The purpose of this study was to examine the association of intrapersonal influences of diet quality as defined by the Health Belief Model constructs in women with recent histories of gestational diabetes.
Methods
A descriptive, correlational, cross-sectional design was used to analyze relationships between diet quality and intrapersonal variables, including perceptions of threat of type 2 diabetes mellitus development, benefits and barriers of healthy eating, and dietary self-efficacy, in a convenience sample of 75 community-dwelling women (55% minority; mean age, 35.5 years; SD, 5.5 years) with previous gestational diabetes mellitus. Diet quality was defined by the Alternative Healthy Eating Index (AHEI). Multiple regression was used to identify predictors of AHEI diet quality.
Results
Women had moderate AHEI diet quality (mean score, 47.6; SD, 14.3). Only higher levels of education and self-efficacy significantly predicted better AHEI diet quality, controlling for other contributing variables.
Conclusions
There is a significant opportunity to improve diet quality in women with previous gestational diabetes mellitus. Improving self-efficacy may be an important component to include in nutrition interventions. In addition to identifying other important individual components, future studies of diet quality in women with previous gestational diabetes mellitus are needed to investigate the scope of influence beyond the individual to potential family, social, and environmental factors.
Get full access to this article
View all access options for this article.
References
1.
BarbourLAMcCurdyCEHernandezTLKirwanJPCatalanoPMFriedmanJE. Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes. Diabetes Care. 2007;30:S112-S119.
2.
NicholsonWKWilsonLMWitkopCT. Therapeutic management, delivery, and postpartum risk assessment and screening in gestational diabetes. Evid Rep Technol Assess (Full Rep). 2008;162:1-96.
3.
American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2003;26:S103-S105.
4.
HuntKJSchullerKL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am. 2007;34(2):173-199.
5.
Bentley-LewisR. Late cardiovascular consequences of gestational diabetes mellitus. Semin Reprod Med. 2009;27(4):322-329.
6.
BellamyLCasasJPHingoraniADWilliamsD. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-1779.
7.
KimCNewtonKMKnoppRH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862-1868.
8.
BantleJPWylie-RosettJAlbrightAL. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31(Suppl 1):S61-S78.
9.
KiefferECSincoBKimC. Health behaviors among women of reproductive age with and without a history of gestational diabetes mellitus. Diabetes Care. 2006;29(8):1788-1793.
10.
ZehleKSmithBJCheyTMcLeanMBaumanAECheungNW. Psychosocial factors related to diet among women with recent gestational diabetes: opportunities for intervention. Diabetes Educ. 2008;34(5):807-814.
11.
RatnerREChristophiCAMetzgerBE. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab. 2008;93(12):4774-4779.
12.
TobiasDKHuFBChavarroJRosnerBMozaffarianDZhangC. Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus. Arch Intern Med. 2012;172(20):1566-1572.
13.
ShyamSArshadFAbdul GhaniR. Low glycaemic index diets improve glucose tolerance and body weight in women with previous history of gestational diabetes: a six months randomized trial. Nutr J. 2013;12:68.
14.
StoryMKaphingstKMRobinson-O’BrienRGlanzK. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253-272.
15.
RodenJ. Revisiting the Health Belief Model: nurses applying it to young families and their health promotion needs. Nurs Health Sci. 2004;6(1):1-10.
16.
ChampionVLSkinnerCS. The Health Belief Model. In: GlanzKRimerBKViswanathK, eds. Health Behavior and Health Education. 4th ed.San Francisco, CA: Jossey-Bass; 2008:45-62.
17.
Rifas-ShimanSLRich-EdwardsJWKleinmanKPOkenEGillmanMW. Dietary quality during pregnancy varies by maternal characteristics in Project Viva: a US cohort. J Am Diet Assoc. 2009;109(6):1004-1011.
18.
NussHFreeland-GravesJClarkeKKlohe-LehmanDMilaniTJ. Greater nutrition knowledge is associated with lower 1-year postpartum weight retention in low-income women. J Am Diet Assoc. 2007;107(10):1801-1806.
