Challenges and support factors in managing type 2 diabetes among pregnant women in Thailand: A convergent mixed-methods study
Original Research Article

Challenges and support factors in managing type 2 diabetes among pregnant women in Thailand: A convergent mixed-methods study

Original Research Article
Categories: Midwifery & Maternity Nursing, Public Health and Community Nursing, Diabetes Mellitus
https://doi.org/10.33546/bnj.3639
Ratchanok Phonyiam
Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital Mahidol University, Bangkok, Thailand
https://orcid.org/0000-0002-2339-8889
Chiao-Hsin Teng
The University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, United States | Chang Gung University School of Nursing, Taoyuan, Taiwan
https://orcid.org/0000-0001-8722-8750
Catherine Sullivan
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Aunchalee Palmquist
Duke Global Health Institute, Durham, North Carolina, United States
https://orcid.org/0000-0002-0848-6952
Eric Hodges
The University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina, United States
https://orcid.org/0000-0002-4358-4398
Yamnia Cortés
University of Iowa, College of Nursing, Iowa City, Iowa, United States
https://orcid.org/0000-0003-1520-2775
Marianne Baernholdt
University of Virginia, School of Nursing, Charlottesville, Virginia, United States
https://orcid.org/0000-0001-5499-7457
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Keywords

diabetes mellitus
self-management
pregnancy
pregnant women
glycemic control
gestational weight gain
maternal health
Thailand

How to Cite

Phonyiam, R., Teng, C.-H. ., Sullivan, C., Palmquist, A., Hodges, E., Cortés, Y., & Baernholdt, M. Challenges and support factors in managing type 2 diabetes among pregnant women in Thailand: A convergent mixed-methods study. Belitung Nursing Journal, 11(1). https://doi.org/10.33546/bnj.3639
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Abstract

Background: Sociocultural and behavioral factors have a multifaceted impact on maternal health. In Thailand, cultural influences significantly shape behaviors of diabetes self-management in women. However, the experience of self-managing diabetes in pregnant women with preexisting Type 2 Diabetes Mellitus (T2DM) remains unclear.

Objectives: The study aimed to explore challenges and support factors of diabetes self-management among pregnant women with preexisting T2DM in Thailand, and to compare these factors between women in two groups (optimal and suboptimal maternal health outcomes).

Methods: A convergent mixed-methods study was conducted at a tertiary hospital (March to October 2022). Eligible participants were Thai pregnant women, aged 20-44, diagnosed with T2DM. Participants first completed a questionnaire and then were interviewed about diabetes self-management. Maternal health outcomes (i.e., gestational weight gain and glycated hemoglobin [HbA1c]) were reviewed and extracted. Descriptive statistics were used for quantitative analysis, while directed content analysis was used for qualitative data. Side-by-side matrices were used to describe the qualitative subthemes with quantitative results.

Results: Twelve Thai pregnant women participated in the study, aged 27 to 40 years, with gestational ages ranging from 7 to 38 weeks and T2DM diagnoses spanning from 3 weeks to 10 years. Half of the participants were obese before pregnancy. Weight gain patterns revealed that 41.67% had inadequate gain, 33.33% had optimal gain, and 25% had excessive gain. HbA1C levels indicated that 75% had good glycemic control. Three women achieved optimal weight gain and glycemic control, while nine exhibited suboptimal health outcomes. We identified six main themes: 1) challenges at the individual level in managing diabetes, 2) support factors at the individual level for diabetes management, 3) challenges at the interpersonal level in controlling diet, 4) interpersonal support factors for managing diabetes, 5) challenges at the societal level in accessing healthcare, and 6) societal support factors for healthcare access.

