The relationship between family function and behavioral decision-making in patients with gestational diabetes mellitus: a multiple mediation model and cross-lagged analysis of pregnancy-related anxiety and hope.

AIM: This study aimed to explore the chain mediating effect and cross-lagged associations between pregnancy-related anxiety and hope in the relationship between family function (FF) and blood glucose management behavioral decision-making (BDM) among patients with gestational diabetes mellitus (GDM). This study also aimed to provide insights into enhancing self-management efficacy and optimizing maternal and infant outcomes.

METHODS

A convenience sample of 245 GDM patients was selected. Surveys were conducted using the Pregnancy-related Anxiety Questionnaire (PAQ), the Herth Hope Index (HHI), the Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Index, and the Blood Glucose Management Decision-Making Behavior Questionnaire at three time points: 24-28 weeks of gestation (T1), 32 weeks of gestation (T2), and 36-42 weeks of gestation (T3). Statistical analyses included equivalence testing and cross-lagged modeling.

RESULTS

A total of 220 valid questionnaires were collected. Equivalence testing indicated that all variables met the requirements for measurement invariance, ensuring cross-temporal comparability of the tools. Cross-lagged path analysis revealed that T1 family function significantly predicted T2 pregnancy-related anxiety (β = -0.26, p < 0.01), T2 hope (β = 0.18, p < 0.01), and T2 behavioral decision-making (β = 0.24, p < 0.001). T1 pregnancy-related anxiety significantly predicted T2 hope (β = -0.11, p < 0.01) and T2 behavioral decision-making (β = -0.28, p < 0.001). T2 family function positively predicted T3 hope (β = 0.18, p < 0.001), while T2 pregnancy-related anxiety negatively predicted T3 behavioral decision-making (β = -0.25, p < 0.001). T2 hope positively predicted T3 behavioral decision-making (β = 0.18, p < 0.001), and T2 behavioral decision-making positively predicted T3 family function (β = 0.11, p < 0.01). Bootstrap analysis demonstrated significant indirect effects of T2 pregnancy-related anxiety (β = 0.065, p < 0.01) and T2 hope (β = 0.032, p < 0.01) in the prediction of T3 behavioral decision-making by T1 family function.

CONCLUSION

Clinical practice should develop family-centered intervention models, assess family function, screen for anxiety, and enhance hope through psychological support and health education to promote positive behavioral decision-making and improve blood glucose control.