ABSTRACT

Background: Gestational diabetes mellitus (GDM) is a prevalent pregnancy complication associated with substantial maternal and neonatal morbidity. Despite the availability of screening services, timely detection remains suboptimal because of limited maternal knowledge, low perceived susceptibility, psychological concerns, and the absence of culturally appropriate educational resources. This study aimed to identify the educational needs for developing a theory-based diabetes education model integrating the Health Belief Model (HBM) and Social Cognitive Theory (SCT) for pregnant women at high risk of GDM in Aceh, Indonesia.
Methods: A qualitative descriptive study was conducted as the needs assessment phase of a research and development project. Two focus group discussions were held in Montasik District, Aceh Besar Regency, Indonesia, in May 2026, involving six midwives and six pregnant women at high risk of GDM selected through purposive sampling. Semi-structured discussion guides were developed based on HBM and SCT constructs. Data were analysed using Braun and Clarke’s thematic analysis through a combination of deductive and inductive coding.
Results: Three overarching themes and nine subthemes emerged. The first theme, insufficient GDM literacy and risk awareness, included limited understanding of GDM, low perceived susceptibility, and inadequate awareness of disease severity. The second theme, behavioural and sociocultural barriers to early detection, encompassed fear of screening outcomes and dietary restrictions, the influence of local dietary practices and social norms, and reliance on midwives, family members, and pregnancy-related symptoms as cues to action. The third theme, requirements for culturally responsive and family-oriented educational interventions, highlighted the absence of standardised educational materials, the importance of husband and family support in reinforcing healthy behaviours, and participants’ preference for concise, visually engaging, smartphone-based educational media.
Conclusions: Early detection of GDM is influenced by interacting cognitive, emotional, sociocultural, and family-related factors. These findings provide an empirical foundation for developing the SIGAP educational model (Aware of Risk, Seek Information, and Overcome GDM Early), which integrates HBM and SCT constructs into culturally tailored, visually engaging, and digitally accessible educational media to enhance community-based antenatal education and facilitate timely GDM screening.

KEYWORDS

gestational diabetes mellitus; health education; Health Belief Model; Social Cognitive Theory; qualitative research; antenatal care; high-risk pregnancy.

