Intention to adopt a healthy diet among women with and without a history of gestational diabetes: Constructs and beliefs from the theory of planned behavior.

Women with a history of gestational diabetes (GDM) have difficulty maintaining a healthy diet after delivery. The theory of planned behavior (TPB) is effective in identifying the determinants of adopting a healthy diet. The objectives were to identify the determinants of the intention to adopt a healthy diet among the TPB constructs in women with (GDM+) and without (GDM-) a history of GDM, and to identify the beliefs associated with these constructs. The study was conducted in Québec (Canada) between 2009 and 2017. Data from 213 GDM+ and 91 GDM- women were analyzed. Women completed a questionnaire on the determinants of intention to adopt a healthy diet, defined as adherence to 2007 Canada's Food Guide. The subjective norm and perceived behavioral control (PBC) constructs were associated with the intention to adopt a healthy diet among GDM+ women (ß = 2.21 and ß = 4.37, respectively, p < 0.0001), whereas among GDM- women, PBC was the only construct associated with intention (ß = 0.78; p < 0.0001). More specifically among GDM+ women, the disapproval of a family member other than the partner (ß = 1.49; p = 0.0005), not feeling capable of adopting a healthy diet with access to food treats (ß = 1.58; p < 0.0001), lack of free time (ß = 1.31; p = 0.002), lack of information about healthy eating (ß = 1.02; p = 0.015) or lack of easy recipes to prepare (ß = 0.84; p = 0.042) was associated with a lower intention to adopt a healthy diet. Overall, among GDM+ women, different beliefs related to the subjective norm and PBC could be targeted to improve the eating habits of this specific population.

Evaluation of the implementation of single points of access for unattached patients in primary care and their effects: a study protocol.

INTRODUCTION: Attachment to a primary care provider is an important component of primary care as it facilitates access. In Québec, Canada, attachment to a family physician is a concern. To address unattached patients' barriers to accessing primary care, the Ministry of Health and Social Services mandated Québec's 18 administrative regions to implement single points of access for unattached patients (Guichets d'accès première ligne (GAPs)) that aim to better orient patients towards the most appropriate services to meet their needs. The objectives of this study are to (1) analyse the implementation of GAPs, (2) measure the effects of GAPs on performance indicators and (3) assess unattached patients' experiences of navigation, access and service utilisation. METHODS AND ANALYSIS: A longitudinal mixed-methods case study design will be conducted. Objective 1. Implementation will be analysed through semistructured interviews with key stakeholders, observations of key meetings and document analysis. Objective 2. GAP effects on indicators will be measured using performance dashboards produced using clinical and administrative data. Objective 3. Unattached patients' experiences will be assessed using a self-administered electronic questionnaire. Findings for each case will be interpreted and presented using a joint display, a visual tool for integrating qualitative and quantitative data. Intercase analyses will be conducted highlighting the similarities and differences across cases. ETHICS AND DISSEMINATION: This study is funded by the Canadian Institutes of Health Research (# 475314) and the Fonds de Soutien à l'innovation en santé et en services sociaux (# 5-2-01) and was approved by the CISSS de la Montérégie-Centre Ethics Committee (MP-04-2023-716).

Prevention of gestational diabetes mellitus: a review of studies on weight management.

Entering pregnancy with overweight, obesity or gaining excessive gestational weight could increase the risk of gestational diabetes mellitus (GDM), which is associated with negative consequences for both the mother and the offspring. The objective of this article was to review scientific evidence regarding the association between obesity and GDM, and how weight management through nutritional prevention strategies could prove successful in reducing the risk for GDM. Studies published between January 1975 and January 2009 on the relationship between GDM, pre-pregnancy body mass index (BMI), gestational weight gain and nutritional prevention strategies were included in this review. Results from these reports suggest that maternal obesity assessed by pre-pregnancy BMI is associated with an increased risk of GDM. They also show an association between gestational weight gain and increased risk for GDM. Higher dietary fat and lower carbohydrate intakes during pregnancy appear to be associated with a higher risk for GDM, independent of pre-pregnancy BMI. Some studies showed that restricting energy and carbohydrates could minimize gestational weight gain. However, a firm conclusion on the most effective nutritional intervention for the control of gestational weight gain and glycaemic responses could not be reached based on available studies. In light of the studies reviewed, we conclude that weight management through nutritional prevention strategies could be successful in reducing the risk of GDM. Further studies are required to identify the most effective diet composition to prevent GDM and excessive gestational weight gain.