基于COM-B模型妊娠期糖尿病妇女产后自我管理促进与阻碍因素的Meta整合

doi:10.16460/j.issn1008-9969.2024.12.041

摘要/Abstract

摘要： 目的基于能力、机会、动机-行为模型（capability,opportunity,and motivation-behavior,COM-B）,探讨妊娠期糖尿病（gestational diabetes mellitus, GDM）妇女产后自我管理行为的促进与阻碍因素。方法系统检索中国知网、万方、维普、SinoMed、Embase、PubMed、Web of Science、Ovid等数据库,年限为建库至2023年2月。采用JBI循证卫生保健中心质性研究质量评价标准进行文献评价,应用Meta整合的方法进行整合。结果共纳入17篇文献,提炼出17个结果,归纳形成6个类别,得到3个整合结果：影响GDM产后自我管理行为的能力层面、影响GDM产后自我管理行为的机会层面、影响GDM产后自我管行为理的动机层面。结论应充分宣教产后自我管理知识;倡导医院多学科合作并与家庭、社区及社会力量联动,关注GDM妇女产后压力与不良情绪,完善随访模式,提高GDM妇女产后自我管理水平。

关键词: 妊娠期糖尿病, 产后, 自我管理, 质性研究, Meta整合

Abstract: Objective To explore the promoting and hindering factors of postpartum self-management behavior in women with gestational diabetes mellitus (GDM) based on COM-B model. Methods We searched databases of CNKI, WanFang, VIP, SinoMed Embase, PubMed, Web of science, and Ovid, with the retrieval period spanning from the inception to February, 2023. The quality evaluation criteria of JBI evidence-based health care center were used for literature evaluation, and meta-synthesis was applied for literature integration. Results Totally 17 pieces of literature were included, and 17 results were extracted, which were summarized into 6 categories. Three integration results were obtained: the ability level influencing postpartum self-management behavior of GDM, the opportunity level influencing postpartum self-management behavior of GDM, and the motivation level affecting post-partum self-management behavior of GDM. Conclusion It is important to fully educate postpartum women with GDM about self-management knowledge. Advocacy for multidisciplinary collaboration in hospitals, along with collaboration with families, communities, and social support networks should be promoted. Attention should be given to postpartum stress and negative emotions experienced by women with GDM. Follow-up models should be improved to enhance the postpartum self-management of women with GDM.

Key words: gestational diabetes mellitus, postpartum, self-management, qualitative studies, Meta-synthesis

中图分类号:

R473.71

. 基于COM-B模型妊娠期糖尿病妇女产后自我管理促进与阻碍因素的Meta整合[J]. 护理学报, 2024, 31(12): 41-46.

ZOU Lan-li, HU Rong, LI Min-xiang, GUO Hong-hua. Promoting and hindering factors of postpartum self-management in women with gestational diabetes mellitus based on COM-B model: a Meta-synthesis[J]. Journal of Nursing, 2024, 31(12): 41-46.

