CHAPTER ONE

1. 0 Introduction

1.1 Background to the Study

Gestational diabetes mellitus often abbreviated as GDM has become one of the leading causes of

maternal and child mortality and morbidity worldwide and has raised health concern due to it’s

rising prevalence in recent years. It is defined as different degrees of abnormal glucose

metabolism that occur or are recognized first during pregnancy (Fang et al., 2020). It is seriously

detrimental to both the women and fetuses. Women with GDM are not only subjected to

preeclampsia, gestational hypertension, polyhydramnios, premature rupture of

membrane and caesarean section, but also are at a higher risk of subsequent type 2 diabetes

mellitus (T2DM) and cardiovascular diseases (Fang et al., 2020).

Globally, the prevalence of GDM is on the rise, with estimates indicating that approximately

16% of live births are affected by some form of hyperglycemia in pregnancy, predominantly

GDM (Gyasi-Antwi, 2020). In Nigeria, recent studies have reported varying prevalence rates. A

systematic review and meta-analysis reported a pooled prevalence of 11.0%, with individual

studies ranging from 0.5% to 38% depending on diagnostic criteria and population studied

(Azeez et al., 2021). Another study conducted in Makurdi, North-Central Nigeria, found a GDM

prevalence of 16.7% among pregnant women (Basil et al., 2023).

Key risk factors identified in Nigerian populations include advanced maternal age, obesity,

family history of diabetes, previous macrosomic births, and prior miscarriages (Azeez et al.,

2021; Basil et al., 2023). Despite the known risks, awareness and screening for GDM remain

suboptimal. A qualitative study in Warri, Delta State, revealed that many pregnant women lacked
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awareness of GDM and its implications, attributing this to inadequate health education during

antenatal care (Offomiyor & Rehal, 2022).

Oke Iyinmi Comprehensive Health Center is a primary health care facility located in Ado Ekiti

Nigeria which serves a significant proportion of pregnant/reproductive women from areas around

Ado Ekiti State. However, limited data exist on the burden of GDM among reproductive-age

women attending antenatal care in this facility

1.2 Statement of the Problem

Gestational Diabetes Mellitus (GDM) remains one of the most common medical complications

during pregnancy, affecting approximately 15% of pregnancies globally and contributing

significantly to maternal and neonatal morbidity. Despite its increasing prevalence and associated

health risks, awareness, knowledge, and perception of GDM among women of reproductive age

particularly in developing countries remain inadequate (Offomiyor & Rehal, 2022). Limited

understanding of the risk factors and preventive measures of GDM had been shown to contribute

to late diagnosis, poor compliance with treatment, and adverse pregnancy outcomes in many

communities, including Ado Ekiti, Nigeria (Oladapo et al., 2020).

Oke Iyinmi Health Center, a primary health facility in Ado Ekiti, serves a diverse population of

women of reproductive age. However, little is known about these women’s level of knowledge,

their attitudes toward GDM, and their perceived risk of developing the condition. Without

adequate information, women may fail to engage in preventive health behaviors or utilize

antenatal services effectively, thereby increasing their susceptibility to complications.

This study seeks to assess the knowledge, attitudes, and perceived risk factors of GDM among

women of reproductive age attending Oke Iyinmi Health Center, Ado Ekiti. Understanding these
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components is crucial for designing targeted health education and intervention programs that can

help reduce the burden of GDM and improve maternal health outcomes in the region.

1.3 Objective of the Study

1.3.1 Broad Objective

The broad objective of this study is to assess the knowledge and awareness of gestational

diabetes mellitus (GDM) among reproductive women attending Oke Iyinmi Health Center, Ado

Ekiti.

1.3.2 Specific Objectives

The specific objectives of the study are to:

1. assess the level of knowledge of gestational diabetes mellitus among reproductive aged

women;

2. assess the attitudes of reproductive-age women toward gestational diabetes screening,

diagnosis, and management;

3. identify perceived risk factors to gestational diabetes mellitus among reproductive age

women and

4 assess the health seeking behaviour of women of reproductive age at Oke Iyinmi Health

Center to gestational diabetes mellitus.

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1.4 Research Questions

1. What is the level of knowledge of gestational diabetes mellitus among reproductive

women attending Oke Iyinmi Health Center?

2. What are the attitudes of reproductive women toward the prevention and management of

gestational diabetes mellitus among the study population?

3. What are the perceived risk factors of gestational diabetes mellitus among women of

reproductive age at Oke Iyinmi Health Center?

4. What are the health seeking behaviour of women of reproductive age at Oke Iyinmi

Health Center to gestational diabetes mellitus?

1.4.1 Research Hypotheses

1. There is no significant difference in the level of knowledge and awareness of gestational

diabetes mellitus among reproductive women attending Oke Iyinmi Health Center

2. There is no significant in the attitudes of reproductive women toward the prevention and

management of gestational diabetes mellitus among the study population

3. There is no significant difference in the perceived risk factors of gestational diabetes

mellitus among women of reproductive age at Oke Iyinmi Health Center

4. There is no significant difference in the health seeking behaviour of women of

reproductive age at Oke Iyinmi Health Center to gestational diabetes mellitus

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1.5 Significance of the Study

This study will provide information on the knowledge, attitude and perceived risk factors

of GDM among reproductive women at Oke Iyinmi Health Center, Ado Ekiti. By

assessing women's knowledge and awareness of GDM, this study will help identify gaps

in health education and barriers to early detection and management. The findings will

guide healthcare policymakers and practitioners in developing targeted interventions to

improve health education and promote better maternal and neonatal outcomes. The study

will help to promote informed health-seeking behavior among women of reproductive

age. In doing so, it supports national efforts to achieve Sustainable Development Goal 3,

which emphasizes maternal health and the reduction of preventable deaths during

pregnancy and childbirth. Additionally, this research will contribute to the existing body

of knowledge on GDM in Nigeria, serving as a valuable resource for future studies and

health programs aimed at reducing the burden of gestational diabetes.

1.6 Scope of the Study

This study will focus on women of reproductive age in Oke Iyinmi Health Center, Ado

Ekiti. It will access their knowledge, attitudes and perceived risk factors on gestational

diabetes mellitus. This study is limited to women of reproductive age.

1.7 Operational Definition of Terms

 Knowledge: The extent to which women of reproductive age at Oke Iyinmi health center

possess information, understanding and awareness of GDM

 Attitude: the behaviour and response of reproductive aged women in OkeIyinmi health

center towards gestational diabetes mellitus

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 Perceived Risk Factors: refers to women’s subjective assessment of their likelihood of

developing GDM based on family history, previous pregnancy, experiences or other

factors

 Gestational Diabetes Mellitus: Gestational diabetes mellitus (GDM) is defined as

glucose intolerance of variable severity with onset of recognition during pregnancy

among women of reproductive age in Oke-Iyinmi Health Center, Ado Ekiti.

 Women: This refers to females of childbearing age (typically between 15 and 49 years)

who are biologically capable of conceiving and giving birth. This group includes both

pregnant and non-pregnant women attending Oke-Iyinmi Health Center, Ado Ekiti.

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 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 Conceptual Review

2.1.1 History of Diabetes Mellitus

Diabetes Mellitus (DM) has been recognized for thousands of years, with descriptions of

symptoms like excessive urination and sweet-tasting urine found in ancient Egyptian and Indian

medical texts (Thomas & Philipson, 2022). Although early physicians identified the clinical signs

of diabetes, the underlying mechanisms remained obscure until the modern era.

The true breakthrough in understanding diabetes came in the 19th and early 20th centuries. In

1889, Joseph von Mering and Oskar Minkowski demonstrated that removing the pancreas in

dogs led to diabetes, linking the pancreas to glucose metabolism. This discovery laid the

foundation for the isolation of insulin by Frederick Banting and Charles Best in 1921, a

milestone that transformed diabetes from a fatal disease to a manageable condition (Patel et al.,

2021).

Over time, researchers distinguished between different types of diabetes—Type 1, an

autoimmune destruction of pancreatic beta cells, and Type 2, largely associated with insulin

resistance and lifestyle factors. Advances in biotechnology since the 1980s have led to the

development of synthetic insulin, insulin analogues, and continuous glucose monitoring systems

(Winkler et al., 2020).

In the 21st century, diabetes has reached epidemic proportions globally, prompting the World

Health Organization and other bodies to categorize it as a major public health concern. Current

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research focuses not only on improving glycemic control but also on preventing long-term

complications such as cardiovascular disease, neuropathy, and nephropathy (Pal et al., 2021).

Gestational Diabetes Mellitus

The World Health Organization (WHO) defined Gestational Diabetes Mellitus (GDM) as:

"hyperglycemia first detected during pregnancy that is not clearly overt diabetes." This definition

encompasses both women with mild glucose intolerance and those with more severe

hyperglycemia, provided the condition is first identified during pregnancy and does not meet

diagnostic criteria for overt (pre-existing) diabetes (Sweeting, 2022).

American Diabetes Association (2022) defined gestational diabetes mellitus as any degree of

glucose intolerance with its onset during pregnancy because of the secretion of placental

hormones which causes insulin resistance.

