The Perspectives of Diabetes Educators and Dietitians on Diet and Lifestyle Management for Gestational Diabetes Mellitus: A Qualitative Study

The perspectives of healthcare professionals in providing care to women with GDM in high-income nations: A qualitative systematic review

BACKGROUND

Gestational Diabetes Mellitus (GDM) represents a growing challenge worldwide, with significant risks to both women and their babies that extend beyond the duration of the pregnancy and immediate post-partum period. Healthcare professionals (HCPs) play important roles in the screening, diagnosis, treatment and management of women with GDM.

METHODS

For this qualitative systematic review, a comprehensive search strategy explored the electronic databases Web of Science, CINAHL, Medline, and Scopus, as well as the reference lists of the included papers, for primary studies investigating the experiences, perspectives and practices of HCPs providing care to women with GDM in high-income healthcare settings. Studies were assessed with the Crowe Critical Appraisal Tool, and findings were synthesised using the approach described by Thomas and Harden.

RESULTS

This review included 33 articles - 26 qualitative and seven mixed method studies, representing ten high-income nations. The total number of HCP participants represented across the studies is 989. This figure is constituted by medical professionals (n = 226), nurses and midwives (n = 583), allied health (n = 40) and other or not numerically specified HCPs (n = 140). From 149 findings, four major themes and 10 subthemes were constructed. The four major themes are: multidisciplinary collaboration; healthcare practice; organizational factors; and working with women.

DISCUSSION AND CONCLUSION

There are barriers to providing optimal care to women with GDM. Including, time and resource constraints, a lack of consensus in practice guidelines, and variable multidisciplinary collaboration. Moving forward, there needs to be a focus on more explicit guidelines, multidisciplinary collaboration, and appropriate resources to support HCPs in providing care to women to manage the short-term and longer-term risks that are associated with a pregnancy affected by GDM.

Systematic development and refinement of a user-centered evidence-based digital toolkit for supporting self-care in gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is a pregnancy complication affecting many women, requiring changes in behaviours, which command them to learn self-care practices shortly. Digital interventions have been developed to support women with GDM. However, they have often overlooked women's needs and characteristics and failed to frame self-care theories into their design. To address this issue, we adopted a mixed methods approach to develop and refine a user-centred, evidence-based digital Toolkit for supporting self-care in GDM, providing behavioural and educational content, particularly about nutrition. To inform the development and refinement of the Toolkit, we conducted a literature review, observed sixty-six nutrition appointments, interviewed eleven dietitians and seventeen patients, and held co-creation sessions with two dietitians, all of which were analysed using a deductive Thematic Analysis. To validate the Toolkit, we conducted a survey with seventeen healthcare professionals, which was analysed using descriptive statistics. The final version of the NUTRIA Toolkit consists of four main modules with thirty-eight artefacts, including behavioural tools to assist women in GDM management. Despite some limitations, this study robustly endorsed the development and refinement of a user-centred, evidence-based Toolkit for supporting self-care in GDM, aiming for future feasibility and trial testing.

Unveiling the Craving: A systematic review of pregnant women's desires for expert nutrition care in Australia

PROBLEM

Poor nutrition during the antenatal period can contribute to adverse health outcomes for both mother and baby.

BACKGROUND

Despite the importance of nutrition during pregnancy, there is limited research exploring the attitudes and experiences pregnant women possess towards nutrition care, particularly within the Australian context. Existing literature has indicated that pregnant women lack knowledge of and are not adhering to pregnancy related nutrition recommendations. Furthermore, although pregnant women rely on many health professionals for nutrition care, there are deficiencies in both the quality and quantity of care provided.

AIM

The aim of this meta-aggregative review was to explore the experiences and attitudes pregnant women in Australia have towards nutrition care.

METHODS

Meta-aggregation was used to synthesise qualitative studies. A search strategy was applied to four electronic databases in May 2023.The findings were extracted and synthesised via the JBI approach.

FINDINGS

A total of 719 studies were identified in the initial database search with seven eligible studies included in the meta-aggregation. From 11 categories, three synthesised findings were developed: (i) approaches to nutrition care delivery matters, (ii) quality and quantity of nutrition care is insufficient, and (iii) pregnant women value nutrition care.

CONCLUSION

This review highlights pregnant women's desires for better nutrition care in Australia, with current provision of nutrition care lacking in quality and quantity. Improved antenatal dietetics services and increased health professional nutrition training is necessary to address these concerns.

Maternity Dietitians' Perspectives on Delivering Gestational Diabetes Care, and Postpartum Follow-Up in Ireland: A Qualitative Study

BACKGROUND

Medical nutrition therapy is recognized as the cornerstone to optimal glycemic management of gestational diabetes (GDM) during pregnancy and registered dietitian nutritionists (RDNs) are central to delivery of this, yet data are lacking on their views of the barriers and enablers to performing this role.

