- Research article
- Open Access
- Open Peer Review
Use of a web-based educational intervention to improve knowledge of healthy diet and lifestyle in women with Gestational Diabetes Mellitus compared to standard clinic-based education
- Padaphet Sayakhot1Email author,
- Mary Carolan-Olah1 and
- Cheryl Steele2
https://doi.org/10.1186/s12884-016-0996-7
© The Author(s). 2016
- Received: 26 September 2015
- Accepted: 29 July 2016
- Published: 5 August 2016
Abstract
Background
This study introduced a web-based educational intervention for Australian women with gestational diabetes mellitus (GDM). The aim was to improve knowledge on healthy diet and lifestyle in GDM. Evaluation of the intervention explored women’s knowledge and understanding of GDM, healthy diet, healthy food, and healthy lifestyle, after using the web-based program compared to women receiving standard clinic-based GDM education.
Methods
A total of 116 women, aged 18–45 years old, newly diagnosed with GDM, participated (Intervention (n) = 56 and control (n) = 60). Women were randomly allocated to the intervention or control groups and both groups attended a standard GDM education class. Group 1(Intervention) additionally used an online touch screen/computer program. All women completed a questionnaire following the computer program and/or the education class. All questions evaluating levels of knowledge had more than one correct answer and scores were graded from 0 to 1, with each correct component receiving a score, eg. 0.25 per each correct answer in a 4 answer question. Chi-square test was performed to compare the two groups regarding knowledge of GDM.
Results
Findings indicated that the majority of women in the intervention group reported correct answers for “types of carbohydrate foods” for pregnant women with GDM, compared to the control group (62.5 % vs 58.3 %, respectively). Most women in both groups had an excellent understanding of “fruits and vegetables” (98.2 % vs 98.3 %), and the majority of women in the intervention group understood that they should exercise daily for 30 min, compared to the control group (92.9 % vs 91.7 %). Both groups had a good understanding across all categories, however, the majority of women in the intervention group scored all correct answers (score = 1) in term of foetal effects (17.9 % vs 13.3 %, respectively), maternal predictors (5.4 % vs 5 %), care requirements (39.3 % vs 23.3 %), GDM perceptions (48.2 % vs 46.7 %) and GDM treatment (67.9 % vs 61.7 %), compared to women in the control group.
Conclusion
The study suggested that both approaches, standard education and standard education plus web-based program, resulted in excellent knowledge scores, but not statistically significant difference between groups. Multiple and immediate access to the web-based education program at home may prove useful as a source of reference for women with GDM. Future study comparing results pre and post intervention is needed.
Trial registration
ACTRN12615000697583; Date registered: 03/07/2015; Retrospectively registered.
Keywords
- Gestational diabetes mellitus
- Knowledge
- Understanding
- Food choice
- Management
Background
Knowledge is considered as a significant component of health literacy [1]. Poor health literacy is associated with limited understanding of disease and may result in limited knowledge of disease management [2–7]. Recent studies have reported that many women misunderstand gestational diabetes mellitus (GDM), with women reporting that GDM only affects them during pregnancy, and that once the baby is born the complication is no longer a health threat [8, 9]. Although GDM usually resolves postpartum, there are long term consequences of obesity and risk of type 2 diabetes mellitus (DM) following diagnosis of GDM [10]. There is also strong evidence indicating that promoting healthy lifestyle habits such as weight loss, exercise, and healthy diet will reduce the risk of developing type 2 diabetes [11–13]. In addition, follow up doctor appointments, and postpartum Oral Glucose Tolerance Test (OGTT), are important for early diagnosis and prevention of type 2 DM in women with GDM [1].
Nowadays, the internet has become a very popular source of health information for pregnant women [14–18]. Many women utilise the internet as a primary resource for information about pregnancy, and as a means to help them deal with concerns, or to navigate pregnancy-related decisions, and to improve knowledge about pregnancy [16, 17, 19]. This popularity may relate to advantages, such as immediate access, usually at home, which avoids travel and is cost saving [20–23]. Pregnant women with GDM are one such group of users. The present study introduced a web-based education program for women with GDM which aimed to support GDM education and self-management. The program was developed in close cooperation with potential users [24] and is based on national guidelines for diabetes care.