GDM is one of the most common medical complications of pregnancy, and its inadequate

treatment can lead to serious adverse health effects for the mother and child. According to the

latest estimates of the International Diabetes Federation (IDF), GDM affects approximately

14.0% (95% confidence interval: 13.97–14.04%) of pregnancies worldwide, representing

approximately 20 million births annually (Wang et al., 2022).

Pregnant women with pre-gestational type 1 or type 2 diabetes and (recently) overt diabetes in

pregnancy are not included in GDM. Women with GDM are at a high risk of developing several

complications. This includes infant macrosomia, neonatal hypoglycemia, and cesarean delivery.

After delivery, blood glucose level in women with GDM usually returns to normal. However,

women with GDM are also at a high risk of developing type 2 diabetes later in life and children

born to women with GDM have increased risk of developing impaired glucose tolerance. Higher
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parity, advanced maternal age, family history of diabetes, ethnicity, and body mass index are

some common risk factors for developing GDM (Adeniyi et al., 2021).

2.1.2 Epidemiology

The growing problem of overweight and obesity around the world significantly contributes to the

steady increase in the incidence of diabetes, including GDM in the population of women of

reproductive age. Approximately 20.4 million women (14.0% of pregnancies) presented with

disorders of carbohydrate metabolism, of which approximately 80% was GDM, i.e., about one in

six births was affected by gestational diabetes. The incidence of hyperglycemia in pregnancy also

increases with age. The delivery of a macrosomic child is another important factor that may

increase the risk of both GDM and DM2 by up to 20%. Even after considering the age of the

woman, pluriparity remains in a linear relationship to the incidence of GDM (Miller et al., 2021).

GDM in a previous pregnancy increases the risk of recurrence by more than six times. In women

with a BMI of at least 30 kg/m2, the GDM frequency is 12.3%, and in women with first-line

relatives that have a history of GDM, it is 11.6%. The combination of these two factors increases

the risk of GDM up to 61% of cases. More than twice the percentage of pregnancies with GDM

was observed in women that were previously treated for polycystic ovary syndrome (PCOS)

(Gyasi-Antwi, 2020).

Globally, the prevalence of GDM varies widely, largely because of different diagnostic criteria.

The global prevalence of GDM was estimated to be 14.7% based on the International

Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria which is the most used

screening method worldwide (Saeedi et al., 2021). In 2019, a study using the same criteria

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reported that the highest pooled prevalence (11.4%) of GDM was in South Asia (Bangladesh,

India, and Sri Lanka) compared to the rest of the world (3.6–6.0%) (Saeedi et. al., 2021).

The global prevalence of gestational diabetes is not a static figure, it varies worldwide among

racial and ethnic groups, population characteristics (e.g., average age and body mass index of

pregnant women), testing method, and diagnostic criteria. Prevalence has been increasing over

time, and the attributed reasons could be due to increase in mean maternal age, weight and other

factors (Powe, 2021).

In 2017, it was estimated by the International Diabetes Federation (IDF) that 21.3 million or

16.2% of women that had live births had some form of hyperglycaemia in pregnancy. An

estimated 86.4% of those cases were due to GDM, 6.2% due to diabetes detected prior to

pregnancy, and 7.4% due to other types of diabetes (including TIDM and TIIDM) first detected

in pregnancy (Yaping, 2022).

Literature has it that most of the cases of hyperglycaemia in pregnancy (88%) were reported in

low- and middle-income countries, where access to maternal care is often limited. In Africa,

number of live births affected by hyperglycaemia in pregnancy in women aged 20–49 years in

2017 was 3.4 million, age-adjusted prevalence of hyperglycaemia in pregnancy was 9.5% and

raw prevalence was 10.4% (Chivese, 2021).

A systematic review and meta-analysis of African GDM cases showed that the pooled

prevalence of GDM was 13.61% and it was 14.28% in the sub-Saharan African region. The study

also showed that overweight and obesity, macrosomia, family history of diabetes, history of

stillbirth, history of abortion, chronic hypertension and history of previous GDM were positively

associated with GDM [9].The prevalence of GDM in South Africa, as assessed by a 2-h oral

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OGTT with blood collected at 0, 30 and 120 min, reported to range between 1.6–8.8% (Nigatu,

et al., 2022).

The pathogenesis of GDM is complex and involves a combination of insulin resistance and

pancreatic β-cell dysfunction. During pregnancy, maternal metabolic adaptations occur to ensure

adequate nutrient supply to the developing fetus. One significant adaptation is increased insulin

resistance, particularly in the second and third trimesters. This physiological insulin resistance is

mediated by several placental hormones, including human placental lactogen (hPL), estrogen,

progesterone, cortisol, and prolactin. These hormones interfere with insulin signaling pathways,

reducing the body's sensitivity to insulin and resulting in elevated blood glucose levels

(Ellerbrock, et al., 2022).

In response to the heightened insulin resistance during pregnancy, pancreatic β-cells typically

compensate by increasing insulin secretion. However, in GDM, this compensatory mechanism is

inadequate due to β-cell dysfunction. Factors contributing to this dysfunction include genetic

predisposition, glucotoxicity, lipotoxicity, and chronic inflammation. The inability of β-cells to

meet the increased insulin demands leads to persistent hyperglycemia characteristic of GDM

(Ellerbrock etal., 2022)

Incretin hormones, such as glucagon-like peptide-1 (GLP-1) and glucose-dependent

insulinotropic polypeptide (GIP), enhance insulin secretion in response to nutrient intake. Studies

have shown that GDM is associated with reduced secretion and impaired signaling of these

incretin hormones, further exacerbating insulin secretion deficits and contributing to

hyperglycemia.

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Genetic predisposition plays a significant role in the development of GDM. Polymorphisms in

genes related to β-cell function and insulin signaling pathways have been identified as risk

factors. Additionally, epigenetic modifications influenced by environmental factors, such as diet

and physical activity, may alter gene expression and contribute to the pathogenesis of GDM

(Ellerbrock etal., 2022).

The placenta plays a significant role in the development of insulin resistance during pregnancy. It

produces hormones and cytokines that modulate maternal metabolism, contributing to decreased

insulin sensitivity. Furthermore, metabolic disturbances in early GDM can affect placental

development, potentially impacting both maternal and fetal health (Egan et al., 2020).

2.1.3 Classifications of Gestational Diabetes Mellitus (GDM)

Gestational Diabetes Mellitus (GDM) is generally classified based on its severity and the need

for pharmacological treatment. The two main classifications are:

A1 GDM (Diet-Controlled Gestational Diabetes)

In this category, blood glucose levels can be managed through lifestyle modifications, including

dietary changes and physical activity. Women with A1 GDM do not require insulin or oral

glucose-lowering medications. Blood sugar levels are typically mildly elevated and can be

controlled with proper nutrition and exercise (Nataly et al., 2022).

A2 GDM (Medication-Requiring Gestational Diabetes)

This form of GDM requires pharmacological intervention (e.g., insulin or oral medications like

metformin or glyburide) to control blood glucose levels. Women in this category cannot maintain

normal glucose levels through diet and exercise alone.A2 GDM is associated with a higher risk

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of complications, including fetal macrosomia (large baby), preterm birth, and increased risk of

type 2 diabetes postpartum (American Diabetes Association. 2024). A study by Nataly et al.,

(2022) revealed that GDMA2 is associated with increased rate of Cesarean Delivery and adverse

neonatal outcome. The similar rate of placental maternal vascular malperfusion lesions among

the study groups, and the increased rate of fetal vascular malperfusion lesions observed among

the one abnormal value group, implies of impaired placental function among the OAV group as

in GDM pregnancies.

Several factors increase the likelihood of developing Gestational Diabetes Mellitus (GDM).

These risk factors can be classified into modifiable and non-modifiable categories: non

modifiable risk factors are factors that cannot be changed but can help identify high-risk

individuals, these includes; advanced Maternal Age (especially ≥35 years), family history of

diabetes especially first-degree relative (parent or sibling) with type 2 diabetes, ethnicity

including African, Hispanic, South Asian, and Indigenous populations, history of GDM in a

previous pregnancy, Polycystic Ovary Syndrome (PCOS) .Modifiable risk factors can be

influenced by lifestyle changes, including overweight and obesity, sedentary lifestyle, unhealthy

diet, excessive gestational weight gain, hypertension or cardiovascular diseases.

Pregnancy-Related Risk Factors include previous macrosomic baby, multiple pregnancies

Clinical manifestations of GDM are often asymptomatic and is primarily diagnosed through

routine screening during pregnancy. However, in some cases, women may experience the

following symptoms: increased thirst (polydipsia), frequent urination (polyuria), excessive

hunger (polyphagia), fatigue, blurred vision, recurrent infections, delayed wound healing

(American Diabetes Association, 2024).

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Screening Tests and Diagnostic Criteria For GDM

 Fasting Plasma Glucose (FPG): A fasting blood sample is taken to check glucose levels.

 Oral Glucose Tolerance Test (OGTT): The most definitive test for GDM.