Conclusion: The findings suggest that managing diabetes during pregnancy necessitates dynamic, patient-centered care throughout the pregnancy journey. Regarding the clinical implication, it is important to tailor approaches to the Thai context and to prioritize education and boost women’s confidence in managing diabetes throughout pregnancy.

https://doi.org/10.33546/bnj.3639
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Supporting Agencies

Ratchanok Phonyiam received the Alpha Alpha Chapter of Sigma Theta Tau International Research Grant, the Sigma Small Grant, and the Arthur C. Maimon Doctoral Student Research Award to complete this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright

Copyright (c) 2025 Ratchanok Phonyiam, Chiao-Hsin Teng, Catherine Sullivan, Aunchalee Palmquist, Eric Hodges, Yamnia Cortés, Marianne Baernholdt

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

References

Aekplakorn, W., Chariyalertsak, S., Kessomboon, P., Assanangkornchai, S., Taneepanichskul, S., & Putwatana, P. (2018). Prevalence of diabetes and relationship with socioeconomic status in the Thai population: National Health Examination Survey, 2004–2014. Journal of Diabetes Research, 2018, 1-8. https://doi.org/10.1155/2018/1654530

Al-Amer, R., Ramjan, L., Glew, P., Darwish, M., & Salamonson, Y. (2015). Translation of interviews from a source language to a target language: Examining issues in cross-cultural health care research. Journal of Clinical Nursing, 24(9-10), 1151-1162. https://doi.org/10.1111/jocn.12681

Alexopoulos, A. S., Blair, R., & Peters, A. L. (2019). Management of preexisting diabetes in pregnancy: A review. Journal of the American Medical Association, 321(18), 1811-1819. https://doi.org/10.1001/jama.2019.4981

Alvidrez, J., Castille, D., Laude-Sharp, M., Rosario, A., & Tabor, D. (2019). The national institute on minority health and health disparities research framework. American Journal of Public Health, 109(S1), S16-S20. https://doi.org/10.2105/AJPH.2018.304883

American Diabetes Association. (2023). 15. Management of diabetes in pregnancy: Standards of care in diabetes—2023. Diabetes Care, 46(Supplement_1), S254-S266. https://doi.org/10.2337/dc23-S015

American Diabetes Association Professional Practice Committee. (2022). 9. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2022. Diabetes Care, 45(Supplement_1), S125-S143. https://doi.org/10.2337/dc22-S009

Auemaneekul, N., Chandanasotthi, P., Rawiworrakul, T., Sowattanangoon, N., & Boonsatean, W. (2016). Community partnership, context-based intervention and diabetes control in Thailand. Journal of Public Health, 46(3), 236-247.

Aumpanseang, V., Suthiwartnarueput, K., & Pornchaiwiseskul, P. (2022). Determinants affecting the health information sharing management and practice for patient referral in Thailand: The perceptions of patients and healthcare professionals. Perspectives in Health Information Management, 19(4), 1b.

Aziz, Z., Riddell, M. A., Absetz, P., Brand, M., & Oldenburg, B. (2018). Peer support to improve diabetes care: An implementation evaluation of the Australasian Peers for Progress Diabetes Program. BMC Public Health, 18(1), 262. https://doi.org/10.1186/s12889-018-5148-8

Bellg, A. J., Borrelli, B., Resnick, B., Hecht, J., Minicucci, D. S., Ory, M., Ogedegbe, G., Orwig, D., Ernst, D., & Czajkowski, S. (2004). Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol, 23(5), 443-451. https://doi.org/10.1037/0278-6133.23.5.443

Buhary, B. M., Almohareb, O., Aljohani, N., Alzahrani, S. H., Elkaissi, S., Sherbeeni, S., Almaghamsi, A., & Almalki, M. (2016). Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy: A retrospective study. Indian Journal of Endocrinology and Metabolism, 20(4), 481-490. https://doi.org/10.4103/2230-8210.183478

Creswell, J. W., & Creswell, J. D. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). Sage Publications.

