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