Path Analysis of Factors Determinants of Self Management behaviors in Women with Gestational Diabetes: Using Precede Model

Introduction: Gestational diabetes as a main metabolic disorder in pregnancy has had an increasing trend in recent years. A various prevalence has been reported in different countries, varying from 4% to 11%. This disorder is accompanied by various complications in the mother, baby. Self-management interventions for controlling blood sugar and reducing the cost of care and improving the quality of life in affected patients indicate the effectiveness of such interventions.Study Design: The present study was cross sectional study (Descriptive- Analytic)Methods:The research population was 329 women with gestational diabetes mellitus who referred to health centers of Qom in order to receive pregnancy care services in 2018. In order to perform a sampling, a list of all clinics in Qom was prepared. Then, by referring to the clinic and obtaining a list of patients, women with Gestational diabetes were selected by using convenience sampling method. For data gathering: the multi sectional instrument was used. It was compromised the demographic characteristics, Knowledge, attitude, self-efficacy, social support, distress, self-management and QoL questionnaires. All the questionnaires were tested regarding validity and reliability.Results: In total 329 pregnant women diabetes were studied. The mean age of participants were 30.93± 5.42 ,.97.9 % were married , the most of subjects had diploma and householder, 37.7 % were overweight and 34.4 % were obsess. there was significant correlation between self-management and PRECEDE Model constructs, Knowledge (r=0.848), attitude (r=0.133), Self-efficacy (r=0.79), Social Support (r= 0.173) and enabling factors(r=0.353), furthermore there was the inverse and significant correlation between the self-management and pregnancy distress (r= -0.875 ). The final path model fit well (CFI = 0.96; RMSEA = .000, RMR=70.84). The results showed that all the constructs of PRECEDE model had the direct effect on self-management in patients with gestational diabetes.the Self efficacy was the strongest predictors for self management in patients with gestational diabetes (β= 0.87), and social support (β= 0.80) was the second one.Discussion:Achieving self-management of diabetes is fundamental elements of positive health outcomes. Self-efficacy as feeling of confidence in one’s ability is essential to self-management. Along with due to the World Health Organization’s conceptual framework of social factors affecting health, social support is one of the several factors which is affect health affect.Conclusion:The current study showed that Self efficacy and Social support were the key factors in enhancing self-management behaviors in women with gestational diabetes.

Keywords:

Self-Management , Gestational Diabetes , PRECEDE Model