Finally, although a number of studies have reported on knowledge evaluation among women with type 1 and type 2 DM, literature related to knowledge evaluation among women with GDM is limited, and no studies were located which used a web-based educational intervention to improve the knowledge about GDM. For these reasons, this study focused on evaluating knowledge of GDM, self-management, healthy diet, exercise, and lifestyle habits.
The aim of this study was to explore whether or not the knowledge/understanding of GDM could be improved by introducing this additional web-based education compared to standard GDM education alone.
Methods
Study design
This study was a randomised controlled trial (RCT) study comparing two groups of participants. All protocols were approved by the WH HREC. Informed written consent was obtained from each participant prior to enrolment. This study was carried out at the Maternity Diabetes Clinic of Western Health Sunshine Hospital from December 2014-May 2015.
Study population
Inclusion and exclusion criteria
Pregnant women aged between 18–45 years old, newly diagnosed with GDM, with a singleton pregnancy, who attended the maternity diabetes clinic at Western Health Sunshine Hospital, were invited to participate in the study. Pregnant women, who had pre-existing diabetes (types 1 and 2), or were unable to write and understand English, were excluded from the study. Participants in both groups (Intervention Group and Control Group) were expected to meet the same criteria.
Study setting
Women were randomly allocated to either an intervention group or a control group:
Intervention group
Women in the intervention group attended the standard clinic-based education and additionally used the web-based education intervention. Access to the web-based education intervention (A touch screen computer) took place at the Maternity diabetes clinic at Western Health Sunshine Hospital, supervised by the researcher. The program provided information on healthy diet and healthy lifestyle and included pictures and simple instructions. The program took 15–30 min to complete. Women were also given the URL link for the website, so they could access the website as they wished at home.
Control group
Women in the control group attended the standard clinic-based education class alone. The single, group education class, lasting 1.5 h, is run by Western Health’s dieticians and diabetes educator nurses. Generally 5–8 newly diagnosed pregnant women with GDM attend. Session and content is based on healthy diet, exercise, healthy lifestyle, and blood glucose level monitoring.
Study tools and measurement
A structured questionnaire and a web-based educational intervention/touch screen computer were used in this study.
Questionnaire
Sample questions/statements about diabetes with one and more than one correct answer. cAll statement in “bold” are represented a correct answer
Website design/intervention program
The web-based education intervention contained four modules about GDM and four information resources. All information on the website was decided by a research panel comprising of dietician, endocrinologist, diabetes nurse educator, midwife and researchers. The website was developed and tested prior to this study and was described in our previous research [24]. The four modules covered: (1) healthy food choices, (2) healthy habits/healthy lifestyle, (3) emotions, family and food, and (4) testing blood glucose level. The four information resources were: (1) What is gestational diabetes?, (2) Healthy eating and exercise in GDM, (3) What to do if you’re still hungry?, and (4) A guide to healthy shopping.
Recruitment
Women, who met the study criteria, were recruited from the Maternity Diabetes Clinic. Once women agreed to participate, they were randomly allocated to the intervention group, or control group by using computer-generated random numbers [27] (Additional file 1). Written consent was obtained prior to participation. Women in the intervention group were invited to complete a questionnaire after they had finished the standard education class plus web-based education. Meanwhile, the control group were invited to complete a questionnaire once they had finished the standard education class at the hospital. All women completed a questionnaire at the hospital (Details of recruitment procedure were shown in Additional file 2).
Sample size
Power analysis was performed for sample size estimation. To ensure a power of 80 % and a significant level of 0.05 for each group, the study required a minimum of 50 participants per group and a maximum of 70 per group. In order to detect minimum differences in all aims, we aimed to recruit a minimum of 50 participants per groups, resulted in 56 women in the intervention group and 60 women for the control group.
Data analysis
Analysis was performed using SPSS software (version 20.0; SPSS). Crosstabs, frequencies and descriptive statistics were used to summarize demographics. Authors also consulted with an expert biostatistician. Crosstabs with Chi-square test and Exact Chi-square were used to analyse data. P ≤ 0.05 was considered statistically significant. Results were reported as frequencies and percentage.
