EVALUATION OF A NEW PSYCHOEDUCATION INTERVENTION FOR WOMEN WITH GESTATIONAL DIABETES IN SAUDI ARABIA: A MIXED METHODS STUDY

Abstract

BACKGROUND

Gestational diabetes mellitus (GDM) is a type of diabetes that occurs during pregnancy. Although GDM occurs in the second or third trimester, it poses significant short and long-term complications for both the mother and the newborn. Moreover, its maternal complications extend beyond physical health including psychological impacts such as stress, anxiety, and depression. These psychological consequences can weaken pregnant women’s abilities to follow the recommended treatment plans and self-management practices. Therefore, effective strategies to overcome the physical and psychological burdens of GDM are needed. Psychoeducation interventions, which integrate psychosocial support along with health education to improve self-care practices, and coping skills, may serve as a promising solution for pregnant women with GDM. Considering the widespread use of the Internet, integrating digital health tools into psychoeducation interventions may offer valuable support for pregnant women with GDM, which could enhance their engagement and treatment adherence.

METHODS

This thesis used an experimental mixed methods design, which consists of two phases. In phase 1, a qualitative descriptive study was carried out using semi-structured phone interviews. The objective of this phase was to obtain deep understanding of the experiences and perspectives of pregnant women with GDM regarding GDM self-management. Data from this phase were used to guide the development of the psychoeducation intervention in phase 2. In phase 2, a randomised controlled trial (RCT) was carried out. The objective of the RCT study was to evaluate the effectiveness of the psychoeducation intervention in enhancing self-efficacy and self-care behaviours (primary outcomes), as well as evaluating its effect on knowledge, anxiety and depression and birthing outcomes, (secondary outcomes). Participants assigned to the intervention group were invited for interviews (process evaluation) after completion of the RCT to evaluate the newly developed psychoeducation intervention.

RESULTS

In phase 1 (qualitative interviews), thirteen pregnant women with GDM were recruited. Themes generated from the qualitative thematic analysis included experience and previous knowledge, current deficit, and factors impacting GDM self-management. These themes highlighted the need for comprehensive education interventions that address the physical and psychological well-being of pregnant women with GDM, and the need for ongoing support through direct communication channels.

In the phase 2 (RCT), 84 participants were assigned randomly into intervention (n=42) and control groups (n=42). The intervention group received a 4-week psychoeducation intervention delivered via face-to-face group sessions and WhatsApp platform, while the control group received usual care at the selected hospitals. The primary outcomes measured included UK-Diabetes Management Self-Efficacy Scale (DSMES-UK), and the Summary of Diabetes Self-Care Activities (SDSCA). The secondary outcomes measured included GDM knowledge questionnaire, Depression, Anxiety and Stress Scale - 21 Items (DASS-21), and birthing outcomes. Data were collected at three time points: baseline, immediate post intervention at 4th week and at 6th week after the intervention. Birthing outcomes were collected only once after the participants gave birth. Findings at 4- and 6-week showed significant improvement in self-efficacy, self-care behaviours, knowledge, and anxiety in the intervention group compared to the control group. Findings at 4-week time point showed significant improvement in depressive symptoms, but this improvement failed to reach the significant level at 6-week time point. No significant difference was observed between groups in birthing outcomes.

In the qualitative process evaluation, twenty-two participants from the intervention group were recruited. The participants’ feedback on the psychoeducation intervention was positive. The participants supported that the 4-week psychoeducation intervention enhanced knowledge, emotional well-being, self-efficacy, motivation and healthy changes in lifestyle practices. They voiced that they received detailed, practical, and accessible contents. They appreciated the value of sharing their experiences, which fostered a sense of connection and strengthened their bonds. The participants offered recommendations for enhancing the psychoeducation intervention including the inclusion of a multidisciplinary team, and the inclusion of family members.

CONCLUSION

The overall study findings supported the feasibility and usefulness of the psychoeducation intervention for pregnant women with GDM. The quantitative outcomes indicated positive effects of the psychoeducation intervention on self-efficacy, self-care behaviours, knowledge, and depression and anxiety. The qualitative process evaluation supported the perceived benefits of the psychoeducation intervention. Conducting future studies with longer follow-up periods to investigate the long-term effects of the psychoeducation intervention is recommended. Future studies should also consider involving family members and evaluate the effectiveness of such approach on social support and relationships.