As gestational diabetes (GD) continues to affect a growing number of pregnancies worldwide, a newly developed and validated questionnaire offers a rigorous method to assess obstetric nurses’ competence in managing the condition—marking a critical advancement in maternal health care training and evaluation.
Published in Frontiers in Public Health, the study addresses a longstanding gap in the assessment of healthcare professionals tasked with GD care. While previous tools have focused on patient education or self-management capabilities, this is the first known instrument designed specifically to evaluate the skills, knowledge, and attitudes of obstetric nurses responsible for managing GD.
Understanding GD and the Need for Competency Assessment
Gestational diabetes is a form of glucose intolerance triggered by hormonal changes during pregnancy. Unlike type 1 diabetes, it arises not from insulin deficiency, but from insulin resistance induced by placental hormones. Though the condition typically resolves postpartum, it poses serious risks to both mother and child if improperly managed. In the United States alone, GD affects an estimated 3% to 8% of pregnancies.
Given the complex nature of GD care, especially during a critical time for both maternal and fetal health, ensuring that nurses are adequately trained is essential.
Two-Phase Development Ensures Scientific Rigor
To build the assessment tool, researchers employed a two-phase methodology. The first phase included an extensive literature review, a competency framework, and qualitative interviews with nurses and nurse managers. From this, an initial 37-item pool was created. Two rounds of expert review, involving 10 specialists in nursing, obstetrics, and diabetes care, refined the questionnaire’s content through Delphi methodology.
In the second phase, a pilot test involving 30 obstetric nurses helped confirm item clarity and relevance. The revised questionnaire was then tested among 239 nurses from seven hospitals in China to evaluate its psychometric properties.
Comprehensive Competency Coverage
The final version of the tool comprises four dimensions:
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Professional Knowledge
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Professional Skills
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Professional Competence
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Personal Attitude
Statistical analyses confirmed strong validity and reliability across all metrics. Internal consistency was high, with Cronbach’s alpha values between 0.793 and 0.928 for each subscale and an overall alpha of 0.970. The split-half reliability was 0.950, and test-retest reliability reached 0.907—highlighting the tool’s stability over time.
Structural validity was also robust. Correlation coefficients between subscales and the total score ranged from 0.754 to 0.967, while inter-dimension correlations ranged from 0.632 to 0.903. Content validity, judged by five subject-matter experts, yielded excellent I-CVI scores (0.80 to 1.00) and an S-CVI/Ave of 0.95—well above standard benchmarks.
Recognizing Limitations and Future Implications
While the tool shows great promise, the study acknowledged several limitations. The expert panel’s composition may have introduced bias, as it did not necessarily reflect the perspectives of less experienced nurses. Additionally, the questionnaire was developed in alignment with Chinese clinical guidelines and cultural contexts, potentially limiting its applicability across other healthcare systems. Furthermore, the pilot study’s small sample size may restrict broader generalization of the results.
Despite these caveats, the study’s authors assert that the questionnaire fills a crucial gap in GD care and offers a valuable benchmark for nurse training and evaluation.
The tool stands as a step forward in standardizing GD management training, ultimately supporting safer, more effective maternal health care practices.
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