Results
Participant rate
The present study sample includes 116 women, with 56 (48 %) of the participants in the intervention group and 60 (52 %) allocated to the control group. The researcher approached a total of 130 pregnant women with GDM, who expressed interest in participation. After screening for eligibility, there were 116 women, who were eligible for the study, 5 (3.8 %) women had pre-existing diabetes mellitus, 2(1.5 %) women could not speak and write English, 2 (1.5 %) women did not complete the questionnaire, and 5(3.8 %) requested to complete the questionnaire at home, these women were excluded from the study. Therefore, the response rate for this study was 89.2 %.
Demographic characteristics
Demographic characteristics
Groups | ||
---|---|---|
Intervention n = 56 (%) | Control n = 60 (%) | |
Age: | ||
ᅟ- ≤25 years | 5 (8.9) | 5 (8.3) |
ᅟ- 26-30 years | 16 (28.6) | 24 (40) |
ᅟ- 31-35 years | 28 (50) | 18 (30) |
ᅟ- ≥36 years | 7 (12.5) | 13 (21.7) |
Country of birth: | ||
ᅟ- Australia, New Zealand | 12 (22.2) | 22 (36.7) |
ᅟ- India, Sri Lanka, Bangladesh | 18 (33.3) | 10 (16.7) |
ᅟ- China, Hong Kong, Taiwan, Nepal | 6 (11.1) | 3 (5.0) |
ᅟ- Vietnam, Laos | 3 (5.6) | 11(18.3) |
ᅟ- Ethiopia, Eritrea, Sudan, Congo, Somalia | 6 (11.1) | 4 (6.7) |
ᅟ- Philippine, Malaysia, Singapore | 2 (3.7) | 3 (5.0) |
ᅟ- Other | 7 (13.0) | 7 (11.6) |
Been in Australia: | ||
ᅟ- ≤10 years | 34 (82.9) | 25 (64.1) |
ᅟ- 11 – 20 years | 2 (4.8) | 6 (15.3) |
ᅟ- ≥21 years | 5 (12.1) | 8 (20.5) |
Religion: | ||
ᅟ- Christian | 18 (32.1) | 20 (33.3) |
ᅟ- Hindu | 8 (14.3) | 7 (11.7) |
ᅟ- Muslim/Islam | 9 (16.1) | 5 (8.3) |
ᅟ- No religion | 13 (23.2) | 12 (20.0) |
ᅟ- Other: Sikh, Catholic, Buddhist | 8 (14.3) | 16 (26.7) |
Education: | ||
ᅟ- Year 11 or below | 3 (5.3) | 7 (11.6) |
ᅟ- Year 12 or equivalent | 10 (17.9) | 11 (18.3) |
ᅟ- Certificate, advanced diploma or diploma | 13 (23.2) | 16 (26.7) |
ᅟ- Bachelor degree | 19 (34.0) | 13 (21.7) |
ᅟ- Postgraduate degree (e.g. Graduate diploma, Masters or PhD) | 11 (19.6) | 13 (21.7) |
Work status: | ||
ᅟ- Full time | 17 (30.4) | 22 (36.7) |
ᅟ- Part time | 12 (21.4) | 8 (13.2) |
ᅟ- No paid work | 18 (32.1) | 14 (23.3) |
ᅟ- Other | 9 (16.1) | 16 (26.7) |
Occupation: | ||
ᅟ- Professional, high level manager or administrator | 10 (17.9) | 5 (8.3) |
ᅟ- Manager or equivalent | 4 (7.1) | 8 (13.3) |
ᅟ- Clerical, service worker or sales | 9 (16.1) | 19 (31.7) |
ᅟ- Student (full time) | 4 (7.1) | 1 (1.7) |
ᅟ- Home duties | 16 (28.6) | 20 (33.3) |
ᅟ- No paid work | 7 (12.5) | 4 (6.7) |
ᅟ- Other | 6 (10.7) | 3 (5.0) |
Income: | ||
ᅟ- No income | 5 (8.9) | 6 (10.0) |
ᅟ- < $60,000 | 16 (28.6) | 19 (31.7) |
ᅟ- $60,000-$80,000 | 10 (17.9) | 16 (26.7) |
ᅟ- Don’t know | 13 (23.2) | 4 (6.6) |
ᅟ- I don’t want to answer | 12 (21.4) | 15 (25.0) |
Marital status: | ||
ᅟ- Married | 46 (82.1) | 43 (71.7) |
ᅟ- Defacto | 5 (8.9) | 12 (20) |
ᅟ- Other | 5 (8.9) | 5 (8.3) |
Knowledge of gestational diabetes mellitus (GDM)
Knowledge of gestational diabetes. Score are range from 0–1; Score 0 = incorrect answer or don’t know the answer; Score 0.33 = one correct answer out of 3 answers; Score 0.66 = two correct answers out of 3 answers; Score 0.25 = one correct answer out of 4 answers; Score 0.5 = one correct answer out of 2 answers; Score 0.75 = three correct answers out of 4 answers; and Score 1 = all correct answers
Both groups had a good understanding of maternal predictors for GDM, with the majority of women in the intervention group scoring = 0.75 compared to the control group (42.9 % and 40 %, respectively) (Fig. 2b). The majority of participants in the intervention group had an excellent understanding of care requirements during pregnancy (39.3 % and 23.3 %, respectively), GDM perceptions (48.2 % and 46.7 %), and GDM treatment (67.9 % and 61.7 %) compared to the control group (Fig. 2c, d and e).
In addition, the overall findings for all categories indicated that more women in the intervention group had achieved a full score (score =1), compared to women in the control group.
Knowledge of food choice and exercise during pregnancy
Knowledge of Food choice and exercise for pregnant women with gestational diabetes mellitus
Groups | p valuea | ||
---|---|---|---|
Intervention n (%) | Control n (%) | ||
The preferred type of carbohydrate food | |||
ᅟ- Correct | 35 (62.5) | 35 (58.3) | 0.647 |
ᅟ- Incorrect | 21 (37.5) | 25 (41.7) | |
Form of fruits and vegetables are better | |||
ᅟ- Correct | 55 (98.2) | 59 (98.3) | 0.961 |
ᅟ- Incorrect | 1 (1.8) | 1 (1.7) | |
Protein intake obtained | |||
ᅟ- Correct | 39 (69.6) | 47 (78.3) | 0.285 |
ᅟ- Incorrect | 17 (30.4) | 13 (21.7) | |
Best type of protein | |||
ᅟ- Correct | 38 (67.9) | 47 (78.3) | 0.203 |
ᅟ- Incorrect | 18 (32.1) | 13(21.7) | |
A balanced diet should have | |||
ᅟ- Correct | 40 (71.4) | 44 (73.3) | 0.819 |
ᅟ- Incorrect | 16 (28.6) | 16 (26.7) | |
Exercise in GDM helps to control blood glucose and improve baby’s health | |||
ᅟ- Correct | 55 (98.2) | 59 (98.3) | 0.961 |
ᅟ- Incorrect | 1 (1.8) | 1 (1.7) | |
Exercises that are recommended during pregnancy | |||
ᅟ- Correct | 54 (96.4) | 58 (96.7) | 0.944 |
ᅟ- Incorrect | 2 (3.6) | 2 (3.3) | |
How hard can you exercise during pregnancy? | |||
ᅟ- Correct | 20 (35.7) | 24 (40) | 0.635 |
ᅟ- Incorrect | 36 (64.3) | 36 (60) | |
How long should you exercise per day? | |||
ᅟ- Correct | 43 (76.8) | 48 (80) | 0.674 |
ᅟ- Incorrect | 13 (23.2) | 12 (20) | |
Should I exercise if I am overweight and unfit | |||
ᅟ- Correct | 48 (85.7) | 56 (93.3) | 0.178 |
ᅟ- Incorrect | 8 (14.3) | 4 (6.7) | |
How can I increase my daily exercise? | |||
ᅟ- Correct | 42 (75) | 50 (83.3) | 0.268 |
ᅟ- Incorrect | 14 (25) | 10 (16.7) | |
You should exercise daily for 30 min | |||
ᅟ- Correct | 52 (92.9) | 55 (91.7) | 0.811 |
ᅟ- Incorrect | 4 (7.1) | 5 (8.3) |
Knowledge of GDM management
Knowledge of testing blood glucose level
Groups | p valuea | ||
---|---|---|---|
Intervention n = 56 (%) | Control n = 60 (%) | ||