REFERENCES

1) K. W. Lee et al., “Prevalence and risk factors of gestational diabetes mellitus in Asia: A systematic review and meta-analysis,” BMC Pregnancy Childbirth, vol. 18, no. 1, Dec. 2018, doi: 10.1186/S12884-018-2131-4.
2) H. D. McIntyre, P. Catalano, C. Zhang, G. Desoye, E. R. Mathiesen, and P. Damm, “Gestational diabetes mellitus,” Nat. Rev. Dis. Primers, vol. 5, no. 1, Dec. 2019, doi: 10.1038/S41572-019-0098-8.
3) C. A. Crowther, J. E. Hiller, J. R. Moss, A. J. McPhee, W. S. Jeffries, and J. S. Robinson, “Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes,” New England Journal of Medicine, vol. 352, no. 24, pp. 2477–2486, Jun. 2005, doi: 10.1056/NEJMOA042973.
4) R. Modzelewski, M. M. Stefanowicz-Rutkowska, W. Matuszewski, and E. M. Bandurska-Stankiewicz, “Gestational Diabetes Mellitus—Recent Literature Review,” J. Clin. Med., vol. 11, no. 19, p. 5736, Oct. 2022, doi: 10.3390/JCM11195736.
5) A. A. Choudhury and V. Devi Rajeswari, “Gestational diabetes mellitus – A metabolic and reproductive disorder,” Biomedicine & Pharmacotherapy, vol. 143, p. 112183, Nov. 2021, doi: 10.1016/J.BIOPHA.2021.112183.
6) L. Chen and Y. Zhu, “Gestational Diabetes Mellitus and Subsequent Risks of Diabetes and Cardiovascular Diseases: the Life Course Perspective and Implications of Racial Disparities,” Curr. Diab. Rep., vol. 24, no. 11, p. 244, Nov. 2024, doi: 10.1007/S11892-024-01552-4.
7) H. Wang et al., “IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria,” Diabetes Res. Clin. Pract., vol. 183, Jan. 2022, doi: 10.1016/J.DIABRES.2021.109050.
8) T. A. Buchanan, A. H. Xiang, and K. A. Page, “Gestational diabetes mellitus: Risks and management during and after pregnancy,” Nat. Rev. Endocrinol., vol. 8, no. 11, pp. 639–649, Nov. 2012, doi: 10.1038/NRENDO.2012.96.
9) L. Guariguata, U. Linnenkamp, J. Beagley, D. R. Whiting, and N. H. Cho, “Global estimates of the prevalence of hyperglycaemia in pregnancy,” Diabetes Res. Clin. Pract., vol. 103, no. 2, pp. 176–185, 2014, doi: 10.1016/J.DIABRES.2013.11.003.
10) J. H. Moon and H. C. Jang, “Gestational Diabetes Mellitus: Diagnostic Approaches and Maternal-Offspring Complications,” Diabetes Metab. J., vol. 46, no. 1, pp. 3–14, Jan. 2022, doi: 10.4093/DMJ.2021.0335.
11) M. M. Agarwal, G. S. Dhatt, and Y. Othman, “Gestational diabetes: Differences between the current international diagnostic criteria and implications of switching to IADPSG,” J. Diabetes Complications, vol. 29, no. 4, pp. 544–549, May 2015, doi: 10.1016/j.jdiacomp.2015.03.006.
12) C. L. Nguyen et al., “Prevalence and pregnancy outcomes of gestational diabetes mellitus by different international diagnostic criteria: A prospective cohort study in Vietnam,” J. Matern. Fetal Neonatal Med., vol. 33, no. 21, pp. 3706–3712, Nov. 2020, doi: 10.1080/14767058.2019.1583733.
13) T. Kunasegaran, V. R. M. T. Balasubramaniam, V. J. T. Arasoo, U. D. Palanisamy, and A. Ramadas, “Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review,” International Journal of Environmental Research and Public Health 2021, Vol. 18, vol. 18, no. 3, pp. 1–21, Jan. 2021, doi: 10.3390/IJERPH18031272.
14) H. D. McIntyre, P. Catalano, C. Zhang, G. Desoye, E. R. Mathiesen, and P. Damm, “Gestational diabetes mellitus,” Nat. Rev. Dis. Primers, vol. 5, no. 1, Dec. 2019, doi: 10.1038/S41572-019-0098-8.
15) L. Rasmussen, C. W. Poulsen, U. Kampmann, S. B. Smedegaard, P. G. Ovesen, and J. Fuglsang, “Diet and healthy lifestyle in the management of gestational diabetes mellitus,” Nutrients, vol. 12, no. 10, pp. 1–24, Oct. 2020, doi: 10.3390/NU12103050.
16) D. Farrar, L. Duley, T. Dowswell, and D. A. Lawlor, “Different strategies for diagnosing gestational diabetes to improve maternal and infant health,” Cochrane Database of Systematic Reviews, vol. 2017, no. 8, Aug. 2017, doi: 10.1002/14651858.CD007122.PUB4.
17) H. Wang et al., “IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria,” Diabetes Res. Clin. Pract., vol. 183, Jan. 2022, doi: 10.1016/J.DIABRES.2021.109050.
18) E. Shepherd, J. C. Gomersall, J. Tieu, S. Han, C. A. Crowther, and P. Middleton, “Combined diet and exercise interventions for preventing gestational diabetes mellitus,” Cochrane Database of Systematic Reviews, vol. 2017, no. 11, Nov. 2017, doi: 10.1002/14651858.CD010443.PUB3.
19) F. Mohammadkhah, A. Kamyab, B. Pezeshki, S. Norouzrajabi, and A. Khani Jeihooni, “The effect of training intervention based on health belief model on self-care behaviors of women with gestational diabetes mellitus,” Front. Glob. Womens Health, vol. 5, p. 1490754, 2024, doi: 10.3389/FGWH.2024.1490754/FULL.
