Development of an Adherence Promotion Framework for Women with Diabetes in Pregnancy to Improve Adherence to Anti-Diabetic Therapy and Perinatal Outcomes

Abstract

Diabetes is now a major public health problem especially in developing countries. The purpose of this study was to develop an adherence promotion framework for diabetes in pregnancy. The study followed a mixed methods sequential dominant status design utilizing both quantitative and qualitative methods. Approval for the study was granted by the respective ethical review committees. All participants gave informed consent. The quantitative phase was conducted with a cohort of 157 pregnant women with a diagnosis of diabetes in pregnancy. The exposure was adherence to anti-diabetic therapy while the outcomes were perinatal outcomes. Data was collected using semi structured interviews and was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20 and STATA. A descriptive qualitative design was used in the qualitative phase where four focus group discussions (FGDs) were held with pregnant women with diabetes. Eight key informant interviews (KII) were conducted with health professionals. Thematic analysis was separately done for the FGDs and KIIs. Adherence to anti-diabetic therapy was suboptimal and the mean was 66.7%. The most common adverse perinatal outcomes were (34.4%), caesarean delivery (45.9%) and macrosomia (33.8%). There were significant associations between adherence and caesarean delivery (RR 1.90 CI 0.8 to 2.03 p>0.001), low Apgar score (RR 1.95 CI 1.03 to 3.69 p>0.039) and perinatal mortality (RR 3.08 CI 1.11 to 8.52 p>0.018). Some barriers to adherence identified in the qualitative phase were financial barriers and lack of social support. Contextual factors deduced from the study were used to develop the Adherence Promotion Framework. Chinn and Kramer's theory of knowledge development was used to guide development of the Framework.