19.
BarkerMLawrenceWCrozierS. Educational attainment, perceived control and the quality of women’s diets. Appetite. 2009;52(3):631-636.
20.
CampbellMKMcLerranDTurner-McGrievyG. Mediation of adult fruit and vegetable consumption in the National 5 a Day for Better Health community studies. Ann Behav Med. 2008;35(1):49-60.
21.
JackaFNPascoJAMykletunA. Association of western and traditional diets with depression and anxiety in women. Am J Psychiatry. 2010;167(3):305-311.
22.
LeungBMKaplanBJ. Perinatal depression: prevalence, risks, and the nutrition link—a review of the literature. J Am Diet Assoc. 2009;109(9):1566-1575.
23.
BodnarLMWisnerKL. Nutrition and depression: implications for improving mental health among childbearing-aged women. Biol Psychiatry. 2005;58(9):679-685.
SubarAFThompsonFEKipnisV. Comparative validation of the Block, Willett, and National Cancer Institue food frequency questionnaires. Am J Epidemiol. 2001;154(12):1089-1099.
26.
BoucherBCotterchioMKreigerNNadalinVBlockTBlockG. Validity and reliability of the Block98 food-frequency questionnaire in a sample of Canadian women. Public Health Nutr. 2006;9(1):84-93.
27.
McCulloughMLFeskanichDStampferMJ. Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance. Am J Clin Nutr. 2002;76(6):1261-1271.
FungTTMcCulloughMvan DamRMHuFB. A prospective study of overall diet quality and risk of type 2 diabetes in women. Diabetes Care. 2007;30(7):1753-1757.
30.
BelinRJGreenlandPAllisonM. Diet quality and the risk of cardiovascular disease: the Women’s Health Initiative. Am J Clin Nutr. 2011;94(1):49-57.
31.
ReedyJMitrouPNKrebs-SmithSM. Index-based dietary patterns and risk of colorectal cancer: the NIH-AARP Diet and Health Study. Am J Epidemiol. 2008;168(1):38-48.
32.
AkbaralyTNSingh-ManouxATabakAG. Overall diet history and reversibility of the metabolic syndrome over 5 years: the Whitehall II prospective cohort study. Diabetes Care. 2010;33(11):2339-2341.
33.
WalkerEAFisherEMarreroDGMcNabbW. Comparative risk judgements among participants in the Diabetes Prevention Program [abstract]. Diabetes. 2001;50:A397.
34.
KimCMcEwenLNPietteJDGoeweyJFerraraAWalkerEA. Risk perception for diabetes among women with histories of gestational diabetes mellitus. Diabetes Care. 2007;30(9):2281-2286.
35.
FowlesERFeuchtJ. Testing the barriers to healthy eating scale. West J Nurs Res. 2004;26(4):429-443.
ZoellnerJBoundsWConnellC. Community health advisors’ perceptions of the 2005 dietary guidelines and MyPyramid. J Extension. 2009;47(2):20.
38.
US Department of Agriculture, US Department of Health and Human Services. Dietary Guidelines for Americans, 2010. 7th ed.Washington, DC: US Government Printing Office; 2010.
39.
KroenkeKSpitzerRLWilliamsJB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606-613.
40.
Pinto-MezaASerrano-BlancoAPenarrubiaMTBlancoEHaroJM. Assessing depression in primary care with the PHQ-9: can it be carried out over the telephone?J Gen Intern Med. 2005;20(8):738-742.
41.
HizaHACasavaleKOGuentherPMDavisCA. Diet quality of Americans differs by age, sex, race/ethnicity, income, and education level. J Acad Nutr Diet. 2012;113(12):297-306.
42.
MorrisonMKKohDLoweJM. Postpartum diet quality in Australian women following a gestational diabetes pregnancy. Eur J Clin Nutr. 2012;66(10):1160-1165.