The WHO recommends that GDM be diagnosed using a 75 g oral glucose tolerance test (OGTT)

at 24–28 weeks of gestation in pregnant women without previously known diabetes. The

diagnosis is confirmed if one or more of the following plasma glucose values are met or

exceeded:

Time (Post-Glucose Load) Diagnostic Cutoff (mg/dL) Diagnostic Cutoff (mmol/L)

Fasting Plasma Glucose (FPG) ≥ 92 mg/Dl ≥ 5.1 mmol/L

1-hour Plasma Glucose ≥ 180 mg/dL ≥ 10.0 mmol/L

2-hour Plasma Glucose ≥ 153 mg/dL ≥ 8.5 mmol/L

 If at least one of these values is elevated, the woman is diagnosed with GDM.

 In some cases, a 50g glucose challenge test (GCT) (non-fasting) is performed first,

followed by the 100g OGTT if initial results are abnormal (Plows et al., 2020).

This approach is based on evidence linking these glucose thresholds to adverse maternal and

fetal outcomes.

2.1.4 Prevention of gestational diabetes mellitus

Preventing GDM involves strategies that focus on reducing insulin resistance and promoting

healthy glucose metabolism before and during pregnancy. While some risk factors (e.g., genetics,

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age, and family history) cannot be modified, adopting a healthy lifestyle can significantly lower

the risk of developing GDM.

 Maintaining a Healthy Weight Before Pregnancy

Women who are overweight or obese (BMI ≥ 25 kg/m²) before pregnancy have a higher risk of

developing GDM. Achieving healthy weight through balanced nutrition and physical activity

before conception can reduce insulin resistance. Even a 5–10% reduction in body weight before

pregnancy can lower the risk of GDM.

 Engaging in Regular Physical Activity

Regular exercise improves insulin sensitivity and helps regulate blood sugar levels. The

American College of Obstetricians and Gynecologists (ACOG) recommend at least 150 minutes

of moderate-intensity exercise per week (e.g., brisk walking, swimming, or prenatal yoga).

Physical activity before and during pregnancy has been shown to reduce the risk of GDM by up

to 50%.

 Eating a Balanced Diet

A nutrient-rich diet with a low glycemic index (GI) can help regulate blood sugar levels.

Recommended foods include high-fiber foods (e.g., whole grains, legumes, vegetables etc.), lean

proteins (e.g., fish, poultry, tofu), healthy fats (e.g., nuts, olive oil, avocado). Foods to be limited

or avoided include sugary beverages and processed foods, refined carbohydrates (e.g., white

bread, pastries), trans fats and saturated fats.

 Monitoring Blood Sugar Levels

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Women at high risk of GDM should have their fasting blood glucose and HbA1c levels

monitored before and during pregnancy. Early glucose tolerance testing (OGTT) can help detect

and manage pre-diabetes before it progresses to GDM.

 Managing Stress and Sleep Patterns

Chronic stress and poor sleep quality can contribute to insulin resistance. Practicing stress-

reducing activities (e.g., meditation, deep breathing exercises) and ensuring 7–9 hours of quality

sleep can improve metabolic health (Mirzakhani et al., 2021).

2.2 Theoretical Review

The theoretical framework that will be used for this study is the Health Belief Model (HBM).

The Health Belief Model (HBM) is one of the most widely used psychological models for

understanding health-related behaviors. It was initially developed in the 1950s by social

psychologists Hochbaum, Rosenstock, and Kegels to explain why individuals adopt or fail to

adopt disease prevention measures. The model was later refined by Rosenstock (1974) and

Becker (1978) to include additional constructions that further explain health behaviors.

The HBM assumes that individuals will take preventive health actions if they believe they are at

risk (perceived susceptibility), believe the condition has serious consequences (perceived

severity), believe that taking action will reduce their risk (perceived benefits), believe that the

benefits outweigh the barriers (perceived barriers), if they are exposed to factors that prompt

them to act (cues to action), or if they feel confident in their ability to perform the behavior (self-

efficacy) (Rahmati et al., 2021).

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2.3 Application of Health Belief Model to Gestational Diabetes Mellitus (GDM)

The Health Belief Model is a popular model applied in nursing, especially in issues focusing on

patient’s compliance and preventive health care practices. The model postulates that health

seeking behaviour is influenced by a person’s perception of a threat posed by a health problem

and the value associated with actions aimed at reducing the threat, health belief model addresses

the relationship between a person’s beliefs and behaviors. It provides a way to understanding and

predicting how clients will behave in relation to their health and how they will comply with

health care therapies.

There are six major concepts in HBM

1. Perceived susceptibility

2. Perceived severity

3. Perceived benefits

4. Perceived costs or barrier

5. Motivation

6. Enabling or modifying factors

Perceived susceptibility: the HBM predicts that individuals who perceive that they are

susceptible to a particular health problem will engage in behaviors to reduce their risk of

developing the health problem. Individuals with low perceived susceptibility may deny that they

are at risk for contracting a particular illness.

Perceived severity: refers to the subjective assessment of the severity of a health problem and its

potential consequences. The HBM proposes that individuals who perceive a given health

problem as serious are more likely to engage in behaviors to prevent the health problem from
17
occurring (or reduce its severity). Perceived seriousness encompasses beliefs about the disease

itself (e.g., whether it is life-threatening or may cause disability or pain) as well as broader

impacts of the disease on functioning in work and social roles.

Perceived Benefits: refer to an individual's assessment of the value or efficacy of engaging in a

health-promoting behavior to decrease risk of disease. If an individual believes that a particular

action will reduce susceptibility to a health problem or decrease its seriousness, then he or she is

likely to engage in that behavior regardless of objective facts regarding the effectiveness of the

action.

Perceived Barriers: refer to an individual's assessment of the obstacles to behavior

change. Even if an individual perceives a health condition as threatening and believes that a

particular action will effectively reduce the threat, barriers may prevent engagement in health-

promoting behavior. In other words, the perceived benefits must outweigh the perceived barriers

for behavior change to occur. Perceived barriers to taking action include the perceived

inconvenience, expense, danger (e.g., side effects of a medical procedure) and discomfort (e.g.,

pain, emotional upset) involved in engaging in the behavior. For instance, lack of access to

affordable health care and the perception that a flu vaccine shot will cause significant pain may

act as barriers to receiving the flu vaccine.

Motivations: this can also be referred to as cues to action. Cues to action can be internal or

external. Physiological cues (e.g., pain, symptoms) are an example of internal cues to

action. External cues include events or information from close others, the media, or health care

providers promoting engagement in health-related behaviors. The intensity of cue needed to prompt

action varies among individuals by perceived susceptibility, seriousness, benefits, and barriers.

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Modifying factors: include individual characteristics, demographic, psychosocial and structural

variables (Zampetakis et al., 2021).

Health Belief Model shows a distinct correlation between reinforcement and behavior. In other

words, positive reinforcement is followed by positive health seeking behaviors.

Finally, self-efficacy was added in an attempt to better explain individual differences in health

behaviors. Self-efficacy refers to an individual's perception of his or her competence to

successfully perform a behavior.

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Fig. 2.2.1 Health Belief Model (adapted from Sereika et al., 2024)

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2.3.1 Relevance of the model to the study

The Health Belief Model is a psychological model that explains and predicts health-related

behaviors by focusing on individuals' perceptions of disease risk, severity, benefits, and barriers

to action. It provides a useful framework for examining why some women actively seek

information, screening, and preventive care for GDM while others do not.

One key aspect of the model is perceived susceptibility, which refers to an individual's belief

about their risk of developing a disease. many women, particularly those in rural communities,

may not perceive themselves as being at risk, even if they exhibit risk factors such as obesity,

family history of diabetes, or advanced maternal age. A lack of awareness regarding personal

susceptibility can prevent women from seeking early screening and adopting preventive

measures. This study explores the extent to which reproductive women recognize their risk of

developing GDM and how this influences their health-seeking behaviors.

Another critical component is perceived severity, which refers to how serious individuals believe

a condition and its consequences to be. Even if women acknowledge their susceptibility to GDM,

their response will depend on whether they believe the condition has significant health risks for

both themselves and their babies. Some women may not be aware of the potential complications

of untreated GDM, such as preeclampsia, preterm birth, neonatal hypoglycemia, and increased

risk of type 2 diabetes. This study assesses whether reproductive women understand the severity

of GDM and whether this awareness impacts their willingness to seek screening and

management.

In addition to perceived susceptibility and severity, the perceived benefits of screening and

prevention play a vital role in influencing behavior. Women who understand that early detection

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and lifestyle modifications can significantly reduce complications are more likely to take

preventive action. Regular screening, a balanced diet, and moderate exercise can help manage

blood glucose levels and improve pregnancy outcomes. This study examines whether awareness

of these benefits translates into increased participation in antenatal care and adherence to

screening recommendations.

Despite recognizing the benefits, women may still face perceived barriers that prevent them from

taking action. These barriers may include financial constraints, cultural beliefs, misinformation,

inadequate healthcare access, and fear of diabetes diagnosis. Women who view these barriers as

insurmountable are less likely to engage in preventive health behaviors. This study investigates

the specific challenges reproductive women encounter regarding GDM screening and

management and how these barriers influence their decision-making.

