Clinician views and knowledge regarding healthcare provision in the postpartum period for women with recent gestational diabetes: a systematic review of qualitative/survey studies (original) (raw)
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Journal of Paediatrics and Child Health, 2014
Aim: To examine clinician views and knowledge regarding postpartum healthcare provision for women who have experienced gestational diabetes (GDM). Methods: Systematic review that searched PubMed, Web of Science, EMBASE and CINAHL. Qualitative studies and surveys, with clinicians as participants, which reported pre-specified outcomes, including barriers and facilitators to postpartum care for GDM, were included. Two authors independently assessed quality and undertook thematic synthesis. Results: Eleven surveys and two interview studies were included (4435 clinicians). Key themes included adequacy of knowledge of risk of type 2 diabetes mellitus (T2DM), gaps between knowledge and practice relating to postpartum screening, and differing perceptions of the value of postpartum screening. Clinicians perceived that women faced obstacles to accessing healthcare, and a need for improved GDM education. Studies reported shortfalls in systems to ensure postpartum screening occurs, and a need to improve communication and collaboration relating to care of women who have experienced GDM. The surveys were often limited in their depth and ability to identify remedial strategies. Conclusions: Barriers to provision of care for women who have had GDM, such as lack of communication of the diagnosis, need to be addressed, and further interview studies exploring clinician views on screening for T2DM are required.
BMC Pregnancy and Childbirth, 2014
Background: Gestational diabetes mellitus (GDM)a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised. Methods: To investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed. Results: Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants. Conclusions: The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.
The Pan African medical journal, 2017
Risk of developing type 2 diabetes is increased in women with previous gestational diabetes mellitus (GDM). Postpartum glycemic screening is recommended in women with recent GDM. But this screening rate is low and the reasons are unclear. The aim of this study was to explore the experiences of Iranian women with recent GDM on barriers of postpartum screening for diabetes. This qualitative study was conducted in Tehran, Iran in 2016. Semi-structured interview was used for data collection. 22 women with recent GDM were interviewed. These women gave birth in Tehran hospitals at a minimum of 6 months before interview. The missed screening defined as not attending to laboratory for Fasting Blood Sugar and/or Oral Glucose Tolerance Test, 6 week to 6 month after their child birthing. The data was analyzed by content analysis method. Themes and sub-themes that illustrated the barriers to postpartum diabetes screening were: inadequate education (about developing diabetes in the future, imple...
Journal of Women's Health, 2011
Objectives: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of developing type 2 diabetes (T2DM) but often do not return for follow-up care. We explored barriers to and facilitators of postpartum follow-up care in women with recent GDM. Methods: We conducted 22 semistructured interviews, 13 in person and 9 by telephone, that were audiotaped and transcribed. Two investigators independently coded transcripts. We identified categories of themes and subthemes. Atlas.ti qualitative software (Berlin, Germany) was used to assist data analysis and management. Results: Mean age was 31.5 years (standard deviation) [SD] 4.5), 63% were nonwhite, mean body mass index (BMI) was 25.9 kg=m 2 (SD 6.2), and 82% attended a postpartum visit. We identified four general themes that illustrated barriers and six that illustrated facilitators to postpartum follow-up care. Feelings of emotional stress due to adjusting to a new baby and the fear of receiving a diabetes diagnosis at the visit were identified as key barriers; child care availability and desire for a checkup were among the key facilitators to care. Conclusions: Women with recent GDM report multiple barriers and facilitators of postpartum follow-up care. Our results will inform the development of interventions to improve care for these women to reduce subsequent diabetes risk.
Nursing and Midwifery Studies
Background: Risk of diabetes mellitus is higher in women with a history of gestational diabetes mellitus (GDM). Postpartum diabetes screening is recommended in women with GDM. However, the rate of this screening is low. Objectives: The purpose of this study was to perform an in-depth exploration of perceived facilitators of attendance to postpartum diabetes screening in women with recent GDM. Methods: This qualitative study was conducted in 2016 in Tehran. Semi-structured interviews carried out with 22 women with a recent GDM who gave birth at least 6 months before the interview. Results: Four main categories were emerged from the data. Each category included two to three subcategories. The first category was appropriate education and included two subcategories of prenatal education and postpartum education. The second category was feeling the ease of screening and included two subcategories of spousal support, and appropriate laboratory facilities. The third category was self-regulation and included three subcategories of importance of health, a desire toward learning about health, and proper planning. The fourth category was attitudes toward the screening and included three subcategories of initial fear better than consequences, feeling comfortable, and uncertainty regarding glucometers' accuracy. The last category was perceived threat and included three subcategories of fear of developing diabetes, being healthy to serve the child/children, and being healthy for other roles. Conclusion: Iranian women with recent GDM reported several facilitators for diabetes postpartum screening. Further studies are suggested.
