Question

• Knowing Your Population

Using data gathered from the text, South University Online Library resources, and websites, create an outline of the entire research paper or internship proposal you will submit for the class.

On the basis of your research, create a 2- to 3-page report:

• Explaining how you will research components of the data required in the paper portion of the appendix of the Capstone handbook

Answer 1

“A PHENAMINOLOGICAL STUDY TO ASSESS THE LIVED EXPERIENCE OF WOMEN WITH GDM’’

1. INTRODUCTION

'Diabetes Mellitus' is one of the major public health issues in India. Kerala being the capital of worldwide diabetic population , the prevalence rate is high. Gestational diabetes (GDM) is characterised by high blood glucose levels which occur at any time during pregnancy most likely after 24 week and usually disappears after the pregnancy. According to International Diabetes Federation [IDF] globally 60 million women in reproductive age are victims of diabetes. In India 6 million births are affected by some form of hyperglycemia during pregnancy, 90% are due to GDM. The GDM rate in India is 26.3% and it is highest in the world. Prevalence of GDM is steadily increasing over the past decades. 1/7 of birth is affected by GDM . Women with history of GDM usually develop type 2 diabetes within five to ten years after child birth.

Ø NEED AND SIGNIFICANCE

GDM has great impact on both mother and newborn. GDM impact on pregnancy leads to adverse pregnancy outcomes. Poorly controlled GDM leads to vascular problems like retinopathy, nephropathy, hypertension, hyperglycemia, hypoglycemia and diabetic ketoacidosis. Besides this other maternal risks of GDM are spontaneous abortion, preeclampsia, preterm labour, polyhydramnios , infections, pyelonephriitis , chorioamnionitis and increased operative interference.   Fetal and neonatal effects include IUGR ,congenital defects like neural tubal defects,cardiac anomalies ,gastrointestinal malformations and renal anomalies ntrauterine fetal death, shoulderdystocia, macrosomia, ,sacral agenesis and increased operative interference which make one’s pregnancy as a complicated one. Infants born to diabetic woman may be large for date but have immature organ function such as delayed lung maturity and respiratory problems. Thus the newborns are more prone to develop asphyxia , hypoglycemia and neonatal jaundice. During childhood children are more prone to have learning disabilities , propensity for obesity and type 2 diabetes mellitus .

The prevalence of hyperglycemia in pregnancy increases repidly with age. In 2019 there were an estimated 233 millions women at 20-29 years of age living with diabetes. This number is projected to increase 345 millions by 2045. 20 millions or 16% of live births had some form of hyperglycemia in pregnancy and 84% were due to GDM. The vast majority of cases of hyperglycemia in pregnancy were in low and middle income countries. 3 out of 4 people with diabetes live in middle income countries. IDF atlas reported that 10% of global expenditure is for diabetes alone.

2. LITERATURE REVIEW

Ø SYNTHESIS AND IDENTIFICATION OF RESEARCH GAP

Many literatures are available regarding various aspects of gestational diabetes.

A retrospective study was conducted at antenatal clinic at KAUH Saudi Arabia in the year 2016 revealed association of parity with GDM. GDM was significantly higher multigravida. Grand multigravida women had lower risk of GDM as compared to multi, primi and multigravida. Prevalence of GDM was found to be 12.75%.

A cross sectional study conducted among 13000 pregnant women attending antenatal clinic at Peru to estimate the prevalence and risk factors of GDM revealed that GDM is prevalent and associated with maternal obesity, family history of diabetes and antepartum depression among women.

A qualitative study to describe the lived experience of women during high risk pregnancy was conducted among 20 nulligravida and multigravida women at urban public health centres in Iran found that women with high risk pregnancy struggle to adapt with maternal role attainment and family functioning and also had fear about pregnancy outcome. Pregnancy itself demands many adaptations and any high risk situation make them more vulnerable which necessitate health sector support for effective completion of safe pregnancy till term.

A phenomenological study was conducted to explore the women experience of self-managing GDM among 15 women showed gradual process of adaptation after diagnosis of GDM   and a desire for a healthy baby motivated the women to be receptive to interventions to control their GDM. Here self awareness of disease conditions brought modification in their health behavior which helped them to attain euglycemia .

A qualitative study was conducted among 19 women to explore the concrens, needs and knowledge of women diagnosed with GDM. Focus group were asked open ended questions to explore current knowledge of GDM, anxiety, understanding and managing GDM and future impact of GDM. This study emphasized that midwives and health care professionals need to give individual and culturally appropriate care to improve health.

A phenomenological qualitative study was conducted in Australia to explore the lived experience of GDM among immigrant South Asian women revealed   that before the diagnosis awareness regarding GDM was low. Women and partners were upset by diagnosis. This findings emphasis the need of culturally appropriate care for the victims of GDM.

In nutshell it is evedent that the better awarness regarding needs and concerns of women with GDM is inevitable to render comprehensive care to the vulnerable population .Thus diabeteic care team could support all expectant mothers to bring their dreams come true.    

Diabetes is one of the most common metabolic disorder which affect most of the women from South Asia .Women from South Asia have a high incidence of GDM make them at risk of adverse pregnancy outcomes. GDM is a severe and negleceted threat to maternal and child health. People with diabetes are two to three times more prone to own depression .Many studies are conducted   regarding GDM management and that would be better if we find real lived experienceof mothers with GDM. There are no such studies are conducted in our country and it is an ever emerging need to expolre women’s experience of having a pregnacy with GDM to help them to manage their prenancy effectively. Pregnacy itself is a period of adaptation for a new mother and to achieve a healthy baby from a healthy mother health sector should focus on mother's perceived need.  

3.OBJECTIVES

A. To assess the lived experience of women with GDM.

B. To develop a health package/ cost effective intervention on selfcare management of GDM.

4. SCOPE

GDM is a health hazard that have the potential to affect health and wellbeing of the entire society by its increased expenditure for treatment. Modern world consider diabetes as worst as cancer . Diabetes demands modification of lifestyle to make one's life safe. Any neglignce may lead to troubles to the individual,family and society.So the best method to control its growing prevalence isto develop cost effective management modalities easily available and acceptable to the victims.In order to develop such a treatment modalities it is essential to understand the lived experience of people with diabetes and health challenges which make their life miserable.

5.LIMITATIONS

This study includes only antenatal mothers admitted in hospital.

6. HYPOTHESIS

Nil. Qualitative study.

7. RESEARCH METHODOLOGY

a. STATEMENT OF THE PROBLEM

‘A PHENAMINOLOGICAL STUDY TO ASSESS THE LIVED EXPERIENCE OF WOMEN WITH GDM ADMITTED IN SELECTED HOSPITALS ’

b.RESEARCH DESIGN - QUALITATIVE INTERVIEW STUDY

c.SAMPLING DESIGN - PURPOSIVE SAMPLING TECHNIQUE.

Tool -Face to face interview 30 mts duration. Open ended questions.

Sample -Women both primi and multimothers diagnosed with GDM

Primi andmulti gravida mothers who are willing .

GDM without other pregnacy complications.

d. DATA COLLECTION STRATEGY

After obtaining ethical clearance and administrative permission from research committee of college researcher plan to conduct pilot study and main study at ........ Samples are mothers both primi and multi who are diagnosed with GDM and admitted at hospital. Samples are collected as per inclusion criteria .Data collection from to till data saturation.

e. PLANNING AND ANALYSIS OF DATA-

PHENAMINOLOGICAL HERMENEUTICS