OBJECTIVE

This qualitative study aimed to explore the perspectives of RDNs providing medical nutrition therapy to people with GDM across the Republic of Ireland.

DESIGN

Focus groups and semistructured interviews were conducted with RDNs from maternity settings whose roles included providing dietetics services to people with GDM.

PARTICIPANTS AND SETTING

Five focus groups and 2 semistructured interviews were conducted with 16 RDNs from 13 maternity sites, whose roles included medical nutrition therapy to people with GDM, in Ireland in February to March 2021. A topic guide addressing GDM management, postpartum care, and future type 2 diabetes prevention was followed.

DATA ANALYSIS

Data from focus groups and interviews were analyzed using reflexive thematic analysis.

RESULTS

RDNs collectively viewed their role as central to supporting people with GDM. Three themes were generated: Theme 1-a complex layered role-addressed complexities in dietetics practice. Theme 2 highlighted challenges in providing optimum care with sub themes of huge changes with COVID-19, care is not equal, and no defined postpartum pathway. Theme three reported on framing future health needs through sub themes of the 6-week check is a missed opportunity, people need to understand their risk, and more integrated care and type 2 diabetes prevention is needed.

CONCLUSIONS

RDNs recognize the need for continuity of care in pregnancy and postpartum for people diagnosed with GDM. However, perceived disparities in allocation of dietetics services for GDM and an absence of agreed care pathways were seen as barriers to optimum care. Collaboration and communication across primary and secondary care settings are essential and require improvement.

The Complexities of Managing Gestational Diabetes in Women of Culturally and Linguistically Diverse Backgrounds: A Qualitative Study of Women's Experiences

AIM

This study aimed to explore women's perspectives and experiences concerning how culture impacts the lifestyle management of gestational diabetes mellitus (GDM) in women of culturally and linguistically diverse (CALD) backgrounds.

METHODS

Women of any cultural background diagnosed with GDM within the previous 12 months were purposively recruited from two Australian metropolitan hospitals. Data collected using semi-structured interviews (n = 18) and focus groups (n = 15 women in three groups) were analysed using reflexive thematic analysis.

RESULTS

Three themes were generated: "cultural beliefs and obligations impact lifestyle management of gestational diabetes", which describes how some cultures lack awareness about GDM, and modifications or restrictions were viewed as depriving the infant, but sometimes adaptions could be made so that a culturally appropriate meal was suitable for GDM management; "the relationship between cultural foods and gestational diabetes management", which discusses how important cultural foods may be incompatible with appropriate GDM management, so women worked to find solutions; "gestational diabetes education lacks cultural awareness and sensitivity", which illustrates how current education fails to address differences in cultural beliefs, language and eating practices.

CONCLUSION

Cultural beliefs, obligations and food practices must be considered when assisting women of CALD backgrounds using lifestyle modification to manage GDM. GDM education must be culturally sensitive and competent and, where possible, be delivered by health professionals of a shared cultural group.

Current practice, attitude and views of providing pregnancy care for women with type 1 diabetes in China: a qualitative study

OBJECTIVE

Data are sparse on healthcare needs related to pregnancy among Chinese women with type 1 diabetes (T1D) or the gap between the needs and healthcare provision in China. We aimed to identify their needs and the gaps in pregnancy care provision.

DESIGN

This is a qualitative, face-to-face, one-to-one in-depth interview study. We recruited our participants using a purposive sampling strategy. Semistructural outlines were used to guide the interviews. The interviews were digitally recorded, transcribed and analysed using a thematic framework method with NVivo V.10.0.

SETTING

Guangdong Province in China.

PARTICIPANTS

This study involved three key stakeholders of pregnancy care for women with T1D: 29 women with T1D of childbearing age (aged 18-50 years), 16 family members (husbands, parents and parents-in-law of women with T1D) and 35 relevant healthcare providers (HCPs).

RESULTS

We found that women with T1D and the family members had a more pessimistic attitude towards pregnancy outcomes, which was different from the more positive view of HCPs. However, all three stakeholders shared the following perspectives regarding pregnancy-related care for women with T1D: (1) lack of knowledge and access to education, (2) lack of multidisciplinary cooperation, (3) education should be started earlier in adulthood, (3) positive role of peer support, and (4) hope for future training of HCPs for relevant knowledge and skills specified for T1D and pregnancy with T1D.

CONCLUSIONS

An immense gap was identified between the needs of women with T1D regarding pregnancy-related care and current care provision in China. These findings suggest that education be provided to patients and HCPs, and the role of professional and multidisciplinary support should be enhanced to optimise pregnancy care for women with T1D in China.