Self‑care Education Needs in Gestational Diabetes Tailored to the Iranian Culture: A Qualitative Content Analysis

Mitra Kolivand, Afsaneh Keramat, MehrAli Rahimi, Zahra Motaghi, Mohammad Shariati, MohammadHassan Emamian


Background: Gestational diabetes is one of the most common health problems in pregnancy that requires participation through self‑care to reduce the maternal and neonatal complications. The present study aimed to determine the needs of women as an essential first step to formulate a self‑care guide fitting the Iranian culture.

Materials and Methods: The present qualitative study was conducted through interviews with 13 diabetic pregnant women and 10 care providers using semi‑structured questionnaires in several cities of Iran in 2016. Further, the data analysis was performed using conventional content analysis. In addition, purposive sampling was performed at the diabetes clinic of Kermanshah University of Medical Sciences, Imam Reza Hospital, and health centers across Kermanshah, Shahroud, and Tehran.

Results: In the present qualitative content analysis study, four themes were identified: awareness and ability (knowing diabetes, mothers training and empowerment, continuity and quality, information resources), lifestyle (healthy diet, physical activity), mental health (counseling, interaction, spirituality, and religion), and supportive family (the husband’s unique role, the psychological atmosphere at home).

Conclusions: The present study highlighted main aspects of self‑care educational/supportive needs, specifically in the domains of lifestyle, awareness and capability, mental health, and family. The results of our analysis highlighted the needs that can be useful for developing comprehensive self‑care educational programs, with a higher focus on physical activity, mental health, the role of the family, and the use of religious interests.


Gestational diabetes, high-risk pregnancy, qualitative study, pregnancy, self-care

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Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, et al. Williams obstetrics. 24th ed. USA: McGraw Hill education; 2016. p. 1125‑45.

Centers for Disease Control and Prevention. National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. Available from: https:// [Last accessed on 2017 Sep 7].

Coustan DR. Gestational diabetes mellitus: Glycemic control and maternal prognosis. Topic 6790 Version 69.0. 2016. Available from:‑diabetes‑ mellitus‑glycemic‑control‑and‑maternal‑prognosis?source=see_ link. [Last accessed on 2017 Sep 29].

International Diabetes Federation. IDF Diabetes atlas. 7th ed. 2015. Available from: [Last accessed on 2016 Dec 22].

Crawford K. Review of 2017 Diabetes Standards of Care. Nurs Clin North Am 2017;52:621‑63.

Webber D, Guo ZH, Mann S. Self‑care in health: We can define it, but should we also measure it? Self Care 2013;4:101‑6. Available from:‑care/. [Last accessed on 22 Nov 2017].

Devsam BU, Bogossian FE, Peacock AS. An interpretive review of women’s experiences of gestational diabetes mellitus: Proposing a framework to enhance midwifery assessment. Women Birth 2013;26:e69‑76.

Nolan JA, McCrone S, Chertok IR. The maternal experience of having diabetes in pregnancy. J Am Acad Nurse Pract 2011;23:611‑8.

Morrison MK, Lowe JM, Colins CE. Australian women’s experiences of living with gestational diabetes. Women Birth 2014;27:52‑7.

Bandyopadhyay M, Small R, Davey MA, Oats JJ, Forster DA, Aylward A. Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. Aust NZ J Obstet Gynaecol 2011;51:360‑4.

Hui A, Sevenhuysen G, Harvey, Salamon E. Barriers and coping strategies of women with gestational diabetes to follow dietary advice. Women Birth 2014;27:292‑7.

Chávez‑Courtois M, Graham C, Romero‑Pérez I, Sánchez‑Miranda G, Sánchez‑Jiménez B, Perichart‑Perera O. Experiences, perceptions and self‑management of gestational diabetes in a group of overweight multiparous women. Cien Saude Colet 2014;19:1643‑52.

Carolan M, Gill GK, Steel CH. Women’s experiences of factors that facilitate or inhibit gestational diabetes self‑management. BMC Pregnancy Childbirth 2012;12:99.

Emamgholi Khooshehchin T, Keshavarz Z, Afrakhteh M, Shakibazadeh E, Faghihzadeh S. Explanation the experiences of mothers with gestational diabetes about the factors affecting self‑care: A qualitative study. J Clin Nurs Midwifery 2016;5:76‑89. [In Persian]. Available from: http://eprints.skums. [Last accessed on 13 Sep 2017].

Ghaffari F, Salsali M, Rahnavard Z, Parvizy S. Compliance with treatment regimen in women with gestational diabetes: Living with fear. Iran J Nurs Midwifery Research 2014;19:S103‑11.

Office of Education and Health Promotion. Service pack of self care, cooperation and participation of urban and rural health centers. Ministry of Health and Medical Education. Deputy of Health. Office of Education and Health Promotion. 1th ed. 2014 [in persian]. Available from: uploads/9_371_90_1.pdf. [Last accessed on 2017 Aug 08].