Dennison, R. A., Ward, R. J., Griffin, S. J., & Usher-Smith, J. A. (2019). Women's views on lifestyle changes to reduce the risk of developing type 2 diabetes after gestational diabetes: A systematic review, qualitative synthesis and recommendations for practice. Diabetic Medicine, 36(6), 702-717. https://doi.org/10.1111/dme.13926

Diabetes Association of Thailand. (2017). Clinical Practice Guideline for Diabetes for 2017. Retrieved May 1 from https://www.dmthai.org/new/index.php/sara-khwam-ru/bukhlakr-thangkar-phaethy/cpg/clinical-practice-2017

E-Mekawy, H. S., Sabbour, A. A., & Radwan, M. M. (2016). Effect of antenatal exercises on umbilical blood flow and neonate wellbeing in diabetic pregnant women. Indian Journal of Physiotherapy and Occupational Therapy, 6(3), 127-131.

Farland, L. V., Rifas-Shiman, S. L., & Gillman, M. W. (2015). Early pregnancy cravings, dietary intake, and development of abnormal glucose tolerance. Journal of the Academy of Nutrition and Dietetics, 115(12), 1958-1964.e1951. https://doi.org/10.1016/j.jand.2015.04.018

Gorska-Ciebiada, M., Masierek, M., & Ciebiada, M. (2020). Improved insulin injection technique, treatment satisfaction and glycemic control: Results from a large cohort education study. Journal of Clinical & Translational Endocrinology, 19, 100217. https://doi.org/10.1016/j.jcte.2020.100217

Guetterman, T. C., Fetters, M. D., & Creswell, J. W. (2015). Integrating quantitative and qualitative results in health science mixed methods research through joint displays. The Annals of Family Medicine, 13(6), 554-561. https://doi.org/10.1370/afm.1865

Hayashi, A., Oguchi, H., Kozawa, Y., Ban, Y., Shinoda, J., & Suganuma, N. (2018). Daily walking is effective for the management of pregnant women with gestational diabetes mellitus. Journal of Obstetrics and Gynaecology Research, 44(9), 1731-1738. https://doi.org/10.1111/jog.13698

Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277-1288. https://doi.org/10.1177/1049732305276687

IBM Corp. (Released 2017). IBM SPSS Statistics for Windows, Version 25.0. In IBM Corp.

Lawrence, R. L., Ward, K., Wall, C. R., & Bloomfield, F. H. (2021). New Zealand women’s experiences of managing gestational diabetes through diet: A qualitative study. BMC Pregnancy and Childbirth, 21(1), 819. https://doi.org/10.1186/s12884-021-04297-0

Liamputtong, P., & Kitisriworapan, S. (2014). Authoritative knowledge, folk knowledge, and antenatal care in contemporary Northern Thailand. In P. Liamputtong (Ed.), Contemporary socio-cultural and political perspectives in Thailand. Dordrecht.

Lim, S. F., Jong, M., Chew, D. E. K., & Lee, J. Y. (2020). Impact of timing between insulin administration and meal consumption on glycemic fluctuation and outcomes in hospitalized patients With type 2 diabetes. Journal of Pharmacy Practice, 33(4), 449-456. https://doi.org/10.1177/0897190018818908

Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications.

Lundberg, P. C., & Thrakul, S. (2013). Religion and self-management of Thai Buddhist and Muslim women with type 2 diabetes. Journal of Clinical Nursing, 22(13-14), 1907-1916. https://doi.org/10.1111/jocn.12130

Mukerji, G., Bacon, S., & Feig, D. S. (2020). Gestational diabetes and type 2 diabetes during pregnancy. Maternal-Fetal and Neonatal Endocrinology, 371-388. https://doi.org/10.1016/B978-0-12-814823-5.00022-2

Netgrajang, C. (2019). Strengthening multidisciplinary approach to prevent and control complications of diabetes mellitus in pregnant women. The Journal of Prapokklao Hospital Clinical Medication Education Center, 36(2), 168-177.

