scholarly journals Healthcare Professionals’ Perspectives on the Cross-Sectoral Treatment Pathway for Women with Gestational Diabetes during and after Pregnancy—A Qualitative Study

2021 ◽  
Vol 10 (4) ◽  
pp. 843
Author(s):  
Anne Timm ◽  
Karoline Kragelund Nielsen ◽  
Ulla Christensen ◽  
Helle Terkildsen Maindal
Keyword(s):  
Type 2 Diabetes ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Adverse Outcomes ◽  
Treatment Pathway ◽  
Healthy Behaviors ◽  
The Cross

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 pregnancy; and (3) “cross-sectoral collaboration”, which relied heavily on knowledge transfers between hospitals, general practice and the local municipality. The findings implicate that clear, transparent guidelines for all sectors should be prioritized to strengthen cross-sectoral care to women with GDM during and after pregnancy. As a result, strong cross-sectoral care throughout the GDM care pathway may improve maternal health by supporting healthy behaviors, facilitate weight loss and reduce the risk of subsequent GDM and early onset diabetes.

Perspectives on Prevention of Type 2 Diabetes After Gestational Diabetes: A Qualitative Study of Hispanic, African-American and White Women

2014 ◽  
Vol 19 (7) ◽  
pp. 1526-1534 ◽  
Author(s):  
Joyce W. Tang ◽  
Krys E. Foster ◽  
Javiera Pumarino ◽  
Ronald T. Ackermann ◽  
Alan M. Peaceman ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
African American ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
White Women

scholarly journals Natural selection? The evolution of diagnostic criteria for gestational diabetes

2016 ◽  
Vol 54 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Claire L Meek
Keyword(s):  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Diagnostic Criteria ◽  
Later Life ◽  
Tolerance Test ◽  
Adverse Outcomes ◽  
Oral Glucose ◽  
Optimal Method ◽  
Considerable Controversy

Gestational diabetes is a common pregnancy disorder which is generally managed with diet, exercise, metformin or insulin treatment and which usually resolves after delivery of the infant. Identifying and treating gestational diabetes improves maternal and fetal outcomes and allows for health promotion to reduce the mother’s risk of type 2 diabetes in later life. However, there remains considerable controversy about the optimal method of identification and diagnosis of women with gestational diabetes. The NICE-2015 diagnostic criteria (75 g oral glucose tolerance test (OGTT) 0 h ≥5.6 mmol/L; 2 h ≥7.8 mmol/L) are based upon cost-effectiveness estimates using observational data, while the WHO-2013 criteria (75 g OGTT 0 h ≥5.1 mmol/L; 1 h ≥10.0 mmol/L; 2 h ≥8.5 mmol/L) identify women and infants at risk of adverse outcomes according to prospective data. There is also considerable controversy about testing for gestational diabetes using universal or risk factor-based screening, and when and how testing should be performed. The aim of this review is to provide a summary of the clinical biochemistry aspects to these debates and to highlight the importance of appropriate identification of gestational diabetes and subsequent type 2 diabetes in this population.

scholarly journals Chinese Women’s Attitudes Towards Postpartum Interventions to Prevent Type 2 Diabetes After Gestational Diabetes: A Semi-Structured Qualitative Study

2020 ◽  
Author(s):  
Jie Shang ◽  
Amanda Henry ◽  
Puhong Zhang ◽  
Huan Chen ◽  
Kelly Thompson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Family Members ◽  
Lifestyle Change ◽  
Blood Glucose Monitoring ◽  
Enabling Environment ◽  
Early Postpartum

Abstract Background: Gestational diabetes (GDM) is a global problem affecting millions of pregnant women, including in mainland China. These women are at high risk of Type II diabetes (T2DM). Cost-effective and clinically effective interventions are needed. We aimed to explore Chinese women’s perspectives, concerns and motivations towards participation in early postpartum interventions and/or research to prevent the development of T2DM after a GDM-affected pregnancy. Methods: We conducted a qualitative study in two hospitals in Chengdu, Southwest China. Face-to-face semi-structured interviews were conducted with 20 women with recent experience of GDM: 16 postpartum women and 4 pregnant women. Women were asked about their attitudes towards postpartum screening for type 2 diabetes, lifestyle interventions, mHealth delivered interventions and pharmacologic interventions (specifically metformin). An inductive approach to analysis was used. Interviews were recorded, transcribed, and coded using NVivo 12 Pro. Results: Most women held positive attitudes towards participating in T2DM screening, and were willing to participate in postpartum interventions to prevent T2DM through lifestyle change or mHealth interventions. Women were less likely to agree to pharmacological intervention, unless they had family members with diabetes or needed medication themselves during pregnancy. We identified seven domains influencing women’s attitudes towards future interventions: (1) experiences with the health system during pregnancy; (2) living in an enabling environment; (3) the experience of T2DM in family members; (4) knowledge of diabetes and perception of risk; (5) concerns about personal and baby health; (6) feelings and emotions, and (7) lifestyle constraints. Those with more severe GDM, an enabling environment and health knowledge, and with experience of T2DM in family members expressed more favourable views of postpartum interventions and research participation to prevent T2DM after GDM. Those who perceived themselves as having mild GDM and those with time/lifestyle constraints were less likely to participate.Conclusions: Women with experiences of GDM in Chengdu are generally willing to participate in early postpartum interventions and/or research to reduce their risk of T2DM, with a preference for non-drug, mHealth based interventions, integrating lifestyle change strategies, blood glucose monitoring, postpartum recovery and mental health.

