الفهرس 
? Aim of the studyOnly 14 pages are availabe for public view
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Abstract
Gestational Diabetes Mellitus (GDM) is defined as a type of glucose intolerance with onset or first recognition during pregnancy and normally goes away after the baby is born. GDM is primarily diagnosed during pregnancy in the second or third trimester which leads to severe maternal and fetal complications. It is a common medical complication in pregnancy that has been rapidly increasing worldwide.
Knowledge is an important component of health concept’s shaping or gestational diabetic women. Also, the pregnant women attitude towards the gestational diabetes could directly affect perception of the need for special training, affect the autonomy in the treatment and the style or channels while communicate with the medical care team and this lead to improvement in the women’s self-care practice. Gestational diabetic self-care practices include a healthy diet, regular exercise, antenatal care blood glucose monitoring and medication compliance, checking cholesterol levels and losing weight. These health practices are associated with good glycemic control, reducing complications and improvement in the pregnant women health status.
Maternity nurses play а crucial role in the quality of antenatal care improvement, which provides pregnant woman education and support. The nurse provide health promotion and psycho social services include assessment, counseling and appropriate referral. The maternity nurses play an important role in designing multidisciplinary strategy and treatment plans to cover women in the antenatal care. Nurses have a significant role in educating women how to prevent gestational diabetes adverse effects on pregnancy and fetal outcomes through providing health education about regular exercises, dietary adjustment, regular blood glucose monitoring and proper taking of medication.
The study aimed to evaluate the effect of instructional package on knowledge, attitudes and self-care practices among gestational diabetic women.
The hypotheses of the current study was: H1: Implementation of instructional package would improve knowledge of the pregnant women regarding gestational diabetes. H2: Implementation of instructional package would improve attitudes of the pregnant women regarding gestational diabetes. H3: Implementation of instructional package would improve self-care practices of the pregnant women regarding gestational diabetes.
Study design: A quasi-experimental study design (one group: time series quasi experimental design) was used to fulfill the aim of study.
Study setting: This study was conducted at obstetrics and gynecological outpatient clinic and Obstetrics and Gynecological department in Benha University hospital.
Sample type: A Purposive sample was used to achieve the aim of the study. Sample size: All pregnant women diagnosed with gestational diabetes and attained to the pre-mentioned setting for 9 months (64 women) according to following inclusion criteria: pregnant women medically diagnosed with gestational diabetes and gestational age during the second and third trimester of pregnancy between 24-28weeks
Tools of data collection: Four tools were used for collecting data: Tool I -:
A structured interviewing questionnaire (Appendix I): This tool was constructed by the researcher in Arabic language after reviewing of related literatures under the guidance of supervisors. It comprised two main parts: Part 1: Socio demographic characteristics of the pregnant women consisted of closed ended questions (4 items) such as (age, residence, level of education and occupation). Part 2: Obstetric history: consisted of closed and open ended questions (5 items) such as (gestational age, gravidity, parity, previous history of gestational diabetes and family history of gestational diabetes). Tool II –: Maternal knowledge questionnaire (Appendix II): It was used to assess knowledge of pregnant women related to gestational diabetes mellitus. It consisted of (15questions). Tool III- Modified likert scale (Appendix III) It was used to assess pregnant women’s attitudes regarding gestational diabetes mellitus. It consisted of 11statements. Tool IV: Diabetic Self- Care Practices Questionnaire (Appendix IV): It was used to assess pregnant women’ self-care practices regarding gestational diabetes, it was used three times before, after and follow up an instructional package implementation. It consisted of (20 items) grouped under (5) categories: Category (1): Pregnant women’ self-care practices regarding following the diet plan developed by the dietitian, It consisted of (6 items). Category (2): Pregnant women’ self-care practices regarding checking of blood glucose at home. It consisted of 4 items. Category (3): Pregnant women’ self-care practices regarding taking medications regularly and following the movement of the fetus. It consisted of 3 items. Category (4): Pregnant women’ self-care practices regarding regular exercise training and monitoring weight. It consisted of 4 items. Category (5): Pregnant women’ self-care practices regarding personal hygiene and skin care. It consisted of 3 items.
