Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet 48 • 2026 • https://doi.org/10.61622/rbgo/2026rbgo7 linkcopy

Development of a Brazilian Portuguese instrument to assess knowledge, attitudes, and practices of pregnant women with diabetes at a Brazilian center

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: To develop and test an instrument in Brazilian Portuguese to evaluate KAP regarding GDM.

Methods: We developed an instrument with 22 items (10 items for practice, 4 for knowledge and 8 for attitude), which was tested in a population of pregnant women (24 – 28 weeks) with GDM. We performed an Exploratory Factor Analysis to evaluate the items included in the instrument, the covariance among the domains evaluated by the instrument, and the robustness of the instrument.

Results: One hundred seventy-five participants were included in this study (mean gestational age: 25.4±7.1 weeks). The majority of them did not present adequate KAP regarding diabetes. The average knowledge score was 0.84±1.02 points; the attitude score was 32.46±2.94; and the practice score was 4.65±1.65. The model with the best robustness to evaluate KAP was composed of 3 items for knowledge, 6 for attitude, and 5 for practice.

Conclusion: The levels of KAP regarding diabetes among Brazilian pregnant women are low. The moderate association between knowledge and practice underscores the need for targeted educational interventions within prenatal care. Implementing a specific Brazilian Portuguese instrument to evaluate KAP among this population can bring evidence regarding the dimension of the problem in the country.

Keywords
Gestational diabetes; Knowledge; Attitudes; Practice; Psychometric

Question		Yes n(%)	No n(%)
K1	Criteria for good control of fasting blood glucose in a patient with GDM (correct answer: ≤ 95mg/dL)	32(18.29)	143(81.71)
K2	Criteria for good control of 1 h postprandial blood glucose in a patient with GDM (correct answer: ≤ 140mg/dL)	68(38.86)	107(61.14)
K3	Criteria for good control of 2 h postprandial blood glucose in a patient with GDM (correct answer: ≤ 120mg/dL)	34(19.43)	141(80.57)
K4	What is the maximum percentage of values that can be outside the target for adequate diabetes control? (correct answer: ≤ 30%).	13(7.47)	162(92.57)

Question		Strongly agree n(%)	Agree n(%)	Neutral n(%)	Disagree n(%)	Strongly disagree n(%)
A1	Blood glucose monitoring throughout pregnancy is essential for patients with gestational diabetes mellitus (GDM)	94(53.71)	75(42.86)	3(1.71)	2(1.14)	1(0.57)
A2	The treatment of GDM includes nutritional therapy, movement therapy, insulin therapy, education on diabetes mellitus, and blood glucose monitoring.	78(44.57)	92(52.57)	5(2.86)	0	0
A3	All patients with GDM should receive a glucose tolerance test at 6–12 weeks after delivery.	25(14.29)	47(26.86)	93(53.14)	9(5.14)	1(0.57)
A4	An individualized management regimen is required for the treatment of GDM.	51(29.14)	118(67.43)	4(2.29)	2(1.14)	0
A5	Individualized guidance by medical staff can provide more reliable information than newspapers, television shows or other media and thus should be followed.	90(51.43)	82(46.86)	2(1.14)	1(0.57)	0
A6	The Nutritional Clinic plays an important role in the management of patients with GDM.	70(40.00)	99(56.57)	4(2.29)	2(1.14)	0
A7	Insulin therapy and drug therapy are difficult to accept by patients.	37(21.14)	69(39.43)	23(13.14)	38(21.71)	8(4.57)
A8	Good blood glucose control can reduce the risk to the mother and fetus.	87(49.71)	86(49.14)	2(1.14)	0	0

Question		Yes / Often n(%)	No / Never / Occasionally n(%)
P1	Do you monitor your blood glucose level regularly?	142(81.14)	33(18.86)
P2	Do you have a habit of recording your diet and weight?	29(16.57)	146(83.43)
P3	Do you stick with exercise?	16(9.14)	159(90.86)
P4	Do you follow the instructions of doctors or dieticians to eat a low-glucose, low-fat and low-oil diet on a daily basis?	76(43.43)	99(56.57)
P5	Do you follow the instructions of doctors or dieticians to control your daily total dietary intake?	27(15.43)	148(84.57)
P6	Do you bring candy with you for possible hypotension when doing exercise?	30(17.14)	145(82.86)
P7	Do you actively acquire knowledge about GDM, its management and other relevant information regularly from doctors, books, the internet or APP?	94(53.71)	81(46.29)
P8	Would you ask the community medical service for help with controlling your blood glucose level?	116(66.29)	59(33.71)
P9	Would you see a doctor immediately if your blood glucose level was not well controlled?	111(63.43)	64(36.57)
P10	Do you receive prenatal examinations regularly?	172(98.29)	3(1.71)

Item		Factor loading	Factor loading	Factor loading
Model		Model 1	Model 2	Model 3
	K1	0.450	0.417	0.418
	K2	0.738	0.811	0.802
	K3	0.469	0.435	0.441
	K4	0.230	Excluded	Excluded
Attitude
	A1	0.649	0.648	0.649
	A2	0.779	0.777	0.777
	A3	0.204	Excluded	Excluded
	A4	0.500	0.496	0.497
	A5	0.660	0.662	0.660
	A6	0.561	0.555	0.555
	A7	0.019	Excluded	Excluded
	A8	0.676	0.687	0.686
Practice
	P1	0.236	0.242	0.285
	P2	0.495	0.521	0.539
	P3	0.143	Excluded	Excluded
	P4	0.567	0.558	0.542
	P5	0.572	0.562	0.559
	P6	0.025	Excluded	Excluded
	P7	0.440	0.430	0.400
	P8	0.106	Excluded	Excluded
	P9	0.440	0.310	Excluded
	P10	0.186	0.183	Excluded
Covariances
	Knowledge and Attitude	0.152	0.134	0.137
	Knowledge and Practice	0.243	0.238	0.277
	Attitude and Practice	0.131	0.117	0.152
	CFI	0.811	0.872	0.922
	TLI	0.788	0.848	0.904
	RMSEA	0.051	0.058	0.050
	SRMR	0.074	0.070	0.065

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E-mail: editorial.office@febrasgo.org.br

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