A normal fasting (on an empty stomach) blood glucose level is: | |||
ᅟ- Correct | 51 (91.1) | 55 (91.7) | 0.909 |
ᅟ- Incorrect | 5 (8.9) | 5 (8.3) | |
A normal 2 h blood glucose level is: | |||
ᅟ- Correct | 51 (91.1) | 54 (90) | 0.844 |
ᅟ- Incorrect | 5 (8.9) | 6 (10) | |
I should test my blood glucose level (eg, in the morning before breakfast/2 h after meals): | |||
ᅟ- Correct | 39 (69.6) | 52 (86.7) | 0.026b |
ᅟ- Incorrect | 17 (30.4) | 8 (13.3) | |
What do I do if my blood glucose level is high on one occasion? | |||
ᅟ- Correct | 45 (80.4) | 48 (80) | 0.962 |
ᅟ- Incorrect | 11 (19.6) | 12 (20) | |
What do I do if my blood glucose level is high on two occasions in one week? | |||
ᅟ- Correct | 34 (60.7) | 36 (60) | 0.937 |
ᅟ- Incorrect | 22 (39.3) | 24 (40) | |
Should I take my blood glucose level if I am feeling sick and haven’t eaten? | |||
ᅟ- Correct | 53 (94.6) | 57 (95) | 0.931 |
ᅟ- Incorrect | 3 (5.4) | 3 (5) | |
When you prick your finger, you should: | |||
ᅟ- Correct | 30 (53.6) | 45 (75) | 0.016b |
ᅟ- Incorrect | 26 (46.4) | 15 (25) |
Management of gestational diabetes mellitus
Groups | p valuea | ||
---|---|---|---|
Intervention n (%) | Control n (%) | ||
You should check your blood glucose levels | |||
ᅟ- Correct | 54 (96.4) | 58 (96.7) | 0.944 |
ᅟ- Incorrect | 2 (3.6) | 2 (3.3) | |
Controlling your blood glucose levels: | |||
ᅟ- Correct | 49 (87.5) | 52(86.7) | 0.894 |
ᅟ- Incorrect | 7 (12.5) | 8(13.3) | |
If there is a social occasion, such as a party, you should: | |||
ᅟ- Correct | 40 (71.4) | 51 (85) | 0.076 |
ᅟ- Incorrect | 16 (28.6) | 9 (15) | |
When your blood glucose levels are high: | |||
ᅟ- Correct | 47 (83.9) | 51 (85) | 0.873 |
ᅟ- Incorrect | 9 (16.1) | 9 (15) | |
To control blood glucose effectively you should | |||
ᅟ- Correct | 35 (62.5) | 44 (73.3) | 0.211 |
ᅟ- Incorrect | 21 (37.5) | 16 (26.7) | |
GDM can be controlled by: | |||
ᅟ- Correct | 48 (85.7) | 58 (96.7) | 0.036b |
ᅟ- Incorrect | 8 (14.3) | 2 (3.3) | |
When you are hungry in between meals: | |||
ᅟ- Correct | 32 (57.1) | 48 (80) | 0.008b |
ᅟ- Incorrect | 24 (42.9) | 12 (20) |
In addition, the majority (76.8 %) of women in the intervention group understood that they should get a follow up glucose test at 6 weeks set up compared to control group (81.7 %). One third (28.3 %) of participants in the control group misunderstood complications of GDM following birth, compared to nearly half (48.2 %) of participants in the intervention group. There was no statistically significant difference between the two groups.
Association of education levels and knowledge about GDM
The majority of women in both groups with tertiary education had the highest knowledge scores (score = 1) in term of knowledge on care requirements during pregnancy (27.6 % vs 3.4 %), GDM perceptions (36.2 % vs 11.2 %) and GDM treatment (49.1 % vs 15.5 %), compared to the women with primary or secondary education. There was no statistically significant difference between the education levels (p > 0.05).
