Psychosocial wellbeing is a further important modifiable factor to target in such interventions. Reviews of the current evidence report that such interventions can enhance glycaemic control and weight management, reduce the risk of foetal macrosomia and post-partum progression to T2D. Lifestyle interventions focusing on diet, physical activity, glycaemic control and weight management are the primary therapeutic strategy for women with GDM. Given this expected increase and the high risk of progression to T2D among our local population, there is an urgent need to develop prevention interventions for our setting. In South Africa, the prevalence of GDM is estimated to be about 10–15% but this is expected to grow, concomitant with the dramatically increasing prevalence of overweight/ obesity seen in women of reproductive age (currently at 60–70%). A study in our setting found that within six years of a GDM pregnancy, 48% of the women followed up had progressed to T2D, more than two-thirds had three or more cardiovascular disease risk factors, and 27% of their children were overweight or obese. In addition, through intrauterine exposure to maternal hyperglycaemia, their offspring are significantly more vulnerable to early onset obesity, T2D and cardio-metabolic disorders. While glucose levels usually return to normal after delivery, women affected by GDM face a significantly increased risk of developing type 2 diabetes (T2D), cardiovascular disease, hypertension and stroke in the longer term. It is now one of the most common complications seen in pregnancy worldwide and is associated with several adverse pregnancy outcomes. Gestational diabetes (GDM) is defined as diabetes, first diagnosed in the second or third trimester of pregnancy that is clearly not pre-existing type 1 or type 2 diabetes. Trial registrationįirst registered on, Pan African Clinical Trials Registry (PACTR): PACTR201805003336174. Using such tools can contribute to improving rigour in the design of behavioural change interventions. It provided a robust and transparent theoretical foundation on which to develop our intervention, assisted us in making the hypothesised pathways for behaviour change explicit and enabled us to describe the intervention in standardised, precisely defined terms. The BCW was a valuable tool to use in designing our intervention and tailoring its content and format to our target population and local setting. This paper offers a rich description and analysis of designing a complex intervention tailored to the challenging contexts of urban South Africa. The peer counsellors and the diabetes nurse were trained in patient-centred, motivational counselling methods. Key objectives of our planned intervention were 1) to address women’s evident need for information and psychosocial support by positioning peer counsellors and a diabetes nurse in the GDM antenatal clinic, and 2) to offer accessible and convenient post-partum screening and counselling for sustained behaviour change among women with GDM by integrating follow-up into the routine immunisation programme at the Well Baby clinic. Findings from primary formative research with women with GDM and healthcare providers were a key source of information for this process. This framework provides a systematic, step-by-step process, starting with a behavioural analysis of the problem and making a diagnosis of what needs to change, and then linking this to intervention functions and behaviour change techniques to bring about the desired result. The Behaviour Change Wheel (BCW) and the COM-B model of behaviour change were used to guide the development of the IINDIAGO intervention. This paper offers a detailed description of the development of a theory-based behaviour change intervention, prior to its preliminary testing for feasibility and efficacy in the health system. The IINDIAGO study aims to develop and evaluate an intervention for disadvantaged GDM women attending three large, public-sector hospitals for antenatal care in Cape Town and Soweto, SA. There is an urgent need to develop tailored interventions to support women with GDM to mitigate pregnancy risks and to prevent progression to type 2 diabetes post-partum. In South Africa, the prevalence of gestational diabetes (GDM) is growing, concomitant with the dramatically increasing prevalence of overweight/obesity among women.
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