Primary care of women after gestational diabetes mellitus: mapping the evidence-practice gap
The Medical journal of Australia, 2014
To determine the extent to which preventive activities, including the ordering of an oral glucose tolerance test (OGTT) between 6 and 12 weeks of birth, are integrated into women's primary care postpartum visits after a gestational diabetes mellitus (GDM)-affected pregnancy. Prospective survey and retrospective chart audit of general practices that provide maternity shared care in south-east Queensland, July 2011 to June 2012. General practitioners (n = 38) and medical records of women to whom they provided care (n = 43 women). GPs' awareness and knowledge of GDM guidelines and delivery of postpartum preventive care. The response rate for the survey/chart audit was 47%. All respondents recommended an OGTT between 6 and 12 weeks; a variety of guidelines informed practice; and weight, blood pressure and infant feeding practices were regularly checked. Mental health status and diet and exercise were discussed less consistently. GPs surveyed knew guidelines around the timing and...
2021
Gestational diabetes mellitus (GDM) increases type 2 diabetes risk; however, postpartum diabetes screening rates are low. Using semi-structured interviews and focus groups, this study investigates the understanding of GDM and its relationship to future diabetes risk and diabetes prevention among patients with public or no insurance (n = 36), health care providers (n = 21), and clinic staff (n = 9) from Federally Qualified Health Centers. Five main themes emerged: 1) general understanding of GDM diagnosis with focus on neonatal complications; 2) variable recall of diet, exercise, and weight recommendations; 3) overwhelming medication and self-monitoring routines; 4) short-term focus of type 2 diabetes risk and screening; and 5) limited understanding of all options for diabetes prevention. The results may inform diabetes screening and prevention interventions in primary care settings.
Canadian Journal of Diabetes, 2012
Mots clés: suivi diabète gestationnel prévention du diabète de type 2 a b s t r a c t Objective: Type 2 diabetes is preventable. Although women with gestational diabetes mellitus (GDM) are an identified target for type 2 diabetes prevention, it remains uncertain how to provide effective prevention interventions. Therefore attendance rates and demographics of women invited to a post-GDM type 2 diabetes prevention seminar were documented. Methods: Women with GDM near term were provided with verbal and written type 2 diabetes prevention advice along with notification about a prevention seminar. Seminar reminders were mailed 1 month prior accompanied by a lab slip for on-site glycated hemoglobin testing, and an explicit invitation to bring along children. Characteristics of attendees vs. non-attendees were recorded. Results: A total of 133 women were invited to the seminars: 59 (44%) attended. Attendees were slightly older than non-attendees (32.7 AE 5.1 vs. 30.9 AE 4.5 years; p¼0.03). No other differences were found in terms of local vs. non-local address, socio-economic status by postal code, previous pregnancies or pregnancy losses, age of youngest/eldest child, weight, GDM diagnosis week, insulin start/dose, ethnicity, missed appointments, contacts with clinic registered nurse, or type 2 diabetes family history. Conclusion: Less than 50% of women returned to a postpartum diabetes prevention seminar despite individualized discussion, personal invitation, written reminder, and family-friendly surroundings. Provision of type 2 diabetes prevention information by postpartum seminar reached <50% of target women.
Journal of Clinical Medicine
Gestational diabetes mellitus (GDM) increases the risk of adverse outcomes during and after pregnancy, including a long-term risk of type 2 diabetes. Women with GDM are treated by numerous healthcare professionals during pregnancy and describe a lack of preventive care after pregnancy. We aim to investigate healthcare professionals’ perspectives on the cross-sectoral treatment pathway for women with GDM—during and after pregnancy. A qualitative study was conducted using systematic text condensation. Nine healthcare professionals (two general practitioners, four midwives, two obstetricians and one diabetes nurse) were interviewed and eight health visitors participated in two focus group discussions., Three major themes emerged: (1) “professional identities”, which were identified across healthcare professionals and shaped care practices; (2) ”unclear guidelines on type 2 diabetes prevention after GDM”, which contributed to uncertainty about tasks and responsibilities during and after...
2021
Background Women who have had gestational diabetes during pregnancy are at very high risk of developing type 2 diabetes later in life, but their understanding of the risks is often limited. In this study we explored the views of health care professionals regarding offering brief opportunistic advice to women after their pregnancy, during unrelated consultations in primary care, relating to reducing diabetes risk. Methods The study took place in three Health Boards in Scotland. We conducted semi-structured one-to-one interviews (either face-to-face or telephone) with three health visitors, three practice nurses, two GPs, two diabetes consultant and two obstetricians. A focus group with five health visitors was also held. A topic guide was followed, covering the feasibility and acceptability of delivering a brief educational intervention during a routine consultation, the optimal way to identify and recall women with previous gestational diabetes, and the possible content and timing o...