In addition, more women with tertiary education reported correct answers for “fruits and vegetables” (72.4 % vs 24.1 %, p = 0.026) and “how long they should exercise per day” (60.3 % vs 18.1 %, p = 0.090), compared to women with primary or secondary education. The majority of women who had tertiary education, had an excellent understanding of “the preferred type of carbohydrate food” (47.4 % vs 12.9 %, p > 0.05), and “how hard they can exercise during pregnancy” (27.6 % vs 10.3 %, p > 0.05), compared to women with lower education level. More women with tertiary education reported correct answers for “time to test blood glucose level” (62.1 % vs 16.4 %, p = 0.007) and “pricking fingers for blood glucose test” (42.2 % vs 22.4 %, p = 0.009), compared to women with lower education level.
Discussion
There are thousands of websites on the Internet that provide nutrition information, including websites that mention the GDM diet. Most of these websites provide static content and are difficult to understand. The present study introduced a web-based education that provides GDM educational information with pictures and simple structures, and convenient ways for self-learning. This study estimated knowledge levels of women who used the web-based education intervention in addition to the standard education class, compared to women who attended the standard education class alone. It also sought to understand if the web-based education was a useful support and additional source of information for women newly diagnosed with GDM. The overall findings of this study indicated that both groups of participants had a good understanding of GDM, food choices, exercise during pregnancy and GDM management. The most probable reason for this finding is that all participants in the intervention group completed the questionnaire following the use of the website and attended the GDM education class before answering questionnaires, and all participants in the control group also completed the questionnaire after they attended the GDM class. Therefore, the information that the women had received from the internet and the class may improve their knowledge about GDM. Future research involving a comparison between pre and post intervention knowledge for both the website and education class would help to clarify this point.
Although both groups of participants had a good understanding across all categories, the majority of women in the intervention group reported excellent understanding of GDM in term of foetal effects, maternal predictions, care requirements, GDM predictions and GDM treatment compared to women in the control group (score =1) (see Fig. 2). This finding suggests that our current online education program does not make an immediate impact on women’s knowledge by improving their understanding of GDM. However, the program has potential as a support for the current education approach, and may need some revision to fill this potential. The literature supports this potential as Moore et al. [28], who studied an internet-based nutrition education program and explored its effect on weight, blood pressure, and eating habits after 12 months of participation. They found the effectiveness of online programs for health, delivered via the Internet, can provide benefits to large numbers of subjects at low cost and may help address the nutritional public health crisis [28]. Similarly, the present web-based education intervention can be used as a source of information for women with GDM.
In addition, another objective of this study was to estimate how much women understand healthy diet/ healthy food and healthy lifestyle following the use of a web-based education compared to women with a standard clinic-based education. The findings indicated that both groups of participants had an excellent understanding of healthy diet and food choices, except one question regarding types of carbohydrate food. This question was answered correctly by the majority of women in the intervention, compared to the control group. The possible reason for this finding is that the information on the online educational website may be easier to understand compared to the education class. As our online education uses pictures of food choices, healthy diet, appropriate portions, healthy lifestyle and exercise, and also simple instructions describing what are healthy diets, food portions, and healthy lifestyle. The present findings are supported by number of studies using web-based nutrition education programs for weight management which confirm that e-learning education/web-based education improves knowledge and promotes behaviours associated with weight loss [28–32].
Other key findings indicated that the poorest knowledge levels were observed for a question on “how hard can they exercise during pregnancy?” with most women in both groups reporting incorrect answers. Most women understood that they should only do gentle exercise during pregnancy. Although the web-based education and class education provided all the necessary information to answer the questions, many women did not assimilate this information. The possible reason for this finding may be the level of education that women in this study had completed, as the majority of women in both groups had lower than average education levels. Women with primary education had the lowest knowledge scores, whereas, women who had bachelor degree/post graduate degree level education showed highest knowledge scores (score =1). Poor knowledge seemed to be associated with lower education level. This finding is supported by a recent study on evaluation of knowledge of GDM among Malaysian women, which found that educational level was a strong influencing factor for level of knowledge across all knowledge domains. This study similarly found poorest knowledge of GDM among women with lower education levels and highest scores in women with higher educational levels [33].
