Factors Influencing Adherence to Dietary Interventions Among Patients with Gestational Diabetes Mellitus in China: A Qualitative Study Based on the COM-B Model.

Objective: Gestational diabetes mellitus (GDM) is a frequent complication during pregnancy, which can cause many adverse effects on mother and baby. Although existing literatures have found that patients with gestational diabetes can benefit from adhering to dietary interventions, many pregnant women exhibit low dietary intervention compliance, leading to unsatisfactory blood glucose control. The qualitative research study aimed to identify the influencing factors of dietary intervention compliance among pregnant women with GDM using the capability, opportunity, motivation, and behavior (COM-B) model. Methods: Pregnant women with gestational diabetes who received regular antenatal care were purposefully recruited from the obstetric clinic of a tertiary general hospital in Beijing, China. The face-to-face semi-structured interviews were used to collect data; Guided by the COM-B model, the directed content analysis was used to analyze data. Results: Nineteen women from a great variety of socio-demographic backgrounds participated in this study. The average age of the participants was 32.26±4.58 years, the average gestational age of them was 36.03±1.75 weeks. 73.69% of them have a bachelor's degree or above in education level, 68.42% of participants were primipara. 52.63% of them had a normal weight, 26.32% were obesity, 15.79% were overweight, only 5.26% were underweight. In total, more than 80% of participants had no history of GDM in prior pregnancy or a family history of type 2 diabetes (T2DM), and 42.11% of participants received insulin treatment. Eight themes (6 barriers and 2 facilitators) were mapped onto the COM-B model representing influencing factors of dietary intervention compliance among GDM pregnant women. The facilitators included high trust in professional support and a positive perception of dietary management benefits. The barriers were lack of pregnancy nutritional knowledge, insufficient knowledge and skills in dietary management, limited support from family members, low disease risk perception, negative experiences with dietary interventions, and low self-efficacy in dietary management. The results will provide basis and reference for the development of diet intervention for pregnant women with gestational diabetes. Conclusion: Our findings underscore the importance for healthcare professionals to strengthen support and guidance of dietary behavior for patients with gestational diabetes in China. Additionally, our findings highlight the need for clinical healthcare professionals to take measures that strengthen the self-efficacy and involve family members in supporting dietary modifications in China.