“A Wake-Up Call”: A Mixed-Methods Analysis of Barriers to Type 2 Diabetes Prevention After Gestational Diabetes Mellitus

Abstract

BACKGROUND Individuals who have gestational diabetes mellitus (GDM) are advised to engage in physical activity and healthy eating behaviors in the postpartum period to prevent type 2 diabetes. We aimed to understand individual perspectives on incorporating such lifestyle choices during the first postpartum year. METHODS This was a mixed-methods analysis of data from individuals with GDM who completed surveys and in-depth interviews at 4–12 weeks and 11–13 months postpartum as part of their participation in a feasibility randomized controlled trial on postpartum patient navigation. Participant attitudes were elicited with surveys (structured items with Likert-scale responses) and interviews that focused on barriers to postpartum type 2 diabetes prevention. We used a concurrent, triangulation design to jointly analyze survey data alongside interview data. RESULTS Of 40 participants, 39 provided data about their type 2 diabetes prevention activities. Interview themes triangulated with survey results to yield consistent insights about attitudes regarding physical activity and healthy eating. The majority of participants reported that caring for a new baby and family responsibilities made it much harder to be physically active; fewer participants identified cost of exercise, accessing a safe area to exercise, or breastfeeding as barriers. The most common barriers to healthy eating included caring for a new baby, family responsibilities, and work/school schedules. Although proximity and transportation to healthy food sources were uncommon barriers, when they did occur, they were experienced as major burdens. CONCLUSION Individuals who had GDM reported many barriers to implementing recommended postpartum lifestyle choices. Recognizing these unique needs may enhance provision of guidance for type 2 diabetes prevention postpartum.