参考文献

[1] International Diabetes Federation.IDF diabetes atlas 10th edition[EB/OL].[2022-09-04].https://diabetesatlas.org/atlas/tenth-edition/.
[2] Gao C, Sun X, Lu L, et al.Prevalence of gestational diabetes mellitus in mainland China: a systematic review and Meta-analysis[J]. J Diabetes Investig, 2019, 10(1):154-162. DOI:10.1111/jdi.12854.
[3] Song C, Lyu Y, Li C, et al.Long-term risk of diabetes in women at varying durations after gestational diabetes: a systematic review and Meta-analysis with more than 2 million women[J]. Obes Rev, 2018, 19(3):421-429. DOI:10.1111/obr.12645.
[4] American Diabetes Association.Management of diabetes in pregnancy, standards of medical care in diabetes-2021[J]. Diabetes Care, 2021, 44(Supplement_1): S73-S84. DOI:10.2337/dc21-S014.
[5] Li N, Yang Y, Cui D, et al.Effects of lifestyle intervention on long-term risk of diabetes in women with prior gestational diabetes: a systematic review and Meta-analysis of randomized controlled trials[J]. Obesity Reviews, 2021, 22(1):e13122. DOI:10.1111/obr.13122.
[6] 胡荣,郭洪花,李彤,等.妊娠期糖尿病女性产后自我管理现状及影响因素分析[J].现代预防医学,2022,49(13):2360-2365. DOI:10.20043/j.cnki.MPM.202110571.
[7] 余雅琪,余艮珍,熊晓菊,等.行为改变轮理论概述及临床护理应用进展[J].护理学报,2023,30(4):38-43. DOI:10.16460/j.issn1008-9969.2023.04.038.
[8] Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions[J]. Implement Sci, 2011(6):42. DOI:10.1186/1748-5908-6-42.
[9] 胡雁,郝玉芳.循证护理学[M].北京:人民卫生出版社,2018:157-174.
[10] Hjelm K, Bard K, Berntorp K, et al.Beliefs about health and illness postpartum in women born in Sweden and the Middle East[J]. Midwifery, 2009, 25(5): 564-575. DOI:10.1016/j.midw.2007.08.007.
[11] Nicklas JM, Zera CA, Seely EW, et al.Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes[J]. BMC pregnancy childbirth, 2011(11):23. DOI:10.1186/1471-2393-11-23.
[12] Lie MLS, Hayes L, Lewis-Barned NJ, et al.Preventing type 2 diabetes after gestational diabetes: women’s experiences and implications for diabetes prevention interventions[J]. Diabet Med, 2013, 30(8):986-993.DOI:10.1111/dme.12206.
[13] Jagiello KP, Azulay Chertok IR.Women’s experiences with early breastfeeding after gestational diabetes[J]. J Obstet Gynecol Neonatal Nurs, 2015,44(4):500-509. DOI:10.1111/1552-6909.12658.
[14] Zulfiqar T, Lithander FE, Banwell C, et al.Barriers to a healthy lifestyle post gestational-diabetes: an Australian qualitative study[J]. Women Birth, 2017, 30(4):319-324. DOI:10.1016/j.wombi.2016.12.003.
[15] 刘竹韵,高玲玲,赵娟娟,等.妊娠期糖尿病产妇产后血糖复查影响因素的质性研究[J].齐鲁护理杂志, 2018,24(23):70-72.
[16] Parsons J, Sparrow K, Ismail K, et al.A qualitative study exploring women’s health behaviours after a pregnancy with gestational diabetes to inform the development of a diabetes prevention strategy[J]. Diabet Med, 2019, 36(2): 203-213. DOI:10.1111/dme.13794.
[17] Sundarapperuma TD, Wijesinghe CJ, Hettiarachchi P, et al.Perceptions on diet and dietary modifications during postpartum period aiming at attenuating progression of GDM to DM: a qualitative study of mothers and health care workers[J]. J Diabetes Res, 2018(2018):6459364. DOI:10.1155/2018/6459364.
[18] Muhwava LS, Murphy K, Zarowsky C, et al.Experiences of lifestyle change among women with gestational diabetes mellitus (GDM): a behavioural diagnosis using the COM-B model in a low-income setting[J]. PloS One, 2019, 14(11): e0225431. DOI:10.1371/journal.pone.0225431.
[19] Krompa K, Sebbah S, Baudry C, et al.Postpartum lifestyle modifications for women with gestational diabetes: a qualitative study[J]. Eur J Obstet Gynecol Reprod Biol, 2020(252):105-111. DOI:10.1016/j.ejogrb.2020.04.060.
[20] 蒋维连,李赛花,阳美珍,等.妊娠期糖尿病产妇产后健康促进行为驱动力的质性研究[J].中国实用护理杂志,2020,36(26):2034-2039.
[21] Sunny SH, Malhotra R, Ang SB, et al.Facilitators and barriers to post-partum diabetes screening among mothers with a history of gestational diabetes mellitus-a qualitative study from singapore[J]. Front Endocrinol (Lausanne), 2020(11):602. DOI:10.3389/fendo.2020.00602.
[22] 赵淑冉,李凯,孔燕,等.妊娠期糖尿病产妇早期母乳喂养体验的质性研究[J]. 中西医结合护理(中英文),2020,6(10):112-117.
[23] Teh K, Quek I P, Tang WE.Postpartum dietary and physical activity-related beliefs and behaviors among women with recent gestational diabetes mellitus: a qualitative study from Singapore[J]. BMC Pregnancy Childbirth, 2021, 21(1):612. DOI:10.1186/s12884-021-04089-6.
[24] 赵淑冉,孔燕,李凯,等.妊娠期糖尿病产妇产褥期自我管理认知及体验的质性研究[J].全科护理,2021,19(24):3418-3421.
[25] Dennison RA, Griffin SJ, Usher-Smith JA, et al."Post-GDM support would be really good for mothers": a qualitative interview study exploring how to support a healthy diet and physical activity after gestational diabetes[J].PLoS One, 2022,17(1):e0262852. DOI:10.1371/journal.pone.0262852.
[26] Qian P, Duan L, Lin R, et al.How breastfeeding behavior develops in women with gestational diabetes mellitus: a qualitative study based on health belief model in China[J]. Front Endocrinol (Lausanne),2022(13):955484.DOI:10.3389/fendo.2022.955484.
[27] 中华医学会妇产科学分会产科学组,中华医学会围产医学分会,中国妇幼保健协会妊娠合并糖尿病专业委员会.妊娠期高血糖诊治指南(2022)[第二部分][J]. 中华妇产科杂志,2022,57(2):81-90.DOI:10.3760/cma.j.cn112141-20210917-00529.
[28] 刘姝. 基于知信行理论的高血压健康行为研究[D].济南: 山东大学,2020.
[29] Azami M, Badfar G, Soleymani A, et al.The association between gestational diabetes and postpartum depression: a systematic review and Meta-analysis[J]. Diabetes Res Clin Pract, 2019(149):147-155. DOI:10.1016/j.diabres.2019.01.034.
[30] Shang J, Dolikun N, Tao X, et al.The effectiveness of postpartum interventions aimed at improving women’s mental health after medical complications of pregnancy: a systematic review and Meta-analysis[J]. BMC Pregnancy Childbirth, 2022,22(1):809. DOI:10.1186/s12884-022-05084-1.
[31] 陆逸凡. “80后”二孩母亲抚育压力纾解的小组工作介入研究[D].南昌:江西财经大学,2022.
[32] 胡荣. 妊娠期糖尿病妇女产后一年内自我管理的混合性研究[D].海口:海南医学院, 2022.
[33] 黄岳青,王黎,杨菁华,等.“五师共管”模式在妊娠期糖尿病患者中的应用与效果研究[J]. 中国慢性病预防与控制,2020, 28(6):413-417.DOI:10.16386/j.cjpccd.issn.1004-6194.2020.06.003.

