Barriers and facilitators for implementing programmes and services to address hyperglycaemia in pregnancy in low and middle income countries: A systematic review

Screening and nursing management of gestational diabetes in Ghana: Evidence-based recommendations

Objective

To describe the development of evidence-based recommendations for screening and nursing management of gestational diabetes mellitus (GDM) in Ghana and present the recommendations.

Design

A qualitative study.

Setting

Military Health Institutions in Ghana.

Measurements

Data from qualitative interviews with 7 women with GDM and 8 midwives, and an integrative literature review including available clinical practice guidelines on screening and nursing management of GDM, was used to develop the recommendations. The National Institute for Health and Care Excellence' steps guided the recommendations' development. Methodological quality of the recommendations was assessed based on an adapted version of the Appraisal of Guidelines for Research and Evaluation (AGREE II) tool. Six experts reviewed the recommendations and an infographic in support of the recommendations.

Findings

Two main recommendations and an infographic were developed, including: 1. Early screening and diagnosis of GDM, and 2. Involvement of women with GDM and their significant others during pregnancy, intrapartum and postpartum management, in a culturally and socio-economically appropriate manner.

Key conclusions

The recommendations and infographic, once reviewed and pilot tested, may assist midwives managing GDM in Ghana, with support of health institution management.

Implications for practice

The study highlights the need for recommendations which can be used by midwives to manage GDM in Ghana. The recommendations are the first to be contextualized for the Ghanaian setting.

A scoping review of gestational diabetes mellitus healthcare: experiences of care reported by pregnant women internationally

Background

Gestational diabetes mellitus (GDM) is a condition associated with pregnancy that engenders additional healthcare demand. A growing body of research includes empirical studies focused on pregnant women’s GDM healthcare experiences. The aim of this scoping review is to map findings, highlight gaps and investigate the way research has been conducted into the healthcare experiences of women with GDM.

Methods

A systematic search of primary research using a number of databases was conducted in September 2021. Studies were included if they had an explicit aim of focusing on GDM and included direct reporting of participants’ experiences of healthcare. Key data from each study was extracted into a purposely-designed form and synthesised using descriptive statistics and thematic analysis.

Results

Fifty-seven articles were included in the analysis. The majority of studies used qualitative methodology, and did not have an explicit theoretical orientation. Most studies were conducted in urban areas of high-income countries and recruitment and research was almost fully conducted in clinical and other healthcare settings. Women found inadequate information a key challenge, and support from healthcare providers a critical factor. Experiences of prescribed diet, medication and monitoring greatly varied across settings. Additional costs associated with managing GDM was cited as a problem in some studies. Overall, women reported significant mental distress in relation to their experience of GDM.

Conclusions

This scoping review draws together reported healthcare experiences of pregnant women with GDM from around the world. Commonalities and differences in the global patient experience of GDM healthcare are identified.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04931-5.

Women's perspectives on motivational factors for lifestyle changes after gestational diabetes and implications for diabetes prevention interventions

Introduction

Gestational diabetes mellitus (GDM) is a common complication in pregnancy and constitutes a public health problem due to the risk of developing diabetes and other diseases. Most women face barriers in complying with preventive programs. This study aimed to explore motivational factors for lifestyle changes among women with a history of GDM and their suggestions for preventive programs.

Methods

This study used a qualitative approach in six focus group interviews with a total of 32 women. The selection criteria were time since onset of GDM, including women diagnosed with GDM, six months and five years after GDM, diagnosed and not diagnosed with diabetes. Inductive analysis was performed.

Results

The women reacted with anxiety about their GDM diagnosis and experienced persistent concerns about the consequences of GDM. They were highly motivated to take preventive initiatives, but faced major adherence challenges. The demotivating factors were lack of time and resources, too little family involvement, lack of knowledge and social norms that may obstruct healthy eating. A powerful motivational factor for complying with preventive strategies was the well-being of their children and partners.

Conclusions

Preventive initiatives should be rooted in the women's perception of GDM/diabetes and based on their experiences with barriers and motivational factors. The well-being and the quality of life within the family are dominant motivational factors which offer powerful potentials for supporting the women's coping capability. Further, there is a need to be responsiveness to the women and their families even a long time after the onset of GDM.

"If I Don't Eat Enough, I Won't Be Healthy". Women's Experiences with Gestational Diabetes Mellitus Treatment in Rural and Urban South India

Gestational diabetes mellitus (GDM) is associated with a range of adverse pregnancy outcomes as well as increased risk of future type 2 diabetes and cardiovascular disease. In India, 10%–35% of pregnant women develop GDM. In this study, we investigated women’s experiences with the dietary and pharmaceutical treatment for GDM in rural and urban Tamil Nadu, India. Semi-structured interviews were conducted with 19 women diagnosed with GDM. Data were analyzed using qualitative content analysis. Three overall aspects were discovered with several sub-aspects characterizing women’s experiences: emotional challenges (fear and apprehension for the baby’ health and struggling to accept a treatment seen as counterintuitive to being safe and healthy), interpersonal challenges (managing treatment in the near social relations and social support, and coordinating treatment with work and social life), and health system-related challenges (availability and cost of treatment, interaction with health care providers). Some aspects acted as barriers. However, social support and positive, high-quality interactions with health care providers could mitigate some of these barriers and facilitate the treatment process. Greater efforts at awareness creation in the social environment and systemic adjustments in care delivery targeting the individual, family, community and health system levels are needed in order to ensure that women with GDM have the opportunity to access treatment and are enabled and motivated to follow it as well.

Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period

BACKGROUND

Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care.

METHODS

Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62).

RESULTS

Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58).

CONCLUSION

These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.