{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:21:14Z","timestamp":1792686074238,"version":"4.5.0"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T00:00:00Z","timestamp":1721174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100013795","name":"Fujian Medical University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013795","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013795","name":"Fujian Medical University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013795","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Social support and e-health literacy are closely related to individual health behaviors, while behavior is premised on decision-making. Few studies have identified the relationships among social support, e-health literacy, and behavioral decision-making, and the nature of these relationships among pregnant women with gestational diabetes remains unclear. Therefore, this study aimed to investigate relationships among social support, e-health literacy, and glycemic management behavioral decisions in pregnant women with gestational diabetes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using continuous sampling, an online cross-sectional survey was conducted among pregnant women with gestational diabetes who met the inclusion and exclusion criteria at four Class 3 hospitals in Fujian Province from October to December 2023. A structured questionnaire was used to collect data on general characteristics, socioeconomic status, social support, e-health literacy, and behavioral decision-making regarding glycemic management. Descriptive statistical analyses, correlation analyses, and mediation effects were used to assess associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 219 pregnant women with gestational diabetes participated, and 217 valid results were obtained. The level of glycemic management behavior decision-making in women with gestational diabetes was positively correlated with e-health literacy (<jats:italic>r<\/jats:italic>\u2009=\u20090.741, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01) and with perceived social support (<jats:italic>r<\/jats:italic>\u2009=\u20090.755, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01). E-health literacy was positively correlated with perceived social support (<jats:italic>r<\/jats:italic>\u2009=\u20090.694, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.01). The indirect effect of perceived social support on glycemic management behavior decisions through e-health literacy (a*b) was 0.153, accounting for 38% of the total effect.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Social support and e-health literacy in pregnant women with gestational diabetes are related to behavioral decision-making in glycemic management. The results of this study provide a reference for developing targeted measures to improve glycemic management behaviors in pregnant women with gestational diabetes, which is crucial for achieving sustainable glycemic management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1416620","type":"journal-article","created":{"date-parts":[[2024,7,17]],"date-time":"2024-07-17T04:51:13Z","timestamp":1721191873000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["The mediating effect of e-health literacy on social support and behavioral decision-making on glycemic management in pregnant women with gestational diabetes: a cross-sectional study"],"prefix":"10.3389","volume":"12","author":[{"given":"Peng","family":"Yumei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Huiying","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shen","family":"Liqin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Xiaoshan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Meijing","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xie","family":"Yaping","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Huifen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,17]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1097\/AOG.0000000000002152","article-title":"American College of Obstetricians and Gynecologists. Practice bulletin No. 180 summary: gestational diabetes mellitus","volume":"130","year":"2017","journal-title":"Obstet Gynecol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","article-title":"IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045","volume":"183","author":"Sun","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1111\/jdi.12854","article-title":"Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta-analysis","volume":"10","author":"Gao","year":"2019","journal-title":"J Diabetes Investig"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"725","DOI":"10.3897\/folmed.64.e65693","article-title":"Gestational diabetes mellitus: a growing economic concern","volume":"64","author":"Staynova","year":"2022","journal-title":"Folia Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1002\/pd.5768","article-title":"Short- and long-term outcomes of gestational diabetes and its treatment on fetal development","volume":"40","author":"Murray","year":"2020","journal-title":"Prenat Diagn"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3390\/ijerph17249517","article-title":"Prevalence, prevention, and lifestyle intervention of gestational diabetes mellitus in China","volume":"17","author":"Juan","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1005","DOI":"10.1001\/jama.2018.11628","article-title":"Association of gestational diabetes with maternal disorders of glucose metabolism and childhood adiposity","volume":"320","author":"Lowe","year":"2018","journal-title":"JAMA"},{"key":"ref8","first-page":"e223","article-title":"Leveraging EHRs for patient engagement: perspectives on tailored program outreach","volume":"23","author":"Brown","year":"2017","journal-title":"Am J Manag Care"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e1002881","DOI":"10.1371\/journal.pmed.1002881","article-title":"Correction: increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: a population-based cohort study","volume":"16","author":"Daly","year":"2019","journal-title":"PLoS Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"425","DOI":"10.3892\/etm.2023.12124","article-title":"Adverse perinatal outcomes complicated with gestational diabetes mellitus in preterm mothers and preterm infants","volume":"26","author":"Zhang","year":"2023","journal-title":"Exp