Using COM-B model in identifying factors influencing exercise adherence in pregnant women with gestational diabetes mellitus in China: a qualitative study

TL;DR

This study explores why pregnant women with gestational diabetes struggle to follow exercise recommendations, using interviews to identify key barriers and motivations.

Contribution

Applies the COM-B model to identify barriers and facilitators of exercise adherence in Chinese pregnant women with GDM through qualitative analysis.

Findings

Limited pre-pregnancy exercise habits and physical discomfort are major barriers to exercise adherence.

Insufficient professional guidance and peer support hinder compliance with exercise recommendations.

Heightened risk perception and recognition of benefits motivate exercise among GDM patients.

Abstract

Gestational Diabetes Mellitus (GDM) is a common complication of pregnancy and that uncontrolled GDM increases the risk of poor maternal and neonatal health outcomes.

While regular exercise benefits GDM pregnant women, exercise adherence remains suboptimal; thus, this study aimed to identify the factors influencing exercise adherence among pregnant women with gestational diabetes in order to inform the development of tailored intervention to improve physical activity adherence and thereby promote more GDM pregnant women to achieve the recommended physical activity level.

The descriptive qualitative study was conducted in the obstetric clinic of tertiary hospital in Beijing, China. A total of 16 pregnant women with GDM were recruited as participants via purposive sampling, and face-to-face semi-structured interviews were adopted to collect data. All the interviews were audio-recorded and timely transcribed. The directed content analysis was used to analyze data and the themes generated were mapped onto the Capability, Opportunity, Motivation and Behavior model components.

Sixteen women from a broad spectrum of socio-demographic backgrounds participated in this study. Three main themes and nine sub-themes were identified as shown below: Capability-related factors included: (1) absence of established exercise habits and exercise foundation, (2) physical discomfort with limited coping strategies, and (3) insufficient knowledge and skills regarding exercise during pregnancy. Opportunity-related factors comprised: (1) inadequate informational support and individualized guidance from healthcare professionals, (2) strong family support, and (3) insufficient peer support and community-based support. Motivation-related factors encompassed: (1) heightened risk perception of GDM promoting exercise intention, (2) recognition of exercise-related benefits enhancing motivation, and (3) negative emotions stemming from uncertainty about exercise safety.

Our study found that limited engagement in pre-pregnancy and early pregnancy physical activity, challenges of physical discomfort, insufficient knowledge and skills regarding exercise during pregnancy, insufficient professional guidance, limited peer support and community-based support, and negative emotions related to uncertain exercise safety during pregnancy were notable barriers to compliance with exercise recommendations in women with GDM. This has clinical implications for healthcare professionals to design context-specific interventions to address these barriers, thereby improving exercise compliance and physical activity levels among women with GDM.