Evaluation of clinical indicators and social context for developing lifestyle modification programs after gestational diabetes mellitus: a case study of a cohort of women in the Illawarra region, Australia
Doctor of Philosophy
Smart Foods Centre and Department of Biomedical Science
Barnard, Janelle, Evaluation of clinical indicators and social context for developing lifestyle modification programs after gestational diabetes mellitus: a case study of a cohort of women in the Illawarra region, Australia, PhD thesis, Department of Biomedical Science, University of Wollongong, 2005. http://ro.uow.edu.au/theses/853
Women with previous gestational diabetes mellitus (GDM) have a 30-50% future risk of developing Type 2 diabetes mellitus (T2DM), a global public health problem. Preventive approaches would target diet and physical activity behaviours yet little is known about these lifestyle parameters in this group. This thesis describes the diet, physical activity and risk factor profile of a sample of women with previous GDM from the Illawarra region of New South Wales, Australia. A comprehensive ethnographic description is created profiling the sample using both quantitative (surveys, diet and physical activity measurements and clinical assessments) and qualitative techniques (in depth interviews). The central hypothesis is that, while the need for diet and physical intervention may be clearly demonstrated in this group of women, the complexities of their lives needs to be considered when developing how these interventions might be delivered.
It is reasonable to assume that providing interventions for women with small children may pose practical and social challenges that warrant consideration in program design.The main aim of the research was therefore to assess the extent of the need for intervention for an identifiable cohort of women and qualify this with and an in-depth analysis of these practical and social issues. Subjects were recruited from the database of women referred to the Illawarra Diabetes Service who would be 10-25 months post-partum at the time of the study. Of a potential 150 subjects, 52 were accessible and completed a telephone interview, 19 completed a more in-depth cross-sectional survey, and 21 completed in-depth interviews with a further ten “support” people recruited through a snowballing technique. The health profile of the subjects confirmed the need for diet and activity intervention. Ten of 18 women completing a standard glucose tolerance test produced an abnormal result and were advised to seek further medical care. Dietary intake patterns were not in keeping with current recommendations for the prevention of T2DM (total fat 34.9±7.7%, SFA 13.2±4.0%, PUFA 5.5±1.7% compared to targets of (less than)30%, (less than)10% and (greater than)10% respectively). While 16 of 19 women met physical activity guidelines, the research indicated that further work on the nature of physical activity in this group warrants consideration and that current, more general physical activity guidelines for the prevention of T2DM be adapted for this group. Most of the women (47 out of 51) initially expressed an interest in lifestyle programs but indicated that time and childcare barriers would prevail. In-depth interviews indicated that there were differences between women in relation to the potential accessibility of lifestyle intervention programs and that this may rest on feelings of empowerment within the limited capacity of family systems. Opportunities for lifestyle intervention in healthcare services are likely to lie within a model of family-centred therapy. This acknowledges that the lives of these women are embedded in an interdependent network of individuals forming the family system.
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