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Abstract
Pre-pregnancy care (PPC) reduces adverse pregnancy outcomes for women with pre-existing diabetes. Yet, despite the compelling case for PPC, participation rates remain poor. The reasons for poor participation are as yet unclear. The aim of this study was to further our understanding of the factors-associated PPC uptake, particularly attitudes and beliefs towards PPC using models of health behaviour: The Health Belief Model, Social Cognitive Theory, and Theory of Reasoned Action. Participants comprised 123 women with type 1 and 2 diabetes attending outpatient clinics for diabetes and pregnancy, who completed questionnaires. Logistic regression analysis indicated that after adjusting for socio-demographic factors, exposure to a greater number of cues was a significant predictor of PPC participation (odds ratio [OR]: 1.93; 95% confidence interval [95% CI]: 1.13–3.28). Other significant predictors of PPC uptake were older age (OR: 1.13; 95% CI: 1.01–1.26) and not having children (OR: 3.93; 95% CI: 1.28–12.06). The findings from this study support initiatives to provide cues to PPC for women with diabetes to enhance PPC uptake. Further, some groups such as younger women as well as women with children may possibly be considered for the focus of more vigorous intervention efforts.
Acknowledgements
This work formed part of A. K.’s PhD. A. K., F. J. and A. N. designed the study. A. K, F. J and H. J interpreted the data and wrote the manuscript. A. K. collected the data. A. N., J. C. and C. A. provided clinical care and supervised data collection. All authors reviewed/edited the manuscript. The authors wish to acknowledge the kind assistance of Dr Denise Charron-Prochownick in providing access to the Pregnancy and Diabetes Interview Schedule (PDIS) and Reproductive Health Attitudes and Behavior (RHAB) questionnaire and the clinical and administrative staff at the Diabetes and Pregnancy Clinics at the Royal Women’s Hospital and Southern Health Network for their assistance in data collection.
Participation rates in pre-pregnancy care (PPC) is poor for women with pre-existing diabetes
PPC attendance is higher for women from higher socio-economic background
Less is known of the influence of attitudes, beliefs and perceptions on the observed low participation rates in PPC
Current knowledge on the subject
Identified that three groups of women with type 1 and type 2 diabetes in an Australian sample are potentially at risk for non-uptake of pre-pregnancy care: women of younger age, women with children and women who have less exposure to cues (about pre-pregnancy care and diabetes)
Identified that in general attitudes, beliefs and perceptions are not sufficient in themselves to distinguish between women who are likely to seek pre-pregnancy care and those who do not