Moreover, cues to action—external influences that trigger a health-related decision—are crucial

in encouraging women to seek care. These cues can come from healthcare providers, community

awareness programs, family members, or mass media campaigns. If women receive clear and

consistent information about GDM risk factors, prevention, and screening, they may be more

likely to take action.

Lastly, an individual's confidence in their ability to take preventive actions is essential in shaping

health behavior. Women who feel capable of managing their diet, engaging in physical activity,

and monitoring their blood sugar levels are more likely to follow healthy pregnancy practices.

However, a lack of self-efficacy can lead to non-compliance with medical advice and lifestyle

recommendations. This study explores whether educational interventions and healthcare support

improve women's confidence in preventing and managing GDM.

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In conclusion, the Health Belief Model provides a valuable theoretical framework for

understanding knowledge and awareness of GDM among reproductive women. By analyzing

perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy, this study

aims to identify gaps in awareness and health behaviors. The findings will contribute to

developing targeted interventions, improving health education programs, and enhancing maternal

healthcare services to reduce the burden of GDM.

2.4 Empirical Review

2.4.1 Knowledge of Gestational Diabetes Mellitus among Women of Reproductive Age in

Nigeria

Several studies in Nigeria have assessed the level of awareness and knowledge of gestational

diabetes mellitus (GDM) among women of reproductive age. The findings consistently reveal

moderate awareness but poor depth of understanding regarding risk factors, symptoms, and long-

term complications.

In a study conducted at the University College Hospital, Ibadan, Adepoju et al. (2021) found that

61% of pregnant women had heard of GDM, yet only 38% could correctly describe it as a

glucose intolerance that develops during pregnancy. Similarly, Oluwaseun and Adebimpe (2020)

in Osun State reported that although 57% of women had encountered the term “GDM,” only one-

third understood its association with maternal obesity and type 2 diabetes risk later in life.

Eze et al. (2023) in Ondo State found that while most women were aware of diabetes in general,

specific knowledge of gestational diabetes was poor, particularly concerning its transient nature

and management after delivery. Okon & Olanrewaju (2022) in Lagos State also observed that

antenatal clinic attendance did not necessarily translate to accurate knowledge of GDM, as only
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45% of respondents could identify correct risk factors such as family history, advanced maternal

age, and overweight.

In a study in Warri, Delta State, Nigeria, Offomiyor, & Rehal (2023), it was revealed that

majority of the pregnant women were unaware of GDM as a particular health condition during

pregnancy that poses a risk to both maternal and infant health and could lead to a long-term risk

of developing the chronic condition of Type 2 Diabetes Mellitus (T2DM). This low level of

knowledge and awareness was attributed to a lack of adequate information during prenatal clinic

sessions

The association between higher education and better awareness has been consistently

documented in Nigeria. Udo & James (2020) reported that women with tertiary education had

significantly higher knowledge scores than those with only secondary education. This suggests

that literacy plays a crucial role in shaping awareness and understanding of GDM.

Collectively, these findings indicate that while awareness of GDM is increasing among Nigerian

women, knowledge gaps remain concerning its causes, complications, and management. This

underscores the need for structured, culturally appropriate antenatal education tailored to GDM

prevention and control across Nigeria.

2.4.2 Attitude toward the Prevention and Management of Gestational Diabetes Mellitus in

Nigeria

Studies in Nigeria have revealed that pregnant women generally express positive attitudes toward

screening and prevention of gestational diabetes when recommended by healthcare providers.

However, these attitudes are often influenced by cultural and traditional beliefs.

24
At the Federal Medical Centre, Abeokuta, Opara & Akintunde (2021) reported that 72% of

respondents perceived GDM as a serious health condition, and 69% agreed that routine antenatal

screening is necessary. However, 28% believed that herbal remedies could help in managing

blood sugar during pregnancy. This reflects the coexistence of biomedical and traditional health

beliefs among Nigerian women.

Similarly, Ogunleye et al. (2023) in Kwara State found that while most respondents supported

blood sugar testing and dietary modification, misconceptions about the causes of GDM and

reliance on traditional healers persisted, especially among those with lower literacy levels. In

Edo State, Adeniran & Ero (2022) revealed that positive attitudes toward preventive care were

strongly linked to the influence of healthcare providers. They emphasized the importance of

nurses and midwives in shaping maternal attitudes through effective antenatal education.

In Enugu State, Nwafor & Ezeani (2020) found that 70% of pregnant women were willing to

adopt lifestyle modifications such as regular exercise and dietary changes if educated by

healthcare staff. Nonetheless, 36% still attributed GDM to spiritual or ancestral causes, reflecting

the persistent influence of socio-cultural factors.

A study at the University College Hospital, Ibadan by Adedeji & Oluwasola (2023) assessed

antenatal care satisfaction and influencing factors among 261 postpartum women. It was reported

that most respondents were aged 25–34 years, had tertiary education, and were skilled

professionals. Overall, 90% expressed satisfaction, particularly with the competence and care

provided by health workers. Factors such as parity, distance to the clinic, number of visits, health

education sessions, waiting time, and service cost significantly affected satisfaction.

Additionally, the number of antenatal visits was statistically linked to fetal outcomes.

25
A similar study at the University of Nigeria Teaching Hospital (UNTH) antenatal clinic by

Chikeme (2024) assessed the awareness, risk factors, perceived effects, and lifestyle

interventions for preventing gestational diabetes mellitus (GDM) among 244 antenatal women.

Most participants were aware of GDM, its risk factors, and effects, though awareness levels

varied across factors. About 78% knew of lifestyle interventions, with regular medical visits

being the most preferred. A significant association was found between educational background

and level of GDM awareness (p = 0.0001). The study recommends strengthening female

education and policy support to improve awareness and prevention of GDM.

These findings from various parts of Nigeria demonstrate that while attitudes toward GDM

prevention and management are generally favorable, they are moderated by cultural beliefs,

insufficient education, and limited access to consistent antenatal counseling. Therefore, sustained

health education by nurses and midwives is vital to reinforce positive attitudes and dispel

misconceptions.

2.4.3 Perceived Risk Factors of Gestational Diabetes Mellitus among Nigerian Women

Perception of risk factors for gestational diabetes among Nigerian women is often moderate but

not comprehensive. Many women acknowledge obesity, family history, and poor diet as

contributors, yet underestimate their personal vulnerability, a reflection of the “optimism bias”

documented in several studies.

Adebayo & Oladimeji (2022) found that although 63% of antenatal women recognized

overweight and family history as risk factors, nearly half did not consider themselves personally

at risk. Similarly, Ogunmodede & Alabi (2023) reported that 60% of women associated GDM

with excessive sugar intake, but only 42% recognized physical inactivity as a contributing factor.

26
In Imo State, Nwosu & Akpan (2021) observed that while many women could identify one or

two risk factors, few demonstrated comprehensive understanding of hormonal changes, previous

history of macrosomia, or prior GDM as risk indicators. Eze & Ehiemere (2020) also found that

women’s perception of GDM risk varied significantly with education level and parity, with

educated and multiparous women being more likely to perceive themselves at higher risk.

Furthermore, Okafor & Igyuse (2021) reported that only 51% of respondents had ever discussed

their personal risk for GDM with healthcare providers, indicating limited patient–provider

communication about individualized risk. These findings underscore the importance of

personalized health education and risk communication during antenatal care to bridge existing

perception gaps.

In another study by Quansah (2024) who provided a scoping review protocol of the barriers and

facilitators of cardiovascular disease prevention services for women with prior gestational

diabetes or hypertensive disorders of pregnancy in low-income, middle-income and high-income

settings. It was observed that women with a history of gestational diabetes mellitus (GDM) or

hypertensive disorders of pregnancy (HDP) face an elevated risk of developing cardiovascular

disease (CVD) later in life. Although early postpartum screening and preventive care are

recommended, various barriers restrict women’s access to these services.

Taken together, the reviewed Nigerian studies suggest that while general awareness of GDM risk

factors exists, most women underestimate their personal risk, reinforcing the need for targeted

and culturally relevant interventions to improve accurate risk perception.

27
2.4.4 Summary of Empirical Review

Empirical evidence from Nigeria reveals that awareness and knowledge of gestational diabetes

mellitus among women of reproductive age remain moderate, with significant gaps in

understanding of its risk factors, symptoms, and consequences. Educational level and health

professional influence are major determinants of knowledge and awareness.

Attitudes toward screening and management are generally positive across Nigerian settings, but

these attitudes are tempered by cultural influences, myths, and reliance on traditional medicine.

Studies consistently highlight that women are more likely to undergo testing or adopt preventive

measures when motivated by healthcare workers.

Perception of risk factors, though improving, remains incomplete, as many women fail to

internalize personal susceptibility. Thus, there is an urgent need for continuous, community-

based health education and effective nurse-led interventions to improve awareness, correct

misconceptions, and foster proactive preventive behaviors toward GDM across Nigeria.

28
 CHAPTER THREE

3.0 RESEARCH METHODOLOGY

This chapter presents the research methodology that was used in the study. It includes research
design, settings, population, sample and sampling techniques, research instruments, data
collection, data analysis and ethical consideration.

