妊娠糖尿病のセルフマネジメント行動を促進・阻害する要因：女性の声を聴く

Facilitators of and Barriers to Self-Management Behaviors Among Women with Gestational Diabetes Mellitus: A Qualitative Descriptive Study

要旨

　目的：妊娠糖尿病の女性が認識するセルフマネジメント行動に影響を与える促進・阻害要因を明らかにする．

　方法：質的記述的研究．妊娠糖尿病と診断された産後の女性に半構造的インタビューを行いフレームワーク分析を行った．

　結果：参加者は8名．促進要因・阻害要因は，個人・人との相互関係・病院・コミュニティの4つの領域に渡り抽出された．促進要因は【妊婦ゆえの受け入れと高いモチベーション】【応援してくれる家族の力】【多職種からの個別性を尊重した専門的な指導】【ピアサポートによる情報共有と孤立感の解消】を含む11カテゴリー，阻害要因は【セルフマネジメントに対する自己効力感の低下】【上の子の育児と療養行動の両立の困難さ】【医療者から提供される情報や保健指導の個別性と具体性の欠如】【妊娠糖尿病に関する社会資源の不足】を含む12カテゴリーが得られた．

　結論：促進・阻害要因は4つの領域に渡り様々な要因が抽出された．それぞれの領域での支援改善が求められる．

　Purpose: This study aimed to identify the facilitators and barriers that influenced self-management behaviors among women with gestational diabetes mellitus (GDM).

　Methods: This was a qualitative descriptive study. Semi-structured interviews were conducted with postpartum women diagnosed with GDM, and framework analysis was conducted.

　Results: 8 women participated. Regarding facilitators and barriers, the following four areas were identified: individuals, inter-personal relationships, hospitals, and communities. Regarding facilitators, 11 categories were identified, including Acceptance and high motivation as a pregnant woman, Power of supportive family members, Professional guidance respecting individuality from multiple professions and reassuring attitude of health professionals, and Relief of isolation through peer support and information about GDM and medical treatment. Regarding barriers, 12 categories were identified, including Low self-efficacy in self-management, Difficulty in balancing treatment behavior with childcare of older children, and Lack of individualization and specificity of information and health guidance provided by health professional, Lack of social resources regarding GDM.

　Conclusion: Various factors that promoted or inhibited self-management behaviors among women with GDM were identified in the four areas. Improvement of support at each level is required.