scholarly journals Chinese women’s attitudes towards postpartum interventions to prevent type 2 diabetes after gestational diabetes: a semi-structured qualitative study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Jie Shang ◽  
Amanda Henry ◽  
Puhong Zhang ◽  
Huan Chen ◽  
Kelly Thompson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Family Members ◽  
Lifestyle Change ◽  
Blood Glucose Monitoring ◽  
Enabling Environment ◽  
Early Postpartum

Abstract Background Gestational diabetes (GDM) is a global problem affecting millions of pregnant women, including in mainland China. These women are at high risk of Type II diabetes (T2DM). Cost-effective and clinically effective interventions are needed. We aimed to explore Chinese women’s perspectives, concerns and motivations towards participation in early postpartum interventions and/or research to prevent the development of T2DM after a GDM-affected pregnancy. Methods We conducted a qualitative study in two hospitals in Chengdu, Southwest China. Face-to-face semi-structured interviews were conducted with 20 women with recent experience of GDM: 16 postpartum women and 4 pregnant women. Women were asked about their attitudes towards postpartum screening for type 2 diabetes, lifestyle interventions, mHealth delivered interventions and pharmacologic interventions (specifically metformin). An inductive approach to analysis was used. Interviews were recorded, transcribed, and coded using NVivo 12 Pro. Results Most women held positive attitudes towards participating in T2DM screening, and were willing to participate in postpartum interventions to prevent T2DM through lifestyle change or mHealth interventions. Women were less likely to agree to pharmacological intervention, unless they had family members with diabetes or needed medication themselves during pregnancy. We identified seven domains influencing women’s attitudes towards future interventions: (1) experiences with the health system during pregnancy; (2) living in an enabling environment; (3) the experience of T2DM in family members; (4) knowledge of diabetes and perception of risk; (5) concerns about personal and baby health; (6) feelings and emotions, and (7) lifestyle constraints. Those with more severe GDM, an enabling environment and health knowledge, and with experience of T2DM in family members expressed more favourable views of postpartum interventions and research participation to prevent T2DM after GDM. Those who perceived themselves as having mild GDM and those with time/lifestyle constraints were less likely to participate. Conclusions Women with experiences of GDM in Chengdu are generally willing to participate in early postpartum interventions and/or research to reduce their risk of T2DM, with a preference for non-drug, mHealth based interventions, integrating lifestyle change strategies, blood glucose monitoring, postpartum recovery and mental health.

scholarly journals Understanding the experiences of long-term maintenance of self-worth in persons with type 2 diabetes in Japan: a qualitative study

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034758
Author(s):  
Asuka Kato ◽  
Kazuhiro Yoshiuchi ◽  
Yuko Fujimaki ◽  
Shin Fujimori ◽  
Yuka Kobayashi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Qualitative Study ◽  
Healthcare Professionals ◽  
Sense Of Self ◽  
Self Management ◽  
Diabetes Treatment ◽  
Cross Sectional ◽  
Self Worth

ObjectivePersons with type 2 diabetes are often stigmatised for having what is considered a lifestyle-related disease. Accordingly, some blame themselves for their condition, resulting in feelings of low self-worth that ultimately impact their self-management behaviours. However, there are no studies examining why some do not blame themselves for their condition and manage to maintain their self-worth in relation to their illness. This study aimed to explore an understanding of how such persons experience the maintenance of self-worth in relation to their illness over the lifelong course of treatment.DesignA cross-sectional qualitative study. Face-to-face semistructured interviews were conducted with a purposive sampling strategy. The data was analysed using a qualitative descriptive method that involved concurrent data collection and constant comparative analysis.SettingTwo tertiary-level hospitals in Japan.ParticipantsThirty-three outpatients with type 2 diabetes who currently had good glycaemic control but had previously had poor glycaemic control.ResultsThree themes explaining the maintenance of self-worth were identified: (1) Participants gained ‘control’ over their illness by living a ‘normal life.’ They found a way to eat preferred foods, dine out with family and friends, travel and work as usual; (2) Participants discovered the positive aspects of type 2 diabetes, as they felt ‘healthier’ from the treatment and felt a sense of security and gratitude for the care they received from healthcare professionals; (3) Participants discovered a new sense of self-worth by moving towards goals for type 2 diabetes treatment and experienced inner growth through positive lifestyle choices.ConclusionsThe process of restoring and maintaining self-worth should be brought to the attention of healthcare professionals in diabetes care. These professionals could help patients discover positive self-representations through diabetes treatment (eg, a realisation that one does not lack self-control) and could aid in increasing patient engagement in diabetes self-management.

