妊娠期糖尿病患者孕期参与体力活动促进及障碍因素的质性研究

doi:10.3761/j.issn.0254-1769.2025.14.003

摘要/Abstract

摘要：

目的了解妊娠期糖尿病（gestational diabetes mellitus，GDM）患者孕期参与体力活动的促进及障碍因素，以期为促进其参与体力活动进而实现良好的血糖管理提供指导。方法采用目的抽样法，选取2023年7月—12月在上海市某三级甲等妇产科医院住院及营养门诊的12例GDM患者进行面对面半结构式深度访谈。以能力、机会、动机-行为模型为理论框架，采用内容分析法分析、提炼主题。结果该研究分别从能力、机会、动机三大因素进行归纳，提炼出GDM患者孕期体力活动的3个促进因素和3个障碍因素，其中，促进因素包括能力因素（对体力活动的积极认知与健康意识的内化、健康管理知识的有效储备）、机会因素（家庭的支持与陪伴、专业人员的指导与监督、虚拟同伴支持的激励效应）、动机因素（保障胎儿安全的愿望、阶段性成就感的激励、体力活动的正向反馈）；障碍因素包括能力因素（妊娠期生理负担与体能限制、改变既往习惯的自我效能匮乏、认知能力不足）、机会因素（专业人员支持不足、信息获取困难）、动机因素（体力活动中的倦怠感、体力活动中的抵触感）。结论 GDM患者的体力活动参与受能力、机会和动机的影响。GDM患者高度依赖权威信息，临床医护人员可借助“虚拟同伴支持”，关注胎儿健康的自发性动机作用，利用阶段性成就感和正向反馈激励机制，提高参与体力活动的积极性与依从性，进而帮助GDM患者实现更佳的血糖控制效果。

关键词: 妊娠期糖尿病, 体力活动, 产前保健, 促进因素, 障碍因素, 质性研究, 产科护理

Abstract:

Objective To investigate the factors that promote or impede physical activity participation in pregnant women with gestational diabetes mellitus（GDM），aiming to offer recommendations and evidence for optimizing blood glucose control in this patient population. Methods The purposive sampling method was used to select 12 pregnant women with GDM from July to December 2023 in a tertiary hospital in Shanghai for semi-structured in-depth interviews. Content analysis and the COM-B model were used to analyze and refine the theme. Results This study categorizes and synthesizes factors influencing physical activity during pregnancy among women with GDM into 3 facilitators：capability factors（positive attitudes towards physical activity，internalization of health consciousness，effective storage of health management knowledge）；opportunity factors（family support and companionship，guidance and supervision from healthcare professionals，motivational effects of virtual peer support）；motivation factors（desire to ensure fetal safety，motivation from achieving milestones，positive feedback from physical activity）. Additionally，3 barriers were identified：capability factors（physiological burden and physical limitations of pregnancy，lack of self-efficacy in changing past habits，insufficient cognitive abilities）；opportunity factors（inadequate support from healthcare professionals，difficulty in accessing information）；motivation factors（feelings of fatigue during physical activity，resistance to engaging in physical activity）. Conclusion The participation of pregnant women with GDM in physical activities is affected by their capability，opportunities，and motivation. GDM patients exhibit a strong dependence on authoritative guidance. Through the utilization of “virtual peer support”，healthcare professionals can stimulate intrinsic motivation towards fetal well-being，enhance positive engagement and compliance with physical activities by incorporating a system of incremental achievements and positive reinforcement. This approach can ultimately assist GDM patients in achieving improved blood glucose control outcomes.

Key words: Gestational Diabetes Mellitus, Physical Activity, Prenatal Care, Facilitators, Barriers, Qualitative Research, Obstetrical Nursing

肖润希, 周英凤. 妊娠期糖尿病患者孕期参与体力活动促进及障碍因素的质性研究[J]. 中华护理杂志, 2025, 60(14): 1683-1689.

XIAO Runxi, ZHOU Yingfeng. Facilitators and barriers of physical activity participation among women with gestational diabetes mellitus during pregnancy：a qualitative study[J]. Chinese Journal of Nursing, 2025, 60(14): 1683-1689.

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