43.
TaggartJWilliamsADennisS. A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Fam Pract. 2012;13:49.
44.
Dickson-SpillmannMSiegristM. Consumers’ knowledge of healthy diets and its correlation with dietary behaviour. J Hum Nutr Diet. 2011;24(1):54-60.
45.
Baptiste-RobertsKGaryTLBecklesGL. Family history of diabetes, awareness of risk factors, and health behaviors among African Americans. Am J Public Health. 2007;97(5):907-912.
46.
ShaikhARYarochALNebelingLYehMCResnicowK. Psychosocial predictors of fruit and vegetable consumption in adults: a review of the literature. Am J Prev Med. 2008;34(6):535-543.
47.
WrightKNorrisKNewman GigerJSuroZ. Improving healthy dietary behaviors, nutrition knowledge, and self-efficacy among underserved school children with parent and community involvement. Child Obes. 2012;8(4):347-356.
48.
ShinHShinJLiuPYDuttonGRAboodDAIlichJZ. Self-efficacy improves weight loss in overweight/obese postmenopausal women during a 6-month weight loss intervention. Nutr Res. 2011;31(11):822-828.
49.
KreausukonPGellertPLippkeSSchwarzerR. Planning and self-efficacy can increase fruit and vegetable consumption: a randomized controlled trial. J Behav Med. 2012;35(4):443-451.
50.
LuszczynskaATryburcyMSchwarzerR. Improving fruit and vegetable consumption: a self-efficacy intervention compared with a combined self-efficacy and planning intervention. Health Educ Res. 2007;22(5):630-638.
51.
ErvinRB. Healthy Eating Index—2005 total and component scores for adults aged 20 and over: National Health and Nutrition Examination Survey, 2003-2004. Natl Health Stat Report. 2011(44):1-9.
52.
ShannonJShikanyJMBarrett-ConnorE. Demographic factors associated with the diet quality of older US men: baseline data from the Osteoporotic Fractures in Men (MrOS) study. Public Health Nutr. 2007;10(8):810-818.
53.
AkbaralyTNBrunnerEJFerrieJEMarmotMGKivimakiMSingh-ManouxA. Dietary pattern and depressive symptoms in middle age. Br J Psychiatry. 2009;195(5):408-413.
54.
AppelhansBMWhitedMCSchneiderKL. Depression severity, diet quality, and physical activity in women with obesity and depression. J Acad Nutr Diet. 2012;112(5):693-698.
55.
KaiserBRazurelC. Determinants of postpartum physical activity, dietary habits and weight loss after gestational diabetes mellitus. J Nurs Manag. 2013;21(1):58-69.
56.
PawlakRColbyS. Benefits, barriers, self-efficacy and knowledge regarding healthy foods; perception of African Americans living in eastern North Carolina. Nutr Res Pract. 2009;3(1):56-63.
57.
HolgadoBde Irala-EstevezJMartinez-GonzalezMAGibneyMKearneyJMartinezJA. Barriers and benefits of a healthy diet in Spain: comparison with other European member states. Eur J Clin Nutr. 2000;54(6):453-459.
58.
NicklasJMZeraCASeelyEWAbdul-RahimZSRudloffNDLevkoffSE. Identifying postpartum intervention approaches to prevent type 2 diabetes in women with a history of gestational diabetes. BMC Pregnancy Childbirth. 2011;11:23.
59.
MumfordSLSiega-RizAMHerringAEvensonKR. Dietary restraint and gestational weight gain. J Am Diet Assoc. 2008;108(10):1646-1653.
60.
FowlesERBryantMKimS. Predictors of dietary quality in low-income pregnant women: a path analysis. Nurs Res. 2011;60(5):286-294.
61.
HaghighatdoostFKarimiGEsmaillzadehAAzadbakhtL. Sleep deprivation is associated with lower diet quality indices and higher rate of general and central obesity among young female students in Iran. Nutrition. 2012;28(11-12): 1146-1150.