Pamungkas, R. A., Chamroonsawasdi, K., & Vatanasomboon, P. (2017). A systematic review: Family support integrated with diabetes self-management among uncontrolled type II diabetes mellitus patients. Behavioral Sciences, 7(3), 62. https://doi.org/10.3390/bs7030062

Park, J., Bigman, E., & Zhang, P. (2022). Productivity loss and medical costs associated With type 2 diabetes among employees aged 18-64 years with large employer-sponsored insurance. Diabetes Care, 45(11), 2553-2560. https://doi.org/10.2337/dc22-0445

Persson, M., Cnattingius, S., Wikström, A.-K., & Johansson, S. (2016). Maternal overweight and obesity and risk of pre-eclampsia in women with type 1 diabetes or type 2 diabetes. Diabetologia, 59(10), 2099-2105. https://doi.org/10.1007/s00125-016-4035-z

Peyrot, M., Dreon, D., Zraick, V., Cross, B., & Tan, M. H. (2018). Patient perceptions and preferences for a mealtime insulin delivery patch. Diabetes Therapy, 9(1), 297-307. https://doi.org/10.1007/s13300-017-0365-1

Phonyiam, R. (2022). Barriers and facilitators to diabetes self-management in pregnant women with pre-existing type 2 diabetes mellitus: A scoping review. Current Diabetes Reviews. https://doi.org/10.2174/1573399819666220627111430

Phonyiam, R. (2024). Self-management and breastfeeding in women with preexisting type 2 diabetes mellitus from Thailand [Dissertation, The University of North Carolina at Chapel Hill]]. Chapel Hill, NC, USA.

Phonyiam, R., Baernholdt, M., & Hodges, E. A. (2023). Self-management of type 2 diabetes mellitus in pregnancy and breastfeeding experiences among women in Thailand: Study protocol. PloS One, 18(6), e0286646. https://doi.org/10.1371/journal.pone.0286646

Somanawat, J., Saramunee, K., & Chanasopon, S. (2020). Process, quality and challenges of diabetes care in primary care: A study of district health network in Thailand. Primary Health Care Research & Development, 21, e46. https://doi.org/10.1017/s1463423620000468

Sowattanangoon, N., Kotchabhakdi, N., & Petrie, K. J. (2009). The influence of Thai culture on diabetes perceptions and management. Diabetes Research and Clinical Practice, 84(3), 245-251. https://doi.org/10.1016/j.diabres.2009.02.011

Sumriddetchkajorn, K., Shimazaki, K., Ono, T., Kusaba, T., Sato, K., & Kobayashi, N. (2019). Universal health coverage and primary care, Thailand. Bulletin of the World Health Organization, 97(6), 415-422. https://doi.org/10.2471/blt.18.223693

Sushko, K., Strachan, P., Butt, M., Nerenberg, K. A., & Sherifali, D. (2023). Understanding the self-management experiences and support needs during pregnancy among women with pre-existing diabetes: A qualitative descriptive study. BMC Pregnancy and Childbirth, 23(1), 309. https://doi.org/10.1186/s12884-023-05542-4

Swarna Nantha, Y., Chelliah, A. A. P., Haque, S., & Md Zain, A. Z. (2021). The internal realities of individuals with type 2 diabetes-Psychological disposition in self-management behaviour via grounded theory approach. PloS One, 16(4), e0249620. https://doi.org/10.1371/journal.pone.0249620

Wirtz, M. A., Röttele, N., Morfeld, M., Brähler, E., & Glaesmer, H. (2021). Handling missing data in the Short Form-12 Health Survey (SF-12): Concordance of real patient data and data estimated by missing data imputation procedures. Assessment, 28(7), 1785-1798. https://doi.org/10.1177/1073191120952886

Xie, J., He, Z., Burnett, G., & Cheng, Y. (2021). How do mothers exchange parenting-related information in online communities? A meta-synthesis. Computers in Human Behavior, 115, 106631. https://doi.org/10.1016/j.chb.2020.106631

Youngwanichsetha, S., & Phumdoung, S. (2017). Lived experience of blood glucose self-monitoring among pregnant women with gestational diabetes mellitus: A phenomenological research. Journal of Clinical Nursing, 26(19-20), 2915-2921. https://doi.org/10.1111/jocn.13571