Self-management of type 2 diabetes mellitus in pregnancy and breastfeeding experiences among women in Thailand: Study protocol.

Women with type 2 diabetes mellitus are at a higher risk of pregnancy complications. Although traditional beliefs and practices influence diabetes management and breastfeeding, recommendations integrating Thai cultural beliefs in maternal care are lacking. The purpose of this study is to describe diabetes self-management in pregnancy and breastfeeding experiences in women with preexisting type 2 diabetes mellitus from Thailand. A convergent parallel mixed-methods study will be conducted. Data will be collected from 20 pregnant women with preexisting type 2 diabetes mellitus in Thailand who are either primigravida or multigravida, aged 20-44 years old, speak the Thai language, and provide consent. The National Institute on Minority Health and Health Disparities Framework's sociocultural and behavioral domains guides the research aims. Data will be collected two times. The first time is during pregnancy (T1); study participants will complete questionnaires and engage in an interview about diabetes self-management, breastfeeding confidence, and breastfeeding intention. The second time is at 4-6 weeks postpartum (T2); study participants will be interviewed about their breastfeeding experiences. We will review and extract maternal health outcomes including body mass index, gestational weight gain, and glycated hemoglobin for T1 as well as fasting plasma glucose for T2. Qualitative data will be analyzed using directed content analysis. Quantitative data will be analyzed using descriptive statistics. Data sources will be triangulated with relative convergence in the results. This proposed study is significant because the findings will be used as a preliminary guide to developing a culturally tailored approach to enhance health outcomes of Thai women with diabetes in pregnancy and postpartum periods.

Symptom Clusters That Included Gastrointestinal Symptoms Among Children Receiving Cancer Treatments: A Scoping Review.

PROBLEM IDENTIFICATION: Composition and measurement of the gastrointestinal (GI) symptom cluster (SC) has been inconsistent; therefore, a gap exists in understanding of the GI SC. The purpose of this study was to synthesize findings from prior studies to better understand the GI SC and accompanying non-GI symptoms in children receiving cancer treatment. LITERATURE SEARCH: PubMed®, Embase®, CINAHL®, Scopus®, and PsycINFO® databases were searched through February 2022. Of 661 articles identified, 8 met inclusion criteria. DATA EVALUATION: A standardized investigator-developed form was used to extract data from eligible studies, including study and sample characteristics, analytic procedure, SCs that included GI symptoms, and influencing factors. SYNTHESIS: The 12 most frequently reported GI and accompanying non-GI symptoms were identified across 20 SCs. Phi correlation coefficients were calculated as indicators of strength of association between each pair of co-occurring symptoms within an SC. IMPLICATIONS FOR RESEARCH: Future studies should develop and test tools to comprehensively assess GI and accompanying non-GI symptoms and interventions that target shared underlying mechanisms.

Cross-cultural adaptation and content validation of the Infant Feeding Intentions Scale for Thai pregnant women.

This study aimed to validate a translated and culturally adapted version of the Infant Feeding Intentions (IFI) Scale for use in Thailand. Prenatal breastfeeding intention is a strong indicator of breastfeeding initiation. The stronger the intention to breastfeed among pregnant women, the more likely breastfeeding will be initiated after childbirth and continue for an extended period. There are currently no IFI scales that have been validated for use in Thailand. The translation of the IFI scale from English to Thai was conducted through a six-stage approach that included initial translation, synthesis of translations, back-translation, expert committee review for content validity, reliability testing, and submission of the translated IFI to notify the scale developers. Both Item and Scale Content Validity Indices equaled 1, scored by five experts, who also validated the content for cross-cultural adaptation. The final Thai IFI (T-IFI) scale demonstrated high content validity. A total of 30 Thai pregnant women participated in the reliability testing. The Cronbach's alpha of the 5-item T-IFI scale was 0.857, which indicated satisfactory internal consistency. The T-IFI scale demonstrated high content validity and was culturally appropriate for use in a Thai-speaking population. It has potential to strengthen assessments of prenatal infant feeding intention among pregnant women in Thailand.