Moreover, women with lower education level might experience barriers in understanding the web-based education and may have difficulty communicating with diabetes educators and dieticians. The findings from this study confirmed previous research outcomes that showed the education had a strong impact on health literacy. Low educational level leads to low health literacy which results in limited knowledge about conditions [25, 34–36]. Participants with low health literacy may have difficulty understanding patient-orientated health literature, medication instructions, appointment cards from clinic and hospital signage [37].
Finally, the present study found that one question regarding “where to prick the fingers for testing blood glucose level?” - was answered incorrectly by nearly half of women in the intervention group compared to less than one third of women in the control group. A statistically significant difference was reported on questions regarding pricking fingers for testing blood glucose (p < 0.05). The probable reason for this finding is that women were new to the website and may have misunderstood the question. However, although this study collected questionnaire information at one time only, women can access the website at home at any time, whereas, women in the control group attend the education class once only. These women may find a difficulty following a self-management plan after they attend the class, and this may increase the incidence of complications, and decrease coping skills. Similar concerns were raised in a study in Malaysian women where GDM participants reported poor knowledge and difficulties related to the management of GDM [33].
Implications
Practice implication:
- 1)
Providing clearer information on the amount of exercise during pregnancy,
- 2)
Providing clearer information on pricking fingers for blood glucose test, and
- 3)
Providing clearer information on the correct time for testing blood glucose levels.
Additionally, women with GDM should be able to attend the hospital education class more than once as some women displayed incorrect knowledge after a single class.
These improvements have the capacity to improve outcomes as better knowledge about GDM is associated with better management of GDM.
Limitations
Although, the desirable aims of the study have been achieved, there are some limitations related to the study. This study was conducted in single centre so results of this study cannot be generalized.
The web-based education was evaluated in a randomized controlled trial comparing two groups of the women: (1) intervention group (women attended the clinic-based education class and additionally used the web-based education intervention) and (2) control group (women attended the clinic-based education class only). There was a limitation in the method of this study due to baseline information/pre-intervention was not collected. Future study comparing results pre- and post-intervention, or a study comparing standard education with web-based education is suggested.
The number of participants in the intervention group was smaller than the number in the control group. This was because it was difficult to recruit participants for the intervention group as the women have to complete the questionnaire after they have used the program, which was inconvenient for them to do at the maternity clinic. Some women partially completed the questionnaire or requested to complete the questionnaire at home and their data was not considered. Therefore, an online survey or reply-paid envelop is recommended for future studies.
Conclusions
Both groups of women had excellent results, and results were not significantly improved by the intervention, nonetheless the online educational program has potential to improve GDM education and may provide convenient ways for self-learning about GDM for women. Revision of the program to tailor it to the women’s needs in terms of reinforcing information and key messages might be the way forward. Future study comparing results pre and post intervention is needed.
Abbreviations
DM, diabetes mellitus; GDM, gestational diabetes mellitus; WH HREC, Western health human research committees
Declarations
Acknowledgements
The authors are grateful to the women who participated in this study. We would like to acknowledge the diabetes education team, especially Ms Gillian Krenzin at Western Health Sunshine Hospital for their assistance in recruiting participants.
Funding
This study was funded by Ian Potter Foundation (201200017).
Availability of data and materials
All raw data will not be shared to the public, because it contains participants’ personal details such as name, address, phone number, sensitive health information, pregnancy status and delivery outcomes which are kept confidential. All datasets are held at Victoria University and Western Health Sunshine Hospital databases. Any release to the public repositories will need to be requested through Victoria University and WH HREC processes.
Authors’ contributions
PS-designed the study, recruited participants, performed statistical analyses, drafted the manuscript and was responsible for the manuscript revisions. MCO-designed the study, revised and edited manuscript. CS-supported and facilitated the recruitment of participants. All authors critically revised the manuscript and approved the final version.
Author's information
PS is a Post-Doctoral Research Fellow (MD, PhD); MCO is a Professor of Midwifery (PhD); CS is a manager of Diabetes Education Services for Western Health (RN and Diabetes Educator).
Competing interests
All authors declare that they have no competing interests.
Consent for publication
Not applicable.
Ethics approval and consent to participate
This study was approved by Western Health Human Research Ethics Committee, approval number HREC/11/WH/81. Informed written consent was obtained from each participant prior to enrolment.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Authors’ Affiliations
References
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