相关文章 15

[1]	李疆伟, 王树君, 李长仔, 胡宝山, 焦桂梅, 张卫红. 基于压力应对理论的护理干预对结直肠癌术后永久性肠造口患者心理压力、负性情绪及自我管理的影响[J]. 护理学报, 2025, 32(4): 64-69.
[2]	吴超瑜, 刘尚昆. 麻醉恢复室护士危机管理能力的质性研究[J]. 护理学报, 2025, 32(3): 17-21.
[3]	谭雯渲, 张容, 张立力, 王玮, 邵艳红, 方庆虹, 朱瑾. 心脏移植患者手术决策困境的现象学研究[J]. 护理学报, 2025, 32(3): 69-73.
[4]	杨蓓, 叶红芳, 张宁, 相卢伟, 路诗雨. 老年2型糖尿病患者体力活动现状及影响因素研究[J]. 护理学报, 2025, 32(2): 7-12.
[5]	曹敏, 张培莉, 侯晓雅, 高超越, 郭林芳, 李滢. ABC-X模型下结直肠癌化疗患者照顾者营养照护体验的质性研究[J]. 护理学报, 2025, 32(2): 13-18.
[6]	孙娟, 李亚莉, 马安娜, 王华, 张会敏. 护理研究生对社区护理实践思政教学体验的质性研究[J]. 护理学报, 2025, 32(1): 19-23.
[7]	王语, 赵慧杰, 肖梦伟, 范硕宁, 孙佳丽, 王珂心, 苏炫, 杨滢瑞. 糖尿病视网膜病变患者硅油填充期间疾病体验与应对的质性研究[J]. 护理学报, 2025, 32(1): 68-72.
[8]	叶香, 黎楷, 黄敏, 张倩, 李际敏, 刘荣珍, 孟敏, 朱少玉, 谢翠华. 对成年2型糖尿病患者基于移动APP+家属共管血糖的研究[J]. 护理学报, 2024, 31(9): 60-65.
[9]	冯春玲, 胡夏晴, 徐琳, 蔡鑫健, 徐琴鸿. 基于社会生态系统理论的电话指导公众实施心肺复苏行为动机及需求的质性研究[J]. 护理学报, 2024, 31(9): 66-71.
[10]	曹依丽, 王玲, 王灿, 陈燕华, 秦虹云. 精神分裂症住院患者家属资源取向的质性研究[J]. 护理学报, 2024, 31(8): 74-78.
[11]	马瑞瑞, 范晓莉, 徐姝娟, 张伟, 陈婷, 谈飞飞. 护士参与终末期患者临终决策体验的质性研究[J]. 护理学报, 2024, 31(7): 6-11.
[12]	龙瑶, 卢春凤, 冯志仙. 临床护士对横向领导者特质感知的质性研究[J]. 护理学报, 2024, 31(7): 27-31.
[13]	张颖, 车晓艳, 万婠, 秦雪, 张恩思, 崇武, 郑淑娟. 我国性治疗护士工作范畴和核心能力的质性研究[J]. 护理学报, 2024, 31(7): 68-72.
[14]	李爱群, 李利花, 王芳, 蒋源元, 蔡益民. 慢性病资源利用在冠心病PCI术后患者自我超越与自我管理行为间的中介效应[J]. 护理学报, 2024, 31(6): 13-17.
[15]	张露心, 焦延超, 文稀, 田利, 王婷, 田凤美, 李惠玲. 护理本科生在“慕课西行”同步课堂学习体验的质性研究[J]. 护理学报, 2024, 31(6): 30-34.

Metrics

Viewed

Full text

Abstract

Cited

Shared