20) A. Afniratri, D. G. Tamtomo, and B. Murti, “Meta-Analysis: Effectiveness of Health Education Based on Health Belief Model in Type 2 Diabetes Mellitus Patients,” Journal of Health Promotion and Behavior, vol. 9, no. 2, pp. 132–144, Apr. 2024, doi: 10.26911/THEJHPB.2024.09.02.04.
21) V. Gopalakrishnan et al., “Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria,” J. Postgrad. Med., vol. 61, no. 3, p. 155, Jul. 2015, doi: 10.4103/0022-3859.159306.
22) I. Lenoir-Wijnkoop, E. M. van der Beek, J. Garssen, M. J. C. Nuijten, and R. D. Uauy, “Health economic modeling to assess short-term costs of maternal overweight, gestational diabetes, and related macrosomia – a pilot evaluation,” Front. Pharmacol., vol. 6, no. MAY, 2015, doi: 10.3389/FPHAR.2015.00103.
23) S. Luewan, P. Bootchaingam, and T. Tongsong, “Comparison of the Screening Tests for Gestational Diabetes Mellitus between ‘one-Step’ and ‘two-Step’ Methods among Thai Pregnant Women,” Obstet. Gynecol. Int., vol. 2018, p. 1521794, 2018, doi: 10.1155/2018/1521794.
24) C. L. Jones, J. D. Jensen, C. L. Scherr, N. R. Brown, K. Christy, and J. Weaver, “The Health Belief Model as an Explanatory Framework in Communication Research: Exploring Parallel, Serial, and Moderated Mediation,” Health Commun., vol. 30, no. 6, p. 566, Jun. 2014, doi: 10.1080/10410236.2013.873363.
25) J. H. Park, L. D. Sherman, M. L. Smith, M. S. Patterson, and T. Prochnow, “The Association Between Health Belief Model Components and Self-Care Practices Among Black/African American Men with Type 2 Diabetes,” International Journal of Environmental Research and Public Health 2025, Vol. 22, vol. 22, no. 3, Mar. 2025, doi: 10.3390/IJERPH22030414.
26) V. H. Flora, E. P. Pamungkasari, and A. Demartoto, “Application of Health Belief Model on Obesity Prevention Behavior in Adolescents,” Journal of Health Promotion and Behavior, vol. 9, no. 3, pp. 261–271, Jul. 2024, doi: 10.26911/THEJHPB.2024.09.03.08.
27) F. Mohammadkhah, A. Kamyab, B. Pezeshki, S. Norouzrajabi, and A. Khani Jeihooni, “The effect of training intervention based on health belief model on self-care behaviors of women with gestational diabetes mellitus,” Front. Glob. Womens Health, vol. 5, p. 1490754, Jan. 2024, doi: 10.3389/FGWH.2024.1490754/TEXT.
28) M. E. Crowther, S. A. Ferguson, C. C. Gupta, and A. C. Reynolds, “The Development and Validation of the Health Belief Model for Shift Workers (HBM-SW) Scale,” Behavioral Sleep Medicine, vol. 22, no. 3, pp. 353–377, May 2024, doi: 10.1080/15402002.2023.2265520.
29) U. V. Sankar, M. Chacko, A. J. Sekhar, S. C. Thomas, S. Anvarsadath, and S. K. Nochikattil, “Why are women with gestational diabetes in Kerala at higher risk for T2DM? A qualitative study on sociocultural factors,” Women and Children Nursing, vol. 4, no. 1, pp. 24–30, Mar. 2026, doi: 10.1016/J.WCN.2026.02.003.
30) H. N. Alenezi et al., “Moderate Awareness of Gestational Diabetes Mellitus and Its Complications Among Women in the Northern Borders Province, Saudi Arabia: Implications for Educational Interventions,” Women 2025, Vol. 5, vol. 5, no. 3, p. 29, Aug. 2025, doi: 10.3390/WOMEN5030029.
31) M. Li, F. R. Wang, L. H. Xu, Y. J. Wang, and Y. Li, “Exploring the relationship between perceived social support and pregnant women’s physical activity behavior: a chain-mediated effect test,” BMC Pregnancy Childbirth, vol. 25, no. 1, Dec. 2025, doi: 10.1186/S12884-025-08482-3.
32) I. M. Lee et al., “Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy,” The Lancet, vol. 380, no. 9838, pp. 219–229, 2012, doi: 10.1016/S0140-6736(12)61031-9.
33) S. Guo et al., “Barriers and facilitators to self-management among women with gestational diabetes: A systematic review using the COM-B model,” Midwifery, vol. 138, p. 104141, Nov. 2024, doi: 10.1016/J.MIDW.2024.104141.
34) S. Xu, J. Wang, Y. Wang, D. Wang, and M. Zhang, “Decision-making behavior of blood glucose management and its influencing factors in pregnant women with gestational diabetes mellitus,” BMC Pregnancy and Childbirth 2025 25:1, vol. 25, no. 1, pp. 83-, Jan. 2025, doi: 10.1186/S12884-025-07207-W.

Cite this article

Yusnaini, Yuniwati, C., Ibrahim, N., Tahlil, T., Fitraniar, I., Kartinazahri, & Miko, A. (2026). Educational Needs for Theory-Based Gestational Diabetes Education among High-Risk Pregnant Women in Aceh, Indonesia: A Qualitative Study. INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH, 5(7), 661-671. https://doi.org/10.58806/ijhmr.2026.v5i7n14