Ther Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e2233955","DOI":"10.1001\/jamanetworkopen.2022.33955","article-title":"Glycemic control trajectories and risk of perinatal complications among individuals with gestational diabetes","volume":"5","author":"Chehab","year":"2022","journal-title":"JAMA Netw Open"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1186\/s12884-023-05996-6","article-title":"Gestational diabetes is associated with the risk of offspring\u2019s congenital anomalies: a register-based cohort study","volume":"23","author":"Kinnunen","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2170378","DOI":"10.1080\/21642850.2023.2170378","article-title":"Exploring the psychological wellbeing of women with gestational diabetes mellitus (GDM): increased risk of anxiety in women requiring insulin. A prospective longitudinal observational pilot study","volume":"11","author":"Fraser","year":"2023","journal-title":"Health Psychol Behav Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1016\/j.jcjd.2020.06.014","article-title":"Association between gestational diabetes and mental illness","volume":"44","author":"Riggin","year":"2020","journal-title":"Can J Diabetes"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"5136","DOI":"10.1038\/s41598-021-84573-3","article-title":"The association between gestational diabetes and ASD and ADHD: a systematic review and meta-analysis","volume":"11","author":"Rowland","year":"2021","journal-title":"Sci Rep"},{"key":"ref16","first-page":"1308","article-title":"Update of clinical nursing practice guideline for gestational diabetes mellitus","volume-title":"Chin J Nurs","author":"Huang","year":"2023"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"CD012327","DOI":"10.1002\/14651858.CD012327.pub2","article-title":"Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews","volume":"2018","author":"Martis","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1892","DOI":"10.16821\/j.cnki.hsjx.2021.20.015","article-title":"Systematic review of qualitative studies on the characteristics and causes of dietary behavior changes in pregnant women with gestational diabetes mellitus","volume":"36","author":"Liu","year":"2021","journal-title":"J Adv Nurs Educ"},{"key":"ref19","first-page":"2","article-title":"To investigate and study the status of self-management behavior in patients with gestational diabetes mellitus","volume":"18","author":"Cheng","year":"2017","journal-title":"Chin J Clin Obstet Gynecol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1111\/j.1471-0528.2011.03156.x","article-title":"An analysis of the interrelationship between maternal age, body mass index and racial origin in the development of gestational diabetes mellitus","volume":"119","author":"Makgoba","year":"2012","journal-title":"BJOG"},{"key":"ref21","first-page":"212","article-title":"Evaluation of information retention and adherence to treatment in patients with gestational diabetes mellitus after multidisciplinary group","volume-title":"Rev Assoc Med Bras","author":"Sousa","year":"2016"},{"key":"ref22","first-page":"1312","article-title":"Study on blood glucose management decision-making behavior and its influencing factors in pregnant women with gestational diabetes mellitus","volume":"56","author":"Huang","year":"2021","journal-title":"Chin J Nurs"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"e017648","DOI":"10.1136\/bmjopen-2017-017648","article-title":"Lived experience of women with gestational diabetes mellitus living in China: a qualitative interview study","volume":"7","author":"Ge","year":"2017","journal-title":"BMJ Open"},{"key":"ref24","first-page":"2233","article-title":"Application of SFEE diet management intervention in patients with gestational diabetes mellitus","volume":"37","author":"Liu","year":"2023","journal-title":"Nurs Res"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.puhe.2016.03.030","article-title":"Why is changing health-related behaviour so difficult?","volume":"136","author":"Kelly","year":"2016","journal-title":"Public Health"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"22","DOI":"10.16460\/j.issn1008-9969.2023.12.022","article-title":"A longitudinal qualitative study on decision-making experience of blood glucose management in patients with gestational diabetes mellitus","volume":"30","author":"Zhang","year":"2023","journal-title":"Chin J Nurs"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1007\/s00404-016-4093-y","article-title":"Pregnancy ehealth and mhealth: user proportions and characteristics of pregnant women using web-based information sources-a cross-sectional study","volume":"294","author":"Wallwiener","year":"2016","journal-title":"Arch Gynecol Obstet"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.ijcard.2019.05.070","article-title":"Best practices in digital health literacy","volume":"292","author":"Conard","year":"2019","journal-title":"Int J Cardiol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e0000279","DOI":"10.1371\/journal.pdig.0000279","article-title":"Digital literacy as a new determinant of health: a scoping review","volume":"2","author":"Arias L\u00f3pez","year":"2023","journal-title":"PLOS Digit Health"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1080\/10810730.2010.522700","article-title":"The internet as a health information source: findings from the 2007 health information National Trends Survey and implications for health communication","volume":"15","author":"Koch-Weser","year":"2010","journal-title":"J Health Commun"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1080\/07359680802126301","article-title":"Understanding health literacy for strategic health marketing: ehealth literacy, health disparities, and the digital divide","volume":"25","author":"Bodie","year":"2008","journal-title":"Health Mark Q"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1111\/j.1468-2958.1993.tb00305.x","article-title":"A comprehensive model of cancer-related information seeking applied to magazines","volume":"19","author":"Johnson","year":"1993","journal-title":"Hum Commun Res"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"100393","DOI":"10.1016\/j.invent.2021.100393","article-title":"Overview of a new ehealth intervention to promote healthy eating and exercise in pregnancy: initial user responses and acceptability","volume":"25","author":"Carolan-Olah","year":"2021","journal-title":"Internet Interv"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1136\/bjsports-2018-100056","article-title":"2019 