title: Readiness for diabetes prevention and barriers to lifestyle change in women with a history of gestational diabetes mellitus: rationale and study design.
abstract: OBJECTIVE
  Women with gestational diabetes mellitus (GDM) have a high risk of future diabetes, which can be prevented with lifestyle modification. Prior diabetes prevention programmes in this population have been limited by lack of adherence. The aim of this study is to evaluate readiness for behaviour change at different time points after GDM diagnosis and identify barriers and facilitators, to inform a lifestyle modification programme specifically designed for this group. The objective of this paper is to present the rationale and methodological design of this study.
  
  
  METHODS
  The ongoing prospective cohort study has recruited a multi-ethnic cohort of 1353 women with GDM from 7 Ontario, Canada hospitals during their pregnancy. A questionnaire was developed to evaluate stage of readiness for behaviour change, and sociodemographic, psychosocial, and clinical predictors of healthy diet and physical activity. Thus far, 960 women (71%) have completed a baseline survey prior to delivery. Prospective postpartum follow-up is ongoing. We are surveying women at 2 time-points after delivery: 3-12 months postpartum, and 13-24 months postpartum. Survey data will be linked to health care administrative databases for long-term follow-up for diabetes. Qualitative interviews were conducted in a subset of women to gain a deeper understanding of barriers and facilitators to lifestyle change.
  
  
  CONCLUSIONS
  Our study is a fundamental first step in effectively addressing diabetes prevention in women with GDM. Our findings will aid in the design of a diabetes prevention intervention specifically targeted to women with recent GDM, which can then be evaluated in a clinical trial.
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6. Electronic address: Lorraine.lipscombe@wchospital.ca.
authors.forename: Lorraine L
authors.initials: LL
authors.lastname: Lipscombe
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8.
authors.forename: Ananya Tina
authors.initials: AT
authors.lastname: Banerjee
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8.
authors.forename: Sarah
authors.initials: S
authors.lastname: McTavish
authors.affiliation: Women's College Research Institute, Women's College Hospital, 76 Grenville St., Toronto, ON, Canada M5G 1N8; Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8.
authors.forename: Geetha
authors.initials: G
authors.lastname: Mukerji
authors.affiliation: Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, Canada M4N 3M5.
authors.forename: Julia
authors.initials: J
authors.lastname: Lowe
authors.affiliation: Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology and Metabolism, St. Michael's Hospital, 61 Queen St. East, Toronto, ON, Canada, M5C 2T2; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8.
authors.forename: Joel
authors.initials: J
authors.lastname: Ray
authors.affiliation: Faculty of Health Sciences, Western University, Arthur and Sonia Labatt Health Sciences Building, London, ON, Canada N6A 5B9.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Evans
authors.affiliation: Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada M5S 1A8; Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St. Suite 425, Toronto, ON, Canada M5T 3M6; Division of Endocrinology, Mount Sinai Hospital, 60 Murray Street, Toronto, ON, Canada, M5T 3L9; Department of Obstetrics and Gyencology, University of Toronto, 123 Edward Street, Toronto, ON, Canada, M5G 1E2.
authors.forename: Denice S
authors.initials: DS
authors.lastname: Feig
mesh_terms: D000328:Adult; D002170:Canada; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000517:prevention & control*; D016640:Diabetes, Gestational / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008019:Life Style; D010342:Patient Acceptance of Health Care; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D012107:Research Design; D011795:Surveys and Questionnaires
keywords: Barriers; Diabetes prevention; Gestational diabetes mellitus; Stage of readiness for lifestyle change