Gestational diabetes in Uganda and India: Design and Evaluation of Educational Films for improving Screening and Self-management (GUIDES)

妊娠糖尿病（GDM）是一种孕妇身体无法控制血糖水平的疾病。这可能会给母亲和孩子带来一些短期和长期的健康问题。这种情况现在在发展中国家变得越来越普遍，但大多数妇女没有及时诊断出来，而那些被诊断出来的人通常没有得到适当的照顾。这是因为这些国家的医生和孕妇对这种情况了解不够，因为这对这些社会来说是一个相对较新的经验。我们的研究的目的是评估是否教育和行为干预，主要通过电影提供，可以改善妇女与GDM的护理。电影是一种简单、低成本的健康干预方式，特别适合那些文化程度不高的人。到目前为止，在发达国家，电影已被证明在传授健康教育和改变与健康有关的行为方面是有用的，但在发展中国家则不然，这是我们研究的主要动机。我们将开发和评估具有三个不同组成部分的干预措施。第一个项目是医生和护士培训方案。电影将涵盖如何识别和治疗GDM，以及如何支持女性改变生活方式（健康饮食，更多的体育活动）。其次，将在妇女接受产前护理（怀孕期间的常规保健）的等候区播放一部针对孕妇及其家人的短片，以提高对GDM的认识。第三，为被诊断患有GDM的妇女制定了一项方案，以帮助她们控制自己的病情。这些电影将教育他们关于治疗，并将支持他们为更健康的生活方式做出改变。电影将由一名受过训练的护士主持的问答环节加以补充。我们将在乌干达（恩德培）和印度（班加西）进行研究，因为它们处于不同的经济发展阶段。首先，我们将开展研究，了解这些国家人民的日常生活，以制定适合其文化的干预措施。然后我们将进一步测试和完善它，直到它适合目的。然后，我们将在两个地点的独立研究中评估干预措施是否改善了对GDM妇女的护理。在每个地点，将选择30个产科单位，从中随机选择一半接受新的干预措施。将邀请妊娠期间访问参与诊所的女性参加研究。为了评估干预是否成功，我们将衡量三件事。首先，妇女是否接受过筛查和/或诊断患有GDM。其次，我们将邀请那些告诉我们被诊断患有GDM的妇女去诊所，这样我们就可以采集血液样本。我们将测试这些血液，看看他们的血糖控制得如何。第三，我们将计算有多少女性经历过可能是由于GDM导致的负面分娩结果（例如，生下比平均年龄大的婴儿，或剖腹产）。我们还将与妇女和卫生服务提供者进行访谈，以帮助我们了解干预可能（或可能不）成功的方式和原因。如果干预措施成功地改善了GDM的检测和管理，我们预计将减少与GDM相关的母婴并发症，从而节省资金。我们还认为，这种干预可能会减少在以后的生活中被诊断患有2型糖尿病的女性人数。从长远来看，希望干预措施将鼓励在所有低收入国家提供GDM筛查和护理，并提高其质量。

Gestational diabetes mellitus (GDM) is a condition in which the body of pregnant women cannot control the levels of blood sugar. This can result in a number of short- and long-term health problems for both the mother and her child. This condition is now becoming much more common in developing countries, yet most women are not diagnosed on time, and those who are diagnosed do not usually receive appropriate care. This is because the doctors and pregnant women in these countries don't know enough about this condition, as it is a relatively new experience for these societies. The aim of our research is to assess whether an educational and behavioural intervention, delivered primarily through film, can improve the care of women with GDM. Films are a simple and low-cost way of delivering health interventions, and they are particularly suitable for people who are not very literate. So far, films have been shown to be useful in imparting health education and changing health-related behaviours in developed countries, but not in developing countries, which is a primary motivation for our research. We will develop and evaluate an intervention with three different components. The first will be a training programme for doctors and nurses. Films will cover how to identify and treat GDM, and how to support women to make changes to their lifestyle (healthy eating, more physical activity). Secondly, a short film for pregnant women and their families, designed to raise awareness of GDM, will be shown in the waiting areas where women receive antenatal care (routine health care in pregnancy). Thirdly, a programme for women diagnosed with GDM to help them manage their condition. These films will educate them about treatment, and will support them to make changes for a healthier lifestyle. Films will be supplemented by Q&A sessions run by a trained nurse. We will carry out our research in Uganda (Entebbe) and India (Bengaluru) because they are at different stage of economic development. First, we will carry out research to understand people's daily lives in these countries to develop an intervention that is suitable for their culture. Then we will test and refine it further until it is fit-for-purpose. We will then assess whether the intervention improves care for women with GDM in independent studies in both sites. In each site, thirty maternity units will be selected, from which half will be randomly chosen to receive the new intervention. Women visiting the participating clinics during pregnancy will be invited to join the study. To evaluate whether the interventions are successful, we will measure three things. Firstly, whether women have been screened for and/or diagnosed with GDM. Secondly, we will invite women who tell us that have been diagnosed with GDM to visit clinics so we can take a blood sample. We will test this blood to see how well their blood sugar is being controlled. Thirdly, we will calculate how many women have experienced a negative birth outcome which could be because of GDM (for example, having a baby who is larger than average, or giving birth by caesarean section). We will also conduct interviews with women and health providers to help us understand how and why the intervention may be (or may not be) successful. If the intervention is successful in improving the detection and management of GDM, we expect there to be financial savings from a reduction in maternal and infant complications associated with GDM. We also think that the intervention may reduce the number of women who are diagnosed with type 2 diabetes later in life. In the longer term, it is hoped that the intervention will encourage the provision and quality of GDM screening and care across all LMICs.