What is the utility of the COM-B model in identifying facilitators and barriers to maintaining a healthy postnatal lifestyle following a diagnosis of gestational diabetes: a qualitative study?
One in twenty pregnant women in the UK develop Gestational Diabetes (GD) and prevalence is increasing. Women who have had GD are over seven times more likely to be diagnosed with type 2 diabetes mellitus (T2DM) in their lifetime. The adverse health outcomes associated with T2DM include a reduction in average life expectancy by 10 years. Although women with GD are generally satisfied with antenatal care, many feel abandoned postnatally and are uncertain about what to expect from their GP regarding follow-up. There is a need to develop innovative postnatal lifestyle interventions to reduce the risk of T2DM amongst women who have had GD. Previous qualitative research investigating the experiences of women diagnosed with gestational diabetes (GD) has provided important insights for intervention development but often lack a theoretical underpinning. This study explores the use of the COM-B framework (Michie et al) to code and the socio-ecological model (Dahlgreen & Whitehead) to contextualise participant responses in order to inform intervention development.
Qualitative semi-structured interviews post-natally were undertaken with women who had received a diagnosis of GD in the preceding six months. Invitations to participate were sent out with appointment letters from Sheffield University Teaching Hospital NHS Trust for a postnatal oral glucose tolerance test (OGTT). A purposive approach was used to achieve a maximum-variety sample (age, parity, socioeconomic status, ethnicity). OGTT non-attenders were targeted, by further study invitations offering a home visit or telephone interview. Interviews were audio-recorded, transcribed and independently coded using the COM-B framework. A socio-ecological approach was adopted to understand the context of intervention facets. The final model was developed within the research team.
We interviewed 27 women diverse in age and parity, most were White-British (20/27). Applying the COM-B framework, we identified sixteen key subthemes which reflected either: capability, opportunity, or motivation components of the model. Four domains adapted from the socio-ecological model: ‘individual’, family life’, ‘community and healthcare provision’, contextualised factors important for these women in terms of behaviour change. ‘Emotional response’ at the individual level was highly motivating or demotivating. Factors related to ‘Family life ‘and ‘Community’ were particularly dominant and could either facilitate or impede change. Many participants relied on ‘Healthcare provision’ during the postnatal periods with timing and positive relationships key to good care.
The application of the COM-B framework in a socio-ecological context provides novel insight into the factors crucial for postnatal behaviour change in women with GD. Intervention facets need to target the micro through to macro-levels to prove effective in this population. Future research should consider family rather than individual level interventions as this could enable sustained behaviour change and consequently prevent the development of T2DM.