3.1 Research Design

This study adopted the descriptive longitudinal survey design which helped to assess the
knowledge, attitude, and perceived risks of GDM over a period of two weeks among
reproductive women in Oke Iyinmi Health Centre, Ado Ekiti.

3.2 Setting of the Study

The setting of this research is Oke Iyinmi Health Center, which is located in Ado Ekiti, along
Oke-Iyinmi road, within Ado Local Government Area, in Ekiti Central Senatorial District of
Ekiti State. It is a comprehensive primary health care facility providing services such as maternal
and child health services; general outpatient services such as diagnosis and treatment of common
ailments; preventive healthcare services such as health education, family planning and disease
prevention. It consists of several wards and units. The categories of health workers in the health
center includes Nurses, health attendants, laboratory scientist, etc. As a research area, Oke Iyinmi
Health Center provides access to the target population (i.e. women of reproductive age) and
opportunities for intervention studies.

On entering through the main gate, the administrative block is positioned at the front of the
premises. To the left of the entrance lies the consulting/recovery room and the delivery room,
with the pharmacy and laboratory department located further in that direction. To the right side
of the entrance is the health records department, adjacent to some consulting spaces and support
facilities.

Towards the rear of the facility are the maternal and child health sections. This includes the
antenatal clinic, family planning unit, and the infant welfare clinic.

29
3.3 Target Population

The population of this study comprises women of reproductive age in Oke Iyinmi Health Center,
Ado Ekiti, Ekiti State, Nigeria.

3.4 Sampling Size

The sample size was determined using Taro Yamene’s formula which states that:

N
n=
1+ N ( e 2 )

Where n = expected sample size

N = total anticipated population of reproductive women (193)

e = level of precision (0.05)

193
n=
1+193 ( 0.05 2 )

193
n= =130
1+0.4825

3.5 Sampling Technique

A purposive sampling technique was used in which questionnaires were distributed to

respondents. One hundred and thirty respondents were selected over the period of two weeks
which included women within the ages of 15-45 years.

3.5.1 Inclusion criteria

1. Women within the age range of 15-45 years.

2. Women who gave informed consent to participate in the study.

3.5.2 Exclusion criteria

1. Women over the age of 45 years.

2. Children less than 15 years.
3. Women who declined participation in the study.
4. Women who are not around during the period of data collection.
30
3.6 Instrument for Data Collection

The instrument that was used for sampling was a structured researcher-designed questionnaire
which was divided into four sections.

Section A: Demographic Data

Section B: Knowledge and awareness about Gestational Diabetes Mellitus

Section C: Attitude towards Gestational Diabetes Mellitus

Section D: Practice of preventive measures against gestational diabetes mellitus

3.7 Validity of the Instrument

The questionnaire was developed by the researcher and ambiguous terms were avoided while
simple English were used for easy comprehension. The validity was established by the
supervisor using face and content validity. The ability of the questionnaire to gather needed
information from the respondent was also considered to affirm its validity.

3.8 Reliability of the Instrument

The reliability of the instrument was determined using Crombach’s Alpha which is a measure of
internal consistency. This analysis revealed an index of0.8 , suggesting good internal consistency
among the scale items. This indicates that the items are highly correlated and measure the same
underlying concept.

3.9 Method of Data Collection

Letter of permission to conduct work was requested from the chairman of research committee of
Oke Iyinmi Health Centre, Ado Ekiti, and the head of department. The questionnaires were given
to the respondents one on one after which the purpose of the research was explained to them. The
questionnaires were filled out by the various respondents and collected. The questionnaires were
administered two days a week (Monday and Wednesday) over the period of two weeks. One
hundred and thirty questionnaires were administered and same was retrieved.
31
3.10 Method of data analysis

The questionnaires after being filled out were sorted out and analyzed manually using descriptive
and inferential statistics. The findings were presented using simple frequency count, bar chart, t-
test and Analysis of Variance (ANOVA).

3.11 Ethical Consideration

Respondents’ consents were duly obtained before the questionnaire was distributed to them.
Most importantly, the ethical and research committee of the health center were properly
informed, and their consents were obtained before using the respondents. Respondents’
confidentiality was guaranteed as provided in the questionnaire and the use was strictly limited to
the purpose to which it was designed.

32
 CHAPTER FOUR

4.0 RESULTS

4.1 Presentation of Results

This section provides the results of data analysis and the interpretation of the results. The results

are presented by employing descriptive analysis and test of hypotheses such as frequency count,

percentages, and analysis of variance (ANOVA). While frequency count and percentages proffer

answers to the items of the questionnaires given to the respondents in the field the ANOVA was

used to test the four hypotheses formulated for the study at the 0.05 level of significance.

The sample characteristics of respondents are presented first followed by the section of

descriptive presentation of data in which an overall picture on the trends of participants’

responses is presented. This is followed by the presentation of the test of hypotheses.

4.2 Respondents’ Demographic Characteristics

The responses of participants to the items of the questionnaire were analyzed descriptively. The

variables of consideration are age, marital status, educational level, occupation, and parity of the

respondents.

33
Table 4.2.1: Frequency and Percentage of Respondents’ Age

Age Frequency (%)

15 -20 years 13 (10.0)

21 – 25 years 35 (26.9)

26 – 30 years 42 (32.3)

31 – 35 years 23 (17.7)

36 – 40 years 11 (8.5)

41 – 45 years 6 (4.6)

Total 130 (100.0)

Table 4.2.1 shows the frequency and percentage of age groups of reproductive women attending

Oke Iyinmi Health Center selected for the study. The table indicates that 13 (10.0%) respondents

are in the age group “15 – 20 years”, 35 (26.9%) respondents are in the age group “21 – 25

years”, 42 (32.3%) respondents are in the age group “26 – 30 years”, 23 (17.7%) respondents are

in the age group “31 – 35 years”, 11 (8.5%) respondents are in the age group “36 – 40 years”,

and 6 (4.6%) respondents are in the age group “41 – 45 years”.

Results of age group distribution of respondents in table 1 are expressed with a bar chat in figure

2 below:

34
Fig. 4.2.1

Fig4.2.2: Frequency and Percentage of Respondents’ Marital Status

Marital Status Total No (%)

Single 48 (36.9)

Married 73 (56.2)

Divorced 5 (3.9)

Widowed 4 (3.1)

Total 130 (100.0)

35
Table 4.2.2 shows the frequency and percentage of marital status of reproductive women

attending Oke Iyinmi Health Center selected for the study. The table indicates that 48 (36.9%)

single women, 73 (56.2%) married women, 5 (3.9%) divorced women, and 4 (3.1%) widowed

women were sampled for the study.

Table 4.2.3: Frequency and Percentage of Respondents’ Educational Level

Educational Level Total No (%)

No formal education 8 (6.2)
Primary 12 (9.2)
Secondary 38 (29.2)
Tertiary 72 (55.3)
Total 130 (100.0)
Table 4.2.3 shows the frequency and percentage of educational level of reproductive women

attending Oke Iyinmi Health Center selected for the study. The table reveals that 8 (6.2%)

women with no formal education, 12 (9.2%) women with primary education, 38 (29.2%) women

with secondary education, and 72 (55.3%) women with tertiary education participated in the

study.

Table 4.2.4: Frequency and Percentage of Respondents’ Occupation

Occupation Total No (%)

Unemployed 17 (13.1)
Trader 45 (34.6)
Civil Servant 36 (27.7)
Artisan 24 (18.5)
Others 8 (6.2)

Total 130 (100.0)

36
Table 4.2.4 shows the frequency and percentage of occupation of reproductive women attending

Oke Iyinmi Health Center selected for the [Link] table shows that 17 (13.1%) unemployed

women, 45 (34.6%) traders, 36 (27.7%) civil servants, 24 (18.5%) artisans, and 8 (6.2%) in

“Others” occupation categories participated in the study.

Table 4.2.5: Frequency and Percentage of Number of Children of Respondents

Number of Children Total No (%)

0 48 (36.9)

1–2 50 (38.5)

3–4 31 (23.8)

5 and above 1 (0.8)

Total 130 (100.0)

Table 4.2.5 shows the frequency and percentage of number of children of reproductive women

attending Oke Iyinmi Health Center selected for the study. The table reveals that among the

women who participated in the study, 48 (36.9%) women have no children, 50 (38.5%) women

have “1-2” children, 31 (23.8%) women have “3-4” children, 1 (0.8%) woman has at least 5

children.

4.3 Answering Research Questions

Research Question One: What is the level of knowledge of gestational diabetes mellitus among

reproductive women attending Oke Iyinmi Health Center?

