will be better
- belief family health will be better
Anticipated negative consequences:
- fingerpicks damage finger pads, too difficult to play the piano or guitar
- testing and controlling CBG did not work last time
Memory, attention, and decision process
Refers to a woman’s ability to remember when and decide where, to perform CBG testing
- mobile phone alarm reminder
- setting timer on microwave
- dedicated bag ready access to glucose testing equipment
- able to decide where to do CBG testing
- forgetful
- no reminder plan in place
- unable to think outside the square
- concern for doing CBG testing outside the home
Environmental context and resources
Refers to a woman’s access to equipment and to a health professional when unsure about results
- free resources for CBG testing
- phone access to diabetes midwife
- booklet fits into glucometer bag
- pharmacist teaching CBG testing
- group teaching sessions for learning CBG testing
- costs of resources needed for CBG testing
- no phone access to diabetes health professionals
- booklet too big for glucometer bag
- health professional not believing results
Social influences
Refers to a woman’s social interactions for CBG monitoring and maintaining optimal CBG control
- supportive and engaged social interactions
- do it wherever, no concern
- work colleagues remind them
- provide healthy food at work
- social pressure and loss of choice
- worried about performing CBG testing in public, being judged
- being told to leave restaurant for CBG testing
- work demands, meetings, unable to stop work for CBG testing
Emotion
Refers to a woman’s reaction/feelings to monitoring and maintaining her CBG concentrations
- privilege to have been diagnosed
- enabled learning a new skill that directed positive lifestyle changes
- fun doing everyone’s CBG level
- not as painful as anticipated
- anxiety, scared, needle phobia
- stress to remember doing CBG testing,
- feeling guilty when forgotten
- focus on numbers not the woman
- not enjoying reading
Behavioural regulation
Refers to a woman’s focus on self-monitoring effectively and planning how to incorporate this into her daily life
- action plan to monitor CBG
- motivated by the baby to monitor CBG regularly
- documenting honestly
- sharing on social media glycaemic target achievements