Examining Diabetes Distress in Pre-existing Diabetes in Pregnancy: Protocol for an Explanatory Sequential Mixed Methods Study

Diabetes distress has been shown to be highly prevalent in adults living with type 1 and type 2 diabetes with important implications for glycemic control, self-care, and self-management behaviors. Despite considerable focus on self-management and glycemic targets during pregnancy, current literature lacks information on diabetes distress in pregnancy, particularly in women with type 2 diabetes. This article outlines an explanatory sequential mixed methods research protocol to examine diabetes distress during pregnancy in women with pre-existing diabetes. The aims of the study were to: (1) establish the prevalence and correlates of diabetes distress in women attending a diabetes and pregnancy clinic; (2) use this quantitative data to inform development of an interview guide and plan for sampling for telephone interviews; and (3) explore and describe the experiences of diabetes distress during pregnancy. The quantitative strand was a cross-sectional survey of 76 women using self-reported questionnaires to collect demographic and clinical data, and validated tools to assess health variables, including the outcome of interest of diabetes distress using the Problem Area in Diabetes scale. The qualitative strand applied interpretive description methodology to explore the quantitative results using semi-structured qualitative interviews with 18 women to obtain patient perspectives of diabetes distress and experiences of managing diabetes in pregnancy. The explanatory sequential mixed methods research will provide an opportunity to add contextual qualitative experiences from women with pre-existing diabetes during pregnancy to provide a comprehensive picture of diabetes distress. The results will inform further research priorities that protect and promote mental health, psychosocial well-being, and self-management practices for this population.