Understanding psycho-social factors influencing lifestyle of women with a history of gestational diabetes in Pakistan

Lifestyle interventions are proven to be effective in preventing or delaying type 2 diabetes mellitus (T2DM) in high risk individuals, such as women with a history of gestational diabetes mellitus (GDM) referred to henceforth as GDM women. This thesis was designed to address the lack of understanding of factors that affect lifestyle of GDM women in Pakistan and identify suitable approaches for intervention. A series of studies were conducted to develop valid and reliable measures for constructs in the trans-theoretical model (TTM), family support and diet and to test a model for lifestyle change. The study participants were recruited from a tertiary care hospital in Karachi, Pakistan. The qualitative study used in-depth interviews (n=24) and group discussions (n=17) and was analysed thematically. Measures were developed and tested in a cross sectional survey of post-natal women (n=331). Exploratory factor analysis was used to examine the construct validity of measures and Partial least Square (PLS) to predict diet and physical activity of GDM women in Pakistan. The qualitative findings revealed lack of knowledge, social support, cultural expectations and gender role as influencing lifestyle of GDM women. Variables that included TTM constructs (pros and cons, self efficacy and stages of change), family support and selected demographic factors predicted 44 percent of variance in dietary fat intake and 38 percent of physical activity of GDM women. These models explained much less of the variance in non-GDM women. Self-efficacy, cons for change and positive family support were the most significant predicators of dietary behaviour. Self-efficacy and cons for change were significant predictors of physical activity. This study makes an original contribution to the gap in knowledge of factors that affect lifestyle behaviours of GDM women in a South Asian context, and specifically Pakistan. The findings indicate that interventions for GDM women using strategies to improve self efficacy, addressing perceived cons, and using family support would be effective. Culturally specific messages, delivered by a health care provider targeting weight management would be acceptable for GDM women in Pakistan. The findings inform the design of a lifestyle intervention for this target group