Canadian guideline for physical activity throughout pregnancy","volume":"52","author":"Mottola","year":"2018","journal-title":"Br J Sports Med"},{"key":"ref35","first-page":"465","volume-title":"Nursing research methods","author":"Zheng","year":"2018"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e27","DOI":"10.2196\/jmir.8.4.e27","article-title":"eHEALS: the ehealth literacy scale","volume":"8","author":"Norman","year":"2006","journal-title":"J Med Internet Res"},{"key":"ref37","first-page":"10","article-title":"The Chinese version of eHEALS health literacy scale and its applicability","volume":"29","author":"Guo","year":"2013","journal-title":"Health Education in China"},{"key":"ref38","first-page":"41","article-title":"Perceived social support scale","volume":"10","author":"Jiang","year":"2001","journal-title":"Chin J Behav Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1207\/s15327752jpa5201_2","article-title":"The multidimensional scale of perceived social support","volume":"52","author":"Zimet","year":"1988","journal-title":"J Pers Assess"},{"key":"ref40","first-page":"1218","article-title":"Meta synthesis of the experience of pregnant women with gestational diabetes mellitus","volume":"21","author":"Deng","year":"2021","journal-title":"Nurs Manag China"},{"key":"ref41","author":"Wang","year":"2023"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"376","DOI":"10.5195\/jmla.2021.1180","article-title":"Exploring digital health care: ehealth, mhealth, and librarian opportunities","volume":"109","author":"Chan","year":"2021","journal-title":"J Med Libr Assoc"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1111\/hir.12325","article-title":"Finding useful cancer information may reduce cancer information overload for internet users","volume":"37","author":"Ser\u00e7eku\u015f","year":"2020","journal-title":"Health Inf Libr J"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/1471-2393-14-41","article-title":"From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review","volume":"14","author":"Nielsen","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12884-019-2185-y","article-title":"How diet, physical activity and psychosocial well-being interact in women with gestational diabetes mellitus: an integrative review","volume":"19","author":"Gilbert","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1016\/j.cjca.2013.12.030","article-title":"Gestational diabetes and hypertensive disorders of pregnancy as vascular risk signals: an overview and grading of the evidence","volume":"30","author":"Nerenberg","year":"2014","journal-title":"Can J Cardiol"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"520","DOI":"10.4103\/ijnmr.ijnmr_90_22","article-title":"Prioritizing the psychosocial support needs of mothers with gestational diabetes: a Delphi study","volume":"28","author":"Javadifar","year":"2023","journal-title":"Iran J Nurs Midwifery Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.1016\/j.wombi.2018.03.001","article-title":"Self-management of gestational diabetes among Chinese migrants: a qualitative study","volume":"32","author":"Wah","year":"2019","journal-title":"Women Birth"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"105263","DOI":"10.1016\/j.ijmedinf.2023.105263","article-title":"Effects of online support and social media communities on gestational diabetes: a systematic review","volume":"180","author":"Cheng","year":"2023","journal-title":"Int J Med Inform"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"e37844","DOI":"10.2196\/37844","article-title":"Cultural and digital health literacy appropriateness of app- and web-based systems designed for pregnant women with gestational diabetes mellitus: scoping review","volume":"24","author":"Birati","year":"2022","journal-title":"J Med Internet Res"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"20552076231191974","DOI":"10.1177\/20552076231191974","article-title":"Ehealth and lifestyle change: the mediating roles of social support and patient empowerment","volume":"9","author":"Liu","year":"2023","journal-title":"Digit Health"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"e14265","DOI":"10.2196\/14265","article-title":"Persuasive system design principles and behavior change techniques to stimulate motivation and adherence in electronic health interventions to support weight loss maintenance: scoping review","volume":"21","author":"Asbj\u00f8rnsen","year":"2019","journal-title":"J Med Internet Res"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1023\/a:1005507603901","article-title":"A social-ecologic approach to assessing support for disease self-management: the chronic illness resources survey","volume":"23","author":"Glasgow","year":"2000","journal-title":"J Behav Med"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1177\/0145721713492570","article-title":"Who can provide diabetes self-management support in primary care? Findings from a randomized controlled trial","volume":"39","author":"Siminerio","year":"2013","journal-title":"Diabetes Educ"},{"key":"ref55","first-page":"1308","article-title":"Best evidence summary for blood glucose self-management education and support in patients with gestational diabetes mellitus","volume":"58","author":"Zha","year":"2023","journal-title":"Chin J Nurs"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1523","DOI":"10.1377\/hlthaff.2015.0365","article-title":"Key features of peer support in chronic disease prevention and management","volume":"34","author":"Fisher","year":"2015","journal-title":"Health Aff (Proj Hope)"}],"updated-by":[{"DOI":"10.3389\/fpubh.2024.1477643","type":"erratum","label":"Erratum","source":"publisher","updated":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T00:00:00Z","timestamp":1724112000000}}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1416620\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,20]],"date-time":"2024-08-20T07:29:14Z","timestamp":1724138954000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1416620\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,17]]},"references-count":56,"alternative-id":["10.3389\/fpubh.2024.1416620"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1416620","relation":{"erratum":[{"id-type":"doi","id":"10.3389\/fpubh.2024.1477643","asserted-by":"object"}]},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,17]]},"article-number":"1416620"}}