Feasibility of a Lifestyle Intervention Program for Prevention of Diabetes Among Women With Prior Gestational Diabetes Mellitus (LIVING Study) in South Asia: A Formative Research Study

Abha Tewari, Devarsetty Praveen, Pavitra Madhira, Lakshmi K Josyula, Rohina Joshi, Suresh B Kokku, Vandana Garg, Ishita Rawal, Kanika Chopra, Nantu Chakma, Sabrina Ahmed, Arunasalam Pathmeswaran, Pavithra Godamunne, A S Lata, Rakesh Sahay, Tulsi Patel, Yashdeep Gupta, Nikhil Tandon, Aliya Naheed, Anushka Patel, Deksha Kapoor, Abha Tewari, Devarsetty Praveen, Pavitra Madhira, Lakshmi K Josyula, Rohina Joshi, Suresh B Kokku, Vandana Garg, Ishita Rawal, Kanika Chopra, Nantu Chakma, Sabrina Ahmed, Arunasalam Pathmeswaran, Pavithra Godamunne, A S Lata, Rakesh Sahay, Tulsi Patel, Yashdeep Gupta, Nikhil Tandon, Aliya Naheed, Anushka Patel, Deksha Kapoor

Abstract

Aim: To refine and contextually adapt a postpartum lifestyle intervention for prevention of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM) in Bangladesh, India, and Sri Lanka. Materials and Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with women with current diagnosis of GDM, and health care professionals involved in their management, to understand relevant local contextual factors for intervention optimization and implementation. This paper describes facilitators and barriers as well as feedback from participants on how to improve the proposed intervention. These factors were grouped and interpreted along the axes of the three main determinants of behavior-capability, opportunity, and motivation. IDIs and FGDs were digitally recorded, transcribed, and translated. Data-driven inductive thematic analysis was undertaken to identify and analyze patterns and themes. Results: Two interrelated themes emerged from the IDIs and FGDs: (i) The lifestyle intervention was acceptable and considered to have the potential to improve the existing model of care for women with GDM; and (ii) Certain barriers such as reduced priority of self-care, and adverse societal influences postpartum need to be addressed for the improvement of GDM care. Based on the feedback, the intervention was optimized by including messages for family members in the content of the intervention, providing options for both text and voice messages as reminders, and finalizing the format of the intervention session delivery. Conclusion: This study highlights the importance of contextual factors in influencing postpartum care and support for women diagnosed with GDM in three South Asian countries. It indicates that although provision of postpartum care is complex, a group lifestyle intervention program is highly acceptable to women with GDM, as well as to health care professionals, at urban hospitals.

Keywords: South Asia; barriers and facilitators; gestational diabetes; health worker; lifestyle intervention; prevention of type 2 diabetes mellitus.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2020 Tewari, Praveen, Madhira, Josyula, Joshi, Kokku, Garg, Rawal, Chopra, Chakma, Ahmed, Pathmeswaran, Godamunne, Lata, Sahay, Patel, Gupta, Tandon, Naheed, Patel and Kapoor.

Figures

Figure 1
Figure 1
Applying the constructs of the COM-B behavior change framework to the themes generated in the analysis.

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