scholarly journals The low-risk perception of developing type 2 diabetes among women with a previous history of gestational diabetes: a qualitative study

2019 ◽  
Vol 36 (1) ◽  
pp. 15-19b
Author(s):  
Manisha Sharma ◽  
Tejpal Singh Purewal ◽  
Stephen Fallows ◽  
Lynne Kennedy
Keyword(s):  
Type 2 Diabetes ◽  
Risk Perception ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Previous History ◽  
Low Risk ◽  
History Of

scholarly journals Migrant Middle Eastern women with gestational diabetes seven years after delivery – positive long-term development of beliefs about health and illness shown in follow-up interviews

2021 ◽  
Vol 22 ◽  
Author(s):  
Katarina Hjelm ◽  
Karin Bard ◽  
Jan Apelqvist
Keyword(s):  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Qualitative Content Analysis ◽  
Self Care ◽  
Adverse Outcomes ◽  
Migrant Women ◽  
Health Lifestyle

Abstract Aim: No previous studies have been found focusing on the long-term development of beliefs about health, illness and healthcare in migrant women with gestational diabetes mellitus (GDM). The aim of this study was to explore this and the influence on health-related behaviour (i.e. self-care and care seeking) in migrant women from the Middle East living in Sweden seven years after delivery. Background: GDM is increasing, particularly in migrant women. The risk of adverse outcomes of GDM for health can be improved by interventions reducing blood glucose and lifestyle modifications which medicalise the woman’s pregnancy due to intensive follow-up and demanding self-care. The reactions might have an enduring impact on the women’s long-term psychological and physical health and adoption of preventive health behaviours. Method: Qualitative exploratory study. Semi-structured follow-up interviews 7 years after delivery with women previously interviewed in gestational weeks 34–38 and 3 and 14 months after delivery. Data analysed with qualitative content analysis. Findings: Health meant freedom from illness, feeling well and living long to be able to care for the children. The present situation was described either positively, changing to a healthier lifestyle, or negatively, with worries about being affected by type 2 diabetes. Beliefs changed among the majority of women, leading to a healthier lifestyle, and they looked positively back at the time when diagnosed and their reactions to it. With few exceptions, they were confident of being aware of future health risks and felt responsible for their own and their children’s health/lifestyle. None except those diagnosed with type 2 diabetes had been in contact with healthcare since the last follow-up a year after delivery. Yet, they still would like and need a healthcare model delivering more information, particularly on developing a healthy lifestyle for children, and with regular check-ups also after the first year after delivery.

scholarly journals Healthcare Professionals’ Perspectives on the Cross-sectoral Treatment Pathway for Women with Gestational Diabetes During and After Pregnancy – A Qualitative Study

2020 ◽  
Author(s):  
Anne Timm ◽  
Karoline Kragelund Nielsen ◽  
Ulla Christense ◽  
Helle Terkildsen Maindal
Keyword(s):  
Knowledge Transfer ◽  
Gestational Diabetes ◽  
General Practitioners ◽  
Healthcare Professionals ◽  
Treatment Pathway ◽  
Health Visitors ◽  
Before And After ◽  
Tailored Communication ◽  
Local Municipality ◽  
The Cross

Abstract Background: Gestational diabetes increases the risk of complications during and after pregnancy, including a long-term risk of type 2 diabetes. Women with gestational diabetes have to navigate a complex treatment pathway during pregnancy, which they often experience as incoherent. These women also report a lack of preventive care after pregnancy. The objective of this study is to investigate healthcare professionals’ views on the cross-sectoral treatment pathway for women with gestational diabetes – under and after pregnancy. Methods: Nine healthcare professionals handling women with gestational diabetes before and after pregnancy in Denmark were interviewed (two general practitioners, four midwives, two obstetricians and one diabetes nurse). Further, eight health visitors participated in focus group discussions. The data material was analysed using systematic text condensation. Results: Three major themes emerged: 1) professional identity which varied across the healthcare professionals and consequently shaped care practices; 2) lack of priority in the area of gestational diabetes contributed to uncertainty of tasks and responsibilities across the treatment pathway; and 3) cross-sectoral collaboration relied heavily on knowledge transfer between hospitals, general practitioners, and the local municipality. Conclusion: Knowledge transfer was fragmented as guidelines for