Barriers and Facilitators to Diabetes Self-Management in Pregnant Women with Pre-existing Type 2 Diabetes Mellitus: A Scoping Review.

BACKGROUND: Pregnant women with pre-existing type 2 diabetes mellitus (T2DM) are at risk of poor maternal and neonatal health outcomes. Previous systematic reviews on pregnant women with T2DM have focused on physical activity, blood glucose monitoring, and insulin injections. OBJECTIVE: The purpose of this scoping review was to examine the barriers and facilitators to diabetes self-management in pregnant women with pre-existing type 2 diabetes mellitus. METHODS: PubMed, CINAHL, and EMBASE databases were searched using the PRISMA-ScR guidelines. Inclusion criteria included manuscripts written in English and qualitative studies. Consensus statements were excluded. A metasummary was used to identify patterns in barriers and facilitators across studies. A vote-counting method was used to summarize qualitative findings. RESULTS: A total of ten qualitative publications were selected. This review suggests four themes describing barriers, including barriers to diabetes self-management in pregnancy, stress related to pregnancy with diabetes, a barrier to access to health care, and sensing a loss of control. The fifth theme described facilitators of diabetes self-management in pregnancy. CONCLUSION: This supports an integrative model of maternity care and culturally relevant practices to overcome critical barriers and optimize key facilitators to enhance diabetes self-management behaviors and improve maternal and neonatal health outcomes.

Adaptation to poststroke fatigue in stroke survivors and their care partners: a scoping review.

PURPOSE: Fatigue is a long-term symptom for stroke survivors. This scoping review synthesized how survivors achieve fatigue adaptation. METHODS: Four databases were searched for studies between 2012 and 2021. Qualitative studies or qualitative findings from mixed-methods studies were included if they described survivors' experiences with fatigue and/or care partners' experiences in helping survivors adapt to fatigue. Studies were excluded if they were poster abstracts, reviews, or editorials. RESULTS: Thirty-six articles were analyzed. Survivors with fatigue described different adaptive challenges - fatigue made them less productive, brought emotional distress, and was indiscernible to others. To respond to these challenges, stroke survivors did adaptive work including conserving energy, changing mindset, and restructuring normality. Care partners, employers, and colleagues showed adaptive leadership by adjusting daily routines or role responsibilities. Most survivors described that the current clinical practice did not meet their needs to address fatigue. CONCLUSIONS: Stroke survivors had many types of challenges and strategies for fatigue adaptation. Survivors received family, employer, and colleague support but how care partners help survivors develop new skills is unknown. Stroke survivors expressed that healthcare professionals need to teach survivors and care partners basic knowledge of fatigue that meet their personal needs and provide adaptive interventions for survivors. Implications for rehabilitationThe challenges of poststroke fatigue are multifaceted because fatigue influences stroke survivors' physical, cognitive, mental, and social aspects of recovery.Stroke survivors need support from their care partners such as helping them adapt to the fatigue, adapt to new life routine, and adjust role responsibilities.Healthcare professionals, stroke survivors, and care partners need to work together to develop strategies about poststroke fatigue that meet stroke survivors' personal needs.

Racial and Ethnic Disparities in Health Care and Health Outcomes for Pregnant Women With Diabetes.

This article summarizes the current literature on racial and ethnic differences among women with diabetes in pregnancy. The PubMed, Scopus, CINAHL, and Embase databases were searched for original qualitative or quantitative studies published in English from January 1, 2009, to May 31, 2020. Consensus statements were excluded. Results of this synthesis indicate that racial and ethnic differences exist among pregnant women with diabetes, including social determinants of health, disparities in maternity care and perinatal care, and maternal and neonatal health outcomes. Health care providers should implement tailored interventions that specifically target racial and ethnic disparities in maternal and neonatal health to promote health equity in pregnant women with diabetes and their offspring, including later in life.