Rutledge SA, Masalovich S, Blacher RJ, Saunders MM. Diabetes self‑management education programs in nonmetropolitan counties‑United States, 2016. MMWR Surveill Summ 2017;66:1‑6.

Hass L, Maryniuk M, Beck J, Cox CE, Duker P, Edwards L, et al. National standards for diabetes self‑management education and support. Diabetes care 2012;35:2393‑401.

NICE guideline. Diabetes in pregnancy: Management diabetes in pregnancy: Management from preconception to the postnatalfrom preconception to the postnatal periodperiod. Available from: [Last accessed on 2015 Feb 25].

Pilot D, Hungler B. Nursing research. 5th ed. Lippincott: Philadelphia; 2002;349‑60.

Sanee AS, Nikbakht AR. Methodology of qualitative research in medical sciences. Publisher for Tommarow, Tehran, Iran, 2005.

Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage Publications; 1985.

Carolan M, Gill GK, Steele C. Women’s experiences of factors that facilitate or inhibit gestational diabetes self‑management. BMC Pregnancy Childbirth 2012;12:99.

Mersereau P, Williams J, Collier SA, Mulholland C, Turay KH, Prue CH. Barriers to managing diabetes during pregnancy: The perceptions of health care practitioners. Birth 2011;38:142‑9.

de Holanda VR, de Souza MA, dos Santos Rodrigues MC, Pinheiro AK, Damasceno MM. Knowledge of pregnant women about gestational diabetes mellitus. Journal of Nursing UFPE on line [JNUOL] 2012;6:1648‑54. Available from: http://www. download/2956/4056. [Last accessed on 6 Dec 2017].

Hirst JE, Tran TH, Thi Do MA, Rowena F, Morris JM, Jeffery HE. Women with gestational diabetes in Vietnam: A qualitative study to determine attitudes and health behaviours. BMC Pregnancy and Childbirth 2012;12:81.

Lindmark A, Smide B, Leksell J. Perception of healthy lifestyle information in women with gestational diabetes A pilot study before and after delivery. Eur Diabetes Nursing 2010;7:16‑20. doi: 10.1002/edn.150. Available from: http://onlinelibrary.wiley. com/doi/10.1002/edn.150/epd. [Last accessed on 6 Dec 2017].

Bell J. Reducing barriers to glucose control in patients with gestational diabetes. American Nurse Today January 2015. Available from: [Last accessed on 2 Dec 2017].

Califorina Department of Public Health. Gestational Diabetes: All you need to know about you and your baby. © Califorina Department of Public Health. June 2014. Available from: /0/Documents/ Gestational%20Diab/GDMbooklet_engl_2014.pdf.

Ransdell A and the Perinatal Providers and Staff. Gestational diabetes. A CDAPP Sweet Success Affiliate Program. CommuniCare Health Centers, Davis, California. Available from: [Last accessed on 2015 Oct 27].

King Edward Memorial Hospital. Dietetic department. Healthy eating for gestational diabetes. January 2013. Available from:

Carolan M, Gill G, Steel CH. Women’s experiences of gestational diabetes self‑management: A qualitative study. Midwifery 2013;29:637‑45.

Rodriguez KM. Intrinsic and extrinsic factors affecting patient engagement in diabetes self‑management: Perspectives of a certified diabetes educator. Clin Ther 2013;35:170‑8.

Mendelson SG, McNeese‑Smith D, Koniak‑Griffin D, Nyamathi A, Lu MC. Community‑based Parish nurse intervention program for Mexican American women with gestational diabetes. J Obstet Gynecol Neonatal Nurs 2008;37:415‑25.

Lorig K, Holman H, Sobel D, Laurent D, Gonzalez V, Minor M. Living a healthy life with chronic conditions. 3th ed. Bull publishing company; 2006. p. 87‑9.

Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. Management of hyperglycemia during pregnancy. Int J Gynecol Obstet 2015;131:S173‑211.

International Diabetes Federation. Global guidline. Pregnancy and diabetes. © International Diabetes Federation, 2009.

Jones EJ, Roche CC, Appel SJ. A Review of the health beliefs and lifestyle behaviors of women with previous gestational diabetes. J Obstet Gyanecol Neonatal Nurs 2009;38;516‑26.

Razee H, van der Ploeg HP, Blignault I, Smith BJ, Bauman AE, McLean M, et al. Beliefs, barriers, social support, and environmental influences related to diabetes risk behaviours among women with a history of gestational diabetes. Health Promot J Austr 2010;21:130‑7.

Wazqar DH, Evans MK. Socio‑cultural aspects of self‑management in gestational diabetes. J Diabetes Nurs 2012;16:62‑7. Available from: doi/10.1002/edn.150/epd. [Last accessed on 6 Dec 2017].


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