Results: The important findings that were obtained from the study can be summarized as follows:
The present study revealed that (60.9%) of studied sample were in age group > 30 years with a mean age of 26.02±7.57 years. As regards the residence, more than half (51.6%) of them lived in rural areas. Moreover, (76.6%) were housewives. In relation to the educational level, (54.7%) of them had secondary education.
There was a marked improvement in knowledge, attitudes and self-care practices of studied sample regarding gestational diabetes after implementation of the instructional package with a highly statistical significant difference (p<0.001) at pre, 2 weeks post and one-month post-intervention phases.
The finding of the present study clarified that, there was a statistically significant relation between total knowledge score regarding gestational diabetes and (educational level and occupation) of the studied pregnant women at pre-intervention phase (p ≤ 0.05).
Also, the finding of the present study clarified that, there was a statistically significant relation between (total attitude score, total self-care practices score) regarding gestational diabetes and only educational level of the studied sample at pre-intervention phase (p ≤ 0.05).
There was no statistically significant relations between total (knowledge scores, attitude scores and self-care practices scores) and socio-demographic data of the studied pregnant women at 2 weeks and one-month post-intervention phases (P> 0.05).
There was a highly statistical significant positive correlation between total knowledge and (total attitude &total self-care practices) regarding gestational diabetes at 2 weeks and one-month post-intervention phases (P≤ 0.001).
There was a highly significant statistical positive correlation between total attitude and total self-care practices regarding gestational diabetes at 2 weeks and one-month post-intervention phases (P≤ 0.001).
Conclusion: Based on the findings of the present study, it was concluded that there was a marked improvement in pregnant women’ total knowledge, attitude and self-care practices regarding gestational diabetes after implementation of the instructional package with a highly statistical significant difference (p<0.001) at pre, 2 weeks post and one-months post-intervention phases. There was a statistically significant relation between total knowledge score regarding gestational diabetes and (educational level and occupation) of the studied sample at pre-intervention phase (p ≤ 0.05). Also, there was a statistically significant relation between (total attitude score, total self-care practices score) regarding gestational diabetes and only educational level of the studied sample at pre-intervention phase (p ≤ 0.05). While, there was no statistically significant relation between total (knowledge, attitude, self-care practices) scores with socio demographic characteristics of the studied sample at 2 weeks and one-month post-intervention phases (P> 0.05). There was a highly statistical significant positive correlation between total knowledge and (total attitude & total self-care practices) regarding gestational diabetes at 2 weeks and one-month post-intervention phases (P≤ 0.001). Furthermore, there was a highly significant statistical positive correlation between total attitude and total self-care practices at 2 weeks and one-month post-intervention phases (P≤ 0.001). Hence the aim of the study was achieved and research hypotheses were accepted.
Recommendations
Development of a training program for maternity nurses and evidence based interventions to provide a better view of the women health promotion strategies related to gestational diabetes.
Application of the instructional guidelines regarding gestational diabetes in the routine care in antenatal care clinics and continuously implemented to increase women’s knowledge and improve their attitude about gestational diabetes as well as promote their self-care practices and lifestyle.
Screening program to discover high risk groups for GDM and pregnant women with positive family history to diabetes for early management and follow up.
Applying instructional package and counseling tips in gestational diabetic women discharge teaching plan to maintain healthy life style and maximum glycemic control prior to a future conception.
Further researches:
Investigate the impact of gestational diabetes educational program on women’s quality of life.
Training courses and workshops about gestational diabetes care and management for health care providers (maternity nurses) at antenatal clinics should be conducted at regular intervals.
Future researches are needed on large probability sample at different settings to generalize the results.