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Table 5 Enablers and barriers for women with GDM understanding what effects their CBG concentrations

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’s understanding of what affects her CBG concentrations
- understanding the difference between carbohydrates, proteins, and fats
- ability to read and comprehend food labels
- able to understand how physical activity or inactivity affects their CBG concentrations
- lack of understanding which foods and exercises raise the CBG concentrations
- not knowing how to read food labels
- knowing how to increase insulin to eat favourite sweets
Belief about consequences
Refers to a woman’s expectations about what affects her CBG concentration
- eating the same food every day for optimal glycaemic control
- using commercially available, pre-assembled ready for cooking, health food bags for optimal glycaemic control
- hearing other women’s stories encourages anticipated regret
- regular activities easy to incorporate into daily life and ensures healthy baby
- belief only medication controls CBG concentrations
- belief that exercises have no effect on CBG concentrations
- belief that physical activity can cause pre-term labour
Environmental context and resources
Refers to a woman’s access to food, exercise equipment and health professionals
- access to dietitian and group sessions
- food diary and discussion
- food costs are less (no fast foods)
- vegetable garden
- recipes on social media
- identifying food in pantry which are suitable with stickers
- being organised
- appropriate food available when not at home
- access to exercise equipment (home bicycle, tread mill)
- family and children creating motivating resources
- dietetic service unavailable
- transport and time issues
- not documenting a food diary or not knowing about it
- health professionals do not discuss content of food diary
- food is more expensive (fruit, special bread)
- no ethnic food options included
- unavailable professional assessment for exercise/physical activities
- easy access to sugary food and drinks
Emotions
Refers to a woman’s reaction/feelings to what affects her CBG concentrations
- excited to understand the link between food and exercise and CBG concentrations - stressed about trying hard but not able to achieve optimal CBG concentrations
- feeling hungry most of the time
Behavioural regulation
Refers to a woman’s focus on self-monitoring effective food intake and exercise and planning how to incorporate this into daily life
- self-monitoring with food diary
- developing an activity diary
- calling exercise physical activity
- calling diet food intake, or what to eat
- action plan for physical activities
- creatively incorporating family exercises affecting CBG concentrations
- family and children creating motivating resources together
- dislike of exercises
- medication and food is enough to maintain CBG levels
- stress or excitement increases CBG concentrations, too hard to control
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