37
Table 4.3.1: Knowledge and awareness of gestational diabetes

S/N Item Yes (%) No (%) RMK

1. Have you ever heard about GDM before 76 (58.5) 54 (41.5) Yes
2. Have you ever been diagnosed with GDM before 38 (29.3) 92 (70.8) No
T F IDK RMK
3. GDM is a type of diabetes that occurs during 60 22 48 T
pregnancy (46.2) (16.9) (36.9)
4. GDM always continues after delivery 52 22 56 IDK
(40.0) (17.0) (43.0)
5. Family history of diabetes increases the risk of GDM 55 25 50 T
(42.3) (18.2) (38.5)
6. Being overweight can increase the risk of GDM 70 13 47 T
(53.8) (10.0) (36.2)
7. Frequent urination is a symptom of GDM 64 7 (5.4) 59 T
(49.2) (45.4)
8. GDM can harm the baby if not properly managed 67 15 48 T
(51.6) (11.5) (36.9)
9. GDM has no impact on delivery 49 32 49 UD
(37.7) (24.6) (37.7)
10. Exercise and proper diet can help manage GDM 51 29 50 T
(39.3) (22.3) (38.5)
11. GDM increases the mother’s risk of developing type 68 10 (7.7) 52 T
2 diabetes later (52.3) (40.0)
12. GDM can be detected through routine antenatal 67 13 50 T
screening (51.5) (10.0) (38.5)
13. Women with GDM usually experience no symptoms 50 21 59 IDK
(38.5) (16.2) (45.4)
14. GDM can lead to a baby being born with a high birth 30 43 57 IDK
weight (23.1) (33.1) (43.8)
15. Only overweight women can develop GDM 28 46 56 IDK
(21.5) (35.4) (43.1)
16. GDM can increase the chance of needing a cesarean 49 35 46 T
section (37.7) (26.9) (35.4)
17. Regular antenatal check-ups can help in early 83 10 (7.7) 37 T
detection and management of GDM (63.8) (28.5)

NB: T – True, F – False, RMK – Remark, Numbers in parenthesis indicate percentages

38
The result in Table 4.3.1 shows the level of knowledge of gestational diabetes mellitus among

reproductive women attending Oke Iyinmi Health Center. The table reveals that for item 1, 76

(58.5%) women have heard about GDM before while 54 (41.5%) have not. In item 2, 38 (29.3%)

women have been diagnosed with GDM before while 92 (70.8%) have not. In item 3, 60 (46.2%)

of the respondents indicated true to “GDM is a type of diabetes that occurs during pregnancy”,

22 (16.9%) indicated false while 48 (36.9%) have no idea. In item 4, 52 (40.0%) women

indicated true to “GDM always continues after delivery” 22 (17.0%) indicated false while 56

(43.0%) women do not know. In item 5, 55 (42.3%) women selected true to “Family history of

diabetes increases the risk of GDM”, 25 (18.2%) selected false while 50 (38.5%) do not know. In

item 6, 70 (53.8%) respondents indicated true to “Being overweight can increase the risk of

GDM”, 13 (10.0%), indicated false while 47 (36.2%) do not know. In item 7, 64 (49.2%)

participants selected true to “Frequent urination is a symptom of GDM” 7 (5.4%) indicated false

while 59(45.4%) have no idea. Item 8, 67 (51.6%) women indicated true to “GDM can harm the

baby if not properly managed” 15 (11.5%) indicated false, while 48 (36.9%) do not know. In

item 9, 49 (37.7%) women selected true regarding the statement “GDM has no impact on

delivery”, 32 (24.6%) selected false while 49 (37.7%) do not know. In item 10, 51 (39.3%)

women selected true regarding the statement “Exercise and proper diet can help manage GDM”,

29 (22.3%) selected false while 50 (38.5%) do not know. In item 11, the largest

proportion of women 68 (52.3%) indicated true to “GDM increases the mother’s risk of

developing type 2 diabetes later”, 10 (7.7%) indicated false, while 52 (40.0%) do not know. In

item 12, 67 (51.5%) participants indicated true to “GDM can be detected through routine

antenatal screening”, 13 (10.0%) indicated false, while 50 (38.5%) have no idea. In item 13, 50

(38.5%) participants indicated true tos “Women with GDM usually experience no symptoms”, 21

39
(16.2%) indicated false while 59 (45.4%) do not know. In item 14, 30 (23.1%) participants

indicated true to “GDM can lead to a baby being born with a high birth weight”, 43 (33.1%)

indicated false, while 57 (43.8%) do not know. In item 15, 28 (21.5%) women selected true on

the statement “Only overweight women can develop GDM”, 46 (35.4%) selected false while 56

(43.1%) have no idea. In item 16, 49 (37.7%) women selected true on the statement “GDM can

increase the chance of needing a cesarean section”, 35 (26.9%) selected false, while 46 (35.4%)

do not know. Lastly, in item 17, 83 (63.8%) of the respondents indicated true to “Regular

antenatal check-ups can help in early detection and management of GDM”, 10 (7.7%) indicated

false, while 37 (28.5%) do not know.

Research Question Two: What are the attitudes of reproductive women toward the prevention

and management of gestational diabetes mellitus among the study population?

Table 4.3.2: Attitudes of reproductive women toward the prevention and management of GDM

S/N Item SA A D SD RMK

90 31 6 (4.6) 3 (2.3) SA
1. I think GDM is a serious health condition.
(69.2) (23.8)

Pregnant women should be screened for GDM during 87 35 4 (3.1) 4 (3.1) SA

2.
antenatal care. (66.9) (26.9)

I am willing to take a test for GDM if advised by a 89 26 13 2 (1.5) SA

3.
health professional. (68.5) (20.0) (10.0)

Managing GDM requires unnecessary effort and 46 20 56 8 (6.2) D

4.
stress. (35.4) (15.4) (43.1)

I would encourage other women to get tested for 70 30 24 6 (4.6) SA

5.
GDM. (53.8) (23.1) (18.5)

I would be embarrassed to talk about GDM with 40 21 35 33 SA

6.
other people. (30.8) (16.2) (26.9) (25.4)

16 32 36 44 SD
7. I think there is a stigma associated with having GDM.
(12.3) (24.6) (27.7) (33.8)

If diagnosed, I would follow medical advice to 66 24 16 1 (0.8) SA

8.
manage GDM. (50.8) (18.5) (12.3)

9. I believe traditional medicine can cure GDM. 41 27 35 27 SA

40
 (31.5) (20.8) (26.9) (20.8)

NB: SA – Strongly Agree, A – Agree, D – Disagree, SD – Strongly Disagree, RMK – Remark,

Numbers in parenthesis indicate percentages

The result in Table 4.3.2 shows the attitudes of reproductive women toward the prevention and

management of gestational diabetes mellitus among reproductive attending Oke Iyinmi Health

Center. The table reveals that for item 1,90 (69.2%) women strongly agree that GDM is a serious

health condition, 31 (23.8%) agree, 6 (4.6%) disagree, while 3 (2.3%) strongly disagree. In item

2, 87 (66.9%) women strongly agree that “Pregnant women should be screened for GDM during

antenatal care”, 35 (26.9%) agree, 4 (3.1%) disagree while 4 (3.1%) strongly disagree. In item 3,

89 (68.5%) women strongly agree that they are willing to take a test for GDM if advised by a

health professional, 26 (20.0%) agree, 13 (10.0%) disagree while 2 (1.5%) strongly disagree. In

item 4, 46 (35.4%) women strongly agree that “Managing GDM requires unnecessary effort and

stress”, 20 (15.4%) agree, 56 (43.1%) disagree while 8 (6.2%) strongly disagree. In item 5, 70

(53.8%) women strongly agree that they would encourage other women to get tested for GDM,

30 (23.1%) agree, 24 (18.5%) disagree while 6 (4.6%). In item 6, 40 (30.8%) strongly agree that

they would be embarrassed to talk about GDM with other people, 21 (16.2%) agree, 35 (26.9%)

disagree while 33 (25.4%) strongly disagree. In item 7, 16 (12.3%) women strongly agree that

“there is a stigma associated with having GDM”, 32 (24.6%) agree, 36 (27.7%) disagree while

44 (33.8%) strongly disagree. In item 8, 66 (50.8%) women strongly agree that “If diagnosed,

they would follow medical advice to manage GDM”, 24 (18.5%) agree, 16 (12.3%) disagree

while 1 (0.8%) strongly disagree. In item 9, 41 (31.5) women strongly agree that “traditional

medicine can cure GDM”, 27 (20.8%) agree, 35 (26.9%) disagree while 27 (20.8%) strongly

disagree.

41
Research Question Three: What are the perceived risk factors of gestational diabetes mellitus

among women of reproductive age at Oke Iyinmi Health Center?

Table 4.3.3: Perceived risk factors of GDM among women of reproductive age

S/N Item SA A N D SD RMK

I believe I am at risk of developing GDM 21 19 49 28 13 N

1.
during pregnancy. (16.2) (14.6) (37.7) (21.5) (10.0)

I think GDM could negatively affect my 44 32 40 5 (3.8) 9 (6.9) SA

2.
baby's health. (33.8) (24.6) (30.8)

If I develop GDM, I believe I can manage it 46 41 37 5 (3.8) 1 (0.8) SA

3.
with proper care. (35.4) (31.5) (28.5)

I worry about my chances of developing 29 26 52 18 5 (3.8) N

4.
GDM in future pregnancies. (22.3) (20.0) (40.0) (13.8)

I believe that having GDM is beyond my 28 23 56 18 5 (3.8) N

5.
control. (21.5) (17.7) (43.1) (13.8)

I do not think I need to worry about GDM if I 32 25 52 15 6 (4.6) N

6.
feel healthy during pregnancy. (24.6) (19.2) (40.0) (11.5)

I think my lifestyle (diet, exercise) puts me at 40 28 43 15 4 (3.1) N

7.
risk of GDM. (30.8) (21.5) (33.1) (11.5)

I would like to learn more about my personal 77 36 9 (6.9) 6 (4.6) 2 (1.5) SA

8.
risk of developing GDM. (59.2) (27.7)

NB: SA – Strongly Agree, A – Agree, N – Neutral, D – Disagree, SD – Strongly Disagree, RMK

– Remark, Numbers in parenthesis indicate percentages

The result in Table 4.3.3 shows the perceived risk factors of gestational diabetes mellitus among

women of reproductive age Iyinmi Health Center. The table reveals that for item 1,21 (16.2%)

participants strongly agree they are at risk of developing GDM during pregnancy, 19 (14.6%)

agree, 49 (37.7%) are neutral,28 (21.5%) disagree while 13 (10.0%) strongly disagree. In item 2,

44 (33.8%) participants strongly agree GDM could negatively affect their baby's health, 32

(24.6%) agree, 40 (30.8%) are neutral, 5 (3.8%) disagree while 9 (6.9%) strongly disagree. In

item 3, 46 (35.4%) participants strongly agree that if they develop GDM, they can manage it
42
with proper care, 41 (31.5%) agree, 37 (28.5%) are neutral, 5 (3.8%) disagree while 1 (0.8%)

strongly agree. In item 4, 29 (22.3%) participants strongly agree that they worry about their

chances of developing GDM in future pregnancies, 26 (20.0%) agree, 52 (40.0%) are neutral, 18

(13.8%) disagree while 5 (3.8%) strongly disagree. In item 5, 28 (21.5%) participants strongly

agree that having GDM is beyond their control, 23 (17.7%) agree, 56 (43.1%) are neutral, 18

(13.8%)disagree while 5 (3.8%) strongly disagree. In item 6, 32 (24.6%) participants strongly

agree that they do not need to worry about GDM if they feel healthy during pregnancy, 25

(19.2%) agree, 52 (40.0%) are neutral 15 (11.5%) disagree while 6 (4.6%) strongly disagree. In

item 7, 40 (30.8%) participants strongly agree that their lifestyle (diet, exercise) puts them at risk

of GDM, 28 (21.5%) agree, 43 (33.1%) are neutral, 15 (11.5%) disagree, while 4 (3.1%) strongly

disagree. In item 8, 77 (59.2%) participants strongly agree that they would like to learn more

about their personal risk of developing GDM, 36 (27.7%) agree, 9 (6.9%) are neutral, 6 (4.6%)

disagree while 2 (1.5%) strongly disagree.

Research Question Four: What is the health-seeking behaviour of women of reproductive age

at Oke Iyinmi Health Center to gestational diabetes mellitus?

Table4.3.4: Health-seeking behaviour of women of reproductive age

S/N Item Yes No RMK

1. Have you ever been tested for blood sugar during pregnancy 68 (52.3) 62 (47.7) Yes

2. Do you know where to get tested for gestational diabetes 78 (60.0) 52 (40.0) Yes

3. Would you be willing to attend an awareness session on GDM if 112 18 (13.8) Yes

43
 one were held nearby (86.2)

If diagnosed with GDM, would you follow up regularly with a 115 15 (11.5) Yes
4.
healthcare provider (88.5)

NB: RMK – Remark, Numbers in parenthesis indicate percentages

The result in Table 4.3.4 shows the health-seeking behavior of among women of reproductive

age Iyinmi Health Center. The table reveals that for item 1, 68 (52.3%) women have been tested

for blood sugar during pregnancy while 62 (47.7%) have not. In item 2, 78 (60.0%) women

know where to get tested for gestational diabetes while 52 (40.0%) do not. In item 3, 112

(86.2%) women are willing to attend awareness session on GDM if one were held nearby while

18 (13.8%) are not willing to attend. In item 4, 115 (88.5%) women would follow up regularly

with a healthcare provider if diagnosed with GDM while 15 (11.5%) indicated they would not.

4.4 Test of Hypotheses

Hypothesis One: There is no significant difference in the level of knowledge and awareness of

gestational diabetes mellitus among reproductive women attending Oke Iyinmi Health Center.

Table 4.4.1: ANOVA of participants’ responses

Sum of df Mean Fcal Ftab Sig. Decision

squares square

Between 8.927 3 2.976 2.172 2.302 0.108 NS

Groups

Within Groups 107.996 128 0.857

Total 118.923 129

44
 P < 0.05 level of significance. NS = Not Significant

The result of the analysis in table 4.4.1 shows the difference in the level of knowledge and

awareness of gestational diabetes mellitus among reproductive women attending Oke Iyinmi

Health Center. The analysis of variance revealed that F-calculated, F cal (2.172), was less than F-

tabulated, Ftab(2.302) at p < 0.05 level of significance. This means that there is no significant

difference in the level of knowledge and awareness of gestational diabetes mellitus among

reproductive women attending Oke Iyinmi Health Center. Hence the null hypothesis was upheld.

Hypothesis Two: There is no significant difference in the attitudes of reproductive women

toward the prevention and management of gestational diabetes mellitus among the study

population.

Table 4.4.2: ANOVA of participants’ responses

Sum of df Mean Fcal Ftab Sig. Decision

squares square

Between 3.343 5 0.889 1.373 2.302 0.239 NS

Groups

Within Groups 60.388 124 0.487

Total 63.731 129

p< 0.05 level of significance. NS = Not Significant

45
The result of the analysis in table 4.4.2 shows the difference in the attitudes of reproductive

women toward the prevention and management of gestational diabetes mellitus among the study

population. The analysis of variance revealed that F-calculated, F cal (1.373), was less than F-

tabulated, Ftab (2.302) at p < 0.05 level of significance. This means that there is no significant

difference in the attitudes of reproductive women toward the prevention and management of

gestational diabetes mellitus among the study population. Hence the null hypothesis was upheld.

Hypothesis Three: There is no significant difference in the perceived risk factors of gestational

diabetes mellitus among women of reproductive age at Oke Iyinmi Health Center.

Table 4.4.3: ANOVA of participants’ responses

Sum of Df Mean Fcal Ftab Sig. Decision

squares square

Between 15.343 4 3.836 3.412 2.302 0.011 S

Groups

Within Groups 140.534 125 1.124

Total 155.877 129

p< 0.05 level of significance. S = Significant

The result of the analysis in table 4.4.3 shows the difference in the perceived risk factors of

gestational diabetes mellitus among women of reproductive age at Oke Iyinmi Health Center.

The analysis of variance revealed that F-calculated, F cal (3.427), was greater than F-tabulated, Ftab

(2.302) at p < 0.05 level of significance. This means that there is a significant difference in the

46
perceived risk factors of gestational diabetes mellitus among women of reproductive age at Oke

Iyinmi Health Center. Hence the null hypothesis was not upheld.

Hypothesis Four: There is no significant difference in the health seeking behaviour of women

of reproductive age at Oke Iyinmi Health Center to gestational diabetes mellitus.

Table 4.4.4: ANOVA of participants’ responses

Sum of df Mean Fcal Ftab Sig. Decision

squares square

Between 0.228 5 0.048 0.314 2.302 0.904 NS

Groups

Within Groups 17.995 124 0.145

Total 18.223 129

p< 0.05 level of significance. NS = Not Significant

The result of the analysis in table 4.4.4 shows the difference in the health seeking behaviour of

women of reproductive age at Oke Iyinmi Health Center to gestational diabetes mellitus. The

analysis of variance revealed that F-calculated, F cal (0.314), was less than F-tabulated, F tab(2.302)

at p < 0.05 level of significance. This means that there is no significant difference in the health

seeking behavior of women of reproductive age at Oke Iyinmi Health Center to gestational

diabetes mellitus. Hence the null hypothesis was upheld.

47
 CHAPTER 5

5.0 DISCUSSION OF FINDINGS, CONCLUSION AND RECOMMENDATIONS

5.1 Discussion of Findings

This chapter presents the discussion of findings, implications of findings to nursing, and

summary of the study, conclusion, recommendations, and suggestions for further studies.

The demographic data revealed that most respondents were within the age group of 26–30 years

(32.3%), predominantly married (56.2%), and more than half had tertiary education (55.3%).

These findings are consistent with Musa (2022), who reported that younger women in their

prime reproductive years dominate antenatal clinic attendance in Nigeria. Similarly, Okafor et al.

(2020) found that higher educational attainment among women is positively associated with

antenatal care utilization and awareness of maternal health conditions, including gestational
48
diabetes mellitus (GDM). The predominance of married participants in this study also aligns with

Igyuse (2020), who observed that marital stability increases health-seeking behaviour during

pregnancy in Nigerian contexts.

Regarding knowledge of gestational diabetes mellitus, results showed that 58.5% had heard

about GDM, but misconceptions persisted as over 40% were unsure whether GDM continues

after delivery, and 43.8% were uncertain about its link to high birth weight. This partial

knowledge mirrors the findings from Owolabi (2024), who reported that many women attending

antenatal clinics in Nigeria have fragmented knowledge of GDM despite exposure to maternal

health education. The association of GDM with overweight, family history, and type 2 diabetes

risk was moderately recognized, consistent with Adebayo et al. (2020), who found moderate

awareness of risk factors but poor understanding of long-term implications among pregnant

women in Southwestern Nigeria. Thus, while awareness exists, knowledge gaps highlight the

need for culturally tailored health education interventions.

On attitudes toward prevention and management of GDM, the majority of women perceived

GDM as a serious health condition (69.2% strongly agree) and supported antenatal screening

(66.9% strongly agree). Importantly, 68.5% were willing to be tested if advised by health

professionals. These positive attitudes are comparable to findings by Dahab (2020), who noted

that Nigerian women are generally receptive to screening if recommended by healthcare

providers. However, misconceptions also surfaced: 31.5% strongly agreed that traditional

medicine can cure GDM. This reflects cultural influences on maternal health attitudes, as

documented by Opara (2025), where reliance on traditional remedies often coexists with

biomedical care in Nigerian communities. Overall, the results confirm that attitudes are

supportive but influenced by cultural beliefs.

49
Regarding perceived risk factors, the study found a significant difference (p = 0.011) in

perceived risk factors of GDM. Notably, 59.2% strongly expressed interest in learning more

about personal risk, but neutrality was high in items related to personal susceptibility (37.7% –

43.1%). This reflects the “optimism bias” identified by Ogunleye et al. (2021), where women

acknowledge general risks of GDM but underestimate personal vulnerability. Such findings

emphasize the importance of personalized risk communication in antenatal care.

About health-seeking behavior, an encouraging 86.2% of respondents were willing to attend

awareness sessions, and 88.5% would follow up regularly if diagnosed. However, just over half

(52.3%) had actually undergone blood sugar testing during pregnancy. This gap between

willingness and practice is consistent with the findings of Eze & Uzochukwu (2022), who

reported that structural barriers such as cost, accessibility, and limited screening protocols often

restrict uptake despite positive attitudes. Therefore, improved health system integration and

routine GDM screening protocols are needed to bridge this gap.

Results of hypothesis testing on knowledge and awareness of GDM showed no significant

difference across groups, while no significant difference in attitude toward GDM was found

among respondents. This suggests a shared cultural and social outlook. There was a significant

difference in perceived risk factors leading to GDM among respondents, supporting prior work

by Dahab (2020), who noted variability in women’s perception of GDM risk depending on

family history, education, and prior exposure. No significant difference was found in health-

seeking behaviour, suggesting that most women in this study share a similar inclination toward

seeking care.

5.2 Implications of Findings to Nursing

50
The findings of this study have important implications for nursing practice, education, and

policy. First, the inadequate awareness and limited knowledge of gestational diabetes mellitus

(GDM) among pregnant women highlight the need for nurses and midwives to take an active

role in patient education during antenatal care. Nurses serve as the primary contact for most

pregnant women; therefore, they are strategically positioned to deliver clear, culturally sensitive,

and evidence-based health information.

In nursing education, curricula should emphasize competencies in maternal health promotion,

particularly in GDM prevention, screening, and management. By equipping nursing students and

practicing nurses with up-to-date knowledge, they can better support women in making informed

lifestyle and treatment decisions.

At the policy level, nurses can serve as advocates for integrating GDM awareness programs into

maternal and child health services, thereby improving early detection and reducing

complications. Ultimately, the role of nursing in empowering women through education and

holistic care is critical for reducing the burden of GDM and improving maternal–child health

outcomes.

5.3 Limitations of the Study

The limitations of the study are as follows:

1. The research was limited to Oke Iyinmi Health Center, which may not represent the

broader population of reproductive women in other health centers, state or country. This

limits the generalizability of the findings.

2. The use of questionnaires relies on the honesty and recall ability of respondents. Some

participants may have given socially desirable answers, which could introduce bias.
51
 3. The study captured data at a single point in time which may not allow for tracking

changes in knowledge, attitudes, risk perception, or health-seeking behavior over time.

4. While demographic characteristics and basic perceptions of gestational diabetes were

considered, other influential factors such as cultural beliefs, accessibility of health

services, or socioeconomic barriers were not deeply explored.

5.4 Contributions to Knowledge

1. The study provides localized empirical data on knowledge, attitudes, and behaviors

toward GDM among women of reproductive age at Oke Iyinmi Health Center.

2. It identifies persistent knowledge gaps regarding GDM symptoms, risk factors, and

complications despite moderate awareness.

3. It reveals positive but inconsistent attitudes, including misconceptions about traditional

cures and stigma surrounding GDM.

4. It shows a significant variation in perceived risk factors, highlighting differing

understandings of GDM causes among women.

5. It establishes that health-seeking behaviors are generally proactive, offering insights for

developing targeted public health education and intervention programs.

5.5 Summary of Study

This study investigated the knowledge, attitudes, perceived risk factors, and health-seeking

behaviors regarding gestational diabetes mellitus (GDM) among women of reproductive age

attending Oke Iyinmi Health Center. A total of 130 respondents participated, with demographic

analysis showing that the majority were between 26–30 years of age, married, and had tertiary

education. Findings revealed that slightly more than half of the women had heard about GDM,
52
but gaps in knowledge persisted, particularly regarding symptoms, long-term risks, and

complications. Attitudes toward prevention and management were generally positive, as most

participants agreed that GDM is a serious health condition and supported antenatal screening and

follow-up care. However, misconceptions about the curability of GDM through traditional

medicine and stigma were also reported. Perceived risk factors showed variability: while many

women acknowledged lifestyle and family history as contributors, others remained uncertain or

felt that GDM was beyond their control. A significant difference was found in perceptions of risk

factors, indicating diverse views among the women. Health-seeking behavior was encouraging,

as the majority of respondents expressed willingness to attend awareness sessions, undergo

testing, and follow medical advice if diagnosed. Hypothesis testing revealed no significant

differences in knowledge, attitudes, or health-seeking behaviors across groups, but there was a

significant difference in perceived risk factors.

Overall, the study highlights moderate awareness but persistent knowledge gaps, positive but

sometimes inconsistent attitudes, and largely proactive health-seeking behaviors among women

regarding GDM.

5.6 Conclusion

The findings of this study underscore that while a reasonable proportion of pregnant women

demonstrated some awareness of gestational diabetes mellitus (GDM), their depth of knowledge

and perception of risk remained inadequate. This limited awareness reflects gaps in antenatal

health education and underscores the need for consistent health promotion strategies.

Comparisons with related scholarly works indicate that these gaps are not peculiar to the study

setting but are consistent with reports from other low- and middle-income countries where

53
cultural, educational, and systemic barriers impede optimal maternal health outcomes Dahab

(2020).

Moreover, the hypothesis testing revealed significant associations between socio-demographic

variables such as education level and GDM awareness, aligning with earlier findings by Petersen

(2022). These results highlight the importance of tailoring educational interventions to the socio-

cultural and literacy context of the target population. Ultimately, the study demonstrates that

improving maternal knowledge and perception of GDM has potential to enhance preventive

health behavior, early diagnosis, and adherence to medical advice, which are essential for

reducing adverse maternal and neonatal outcomes.

5.7 Recommendations

Based on the findings, the following recommendations are suggested:

1. Health workers should incorporate structured GDM education sessions into routine

antenatal care visits. This should include simple explanations of causes, risk factors,

complications, and lifestyle modifications.

2. Outreach programs using radio, community forums, and local leaders should be

employed to raise awareness of GDM beyond hospital settings, especially in rural and

underserved areas.

3. Continuous professional development and training for midwives, nurses, and doctors

should be prioritized to ensure accurate communication and screening practices for

GDM.

54
 4. Universal GDM screening should be integrated into routine antenatal care, with

accessible diagnostic tools provided even in primary health centers.

5. Ministries of Health should implement national guidelines on GDM screening,

management, and follow-up, ensuring subsidies for screening tests and treatment where

possible.

5.8 Suggestions for Further Studies

1. Future research should include multiple health centers across different urban and rural

areas to enhance the representativeness of the findings.

2. A larger sample size would improve the statistical power and reliability of results, making

the findings more generalizable.

3. Follow-up studies over time could be conducted to track changes in knowledge, attitudes,

and behaviors regarding gestational diabetes, especially before, during, and after

pregnancy.

4. Combination of quantitative analysis with qualitative methods such as interviews or focus

group discussions may help to capture in-depth insights into cultural and social factors

influencing knowledge and attitudes toward GDM.

5. Future studies could explore the role of healthcare access, health literacy, traditional

beliefs, and economic status in shaping women’s understanding and management of

GDM.

6. Research could test the effectiveness of educational or awareness programs on improving

knowledge, attitudes, and practices regarding gestational diabetes management.

55
 7. Comparative research across different regions, healthcare facilities, or between rural and

urban populations could highlight contextual differences in GDM awareness and

management.

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