Questionnaire Evaluates Obstetric Nurse Competency in Managing Gestational Diabetes

As gestational diabetes (GD) cases rise, a new study introduces a reliable, evidence-based questionnaire to assess obstetric nurses’ competency in GD care, addressing a critical gap in training and evaluation to enhance maternal and fetal outcomes.¹

Validated questionnaire assesses skills, knowledge, and attitudes for effective gestational diabetes management. | Image credit: Phushutter - stock.adobe.com

The study was published in Frontiers in Public Health.

“A review of the literature revealed the existence of instruments such as the questionnaire for the health education needs of [GD] patients and the questionnaire for [GD] self-management ability, both of which focus on the patient perspective,” wrote the researchers of the study. “However, no instrument appears to be specifically designed to assess the competence of obstetric nurses in the management of [GD], which complicates efforts to evaluate the current state of practice in this area. The aim of this study was to develop an appropriate questionnaire to provide a tool to measure the competence of obstetric nurses in the management of [GD].”

GD is a pregnancy-related condition in which hormones produced by the placenta lead to insulin resistance, causing glucose to accumulate in the blood rather than being used by the body’s cells.² Unlike type 1 diabetes, GD is not due to an insulin deficiency but to the reduced effectiveness of insulin caused by pregnancy hormones. Symptoms typically resolve after childbirth. In the US, GD affects approximately 3% to 8% percent of all pregnant women.

The questionnaire was developed using a 2-phase process.¹ First, the researchers designed the questionnaire based on the definition of competency, literature review, and qualitative interviews with nurses and nurse managers. An initial pool of 37 items was created and refined through 2 rounds of Delphi expert inquiry involving 10 specialists in nursing, obstetrics, and diabetes care. The second phase involved a pilot study with 30 obstetric nurses to confirm item clarity and relevance. Subsequently, the questionnaire’s validity and reliability were tested using a larger sample of 239 obstetric nurses from 7 hospitals across China.

The final questionnaire was comprised of 4 dimensions: professional knowledge, professional skills, professional competence, and personal attitude. Correlation analysis showed statistically significant associations (P < .01) between each item and the total score, although 2 items with R values below 0.4 were removed due to weak correlations. Cronbach α coefficients for the 4 dimensions ranged from 0.793 to 0.928 and had an overall coefficient of 0.970. Split-half reliability was also high, with a total score coefficient of 0.950, while test-retest reliability reached 0.907, indicating strong stability over time.

Structural validity was supported by high correlation coefficients between individual dimensions and the total score (0.754–0.967), and between dimensions (0.632–0.903), confirming coherent internal structure. Content validity, evaluated by 5 experts, yielded I-CVI values of 0.80 to 1.00 and an S-CVI/Ave of 0.95, surpassing the accepted thresholds.

These results demonstrate that the questionnaire is psychometrically sound and suitable for assessing obstetric nurses’ competencies in managing patients with GD.

However, the researchers noted the study has several limitations. First, although the expert panel involved in content validation was composed of highly qualified professionals, the selection may have introduced bias, as their perspectives may not reflect those of nurses with less experience in GD management. Second, the questionnaire was developed based on national guidelines in China and within a specific cultural and health care context, which may limit its applicability in other regions with different clinical practices and cultural norms. Third, the relatively small sample size in the pilot study may also have constrained the generalizability of the results.

Despite these limitations, the researchers believe the study successfully developed a comprehensive assessment tool to evaluate the management ability of obstetric nurses caring for patients with GD.

“It is recommended that health care institutions integrate this questionnaire into training and evaluation programs for obstetric nurses to improve care quality for [GD] patients,” wrote the researchers. “Regular use will ensure nurses have the knowledge, skills, and attitudes needed to provide optimal care.”

References

1. Zhu Y, Ren Y, Ma J, et al. Development of a questionnaire to evaluate the management of gestational diabetes mellitus patients among obstetric nurses. Front Public Health. 2025;13:1521673. doi:10.3389/fpubh.202

2. Gestational diabetes mellitus (GDM). Johns Hopkins Medicine. Accessed May 8, 2025. https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes