妊娠期糖尿病孕妇血糖管理决策困境的质性研究

The Decision Conflict of Blood Glucose Management among Pregnant Women with Gestational Diabetes Mellitus:A Qualitative Study

目的了解妊娠期糖尿病孕妇在血糖管理过程中面临的决策困境,为促进孕妇良好的血糖管理决策提供支持。方法采用目的抽样方法,选取2020年9-12月上海市4所医疗机构就诊的28名妊娠期糖尿病孕妇进行半结构式个人深度访谈。采用内容分析法分析资料并提炼主题。结果妊娠期糖尿病孕妇在血糖管理过程中主要有三大决策困境,包括:信息来源广但专业化信息不足、信息内容多但个性化支持不足导致的信息困境;难以兼顾血糖控制与妊娠安全、孕期营养导致的利弊权衡困境;被动决策和参与决策之间矛盾导致的偏好困境。结论产科专业人员应为妊娠期糖尿病孕妇提供多种途径、可操作性强的血糖管理信息,帮助其分析各种决策之间的利弊风险,提供充分的决策辅助,减少其决策困惑,提高孕妇在血糖管理中的主动决策意愿和决策能力。

Objective To understand the decision conflict of blood glucose management in pregnant women with gestational diabetes mellitus(GDM),in order to provide support for promoting good blood glucose management decision-making of pregnant women.Methods A purposive sampling method was used to select 28 pregnant women with GDM from 4 hospitals in Shanghai from September to December 2020,and an individual semi-structured in-depth interview was adopted to collect the data.Content analysis was used to analyze the interview data and refine the themes.Results Pregnant women with GDM had three major decision-making difficulties in the process of blood glucose management,including:Information dilemma caused by various information sources but insufficient professional information,many information contents but insufficient personalized support;Trade-off dilemma caused by blood glucose control,pregnancy safety and nutrition during pregnancy;Preference dilemma caused by the contradiction between passive decision-making and participatory decision-making.Conclusions Obstetric clinicians could provide individual and feasible information for GDM pregnant women through various ways,help them to balance the benefit and risk of decisions,and provide sufficient decision-making assistance,reduce their decision-making confusion,and improve pregnant women’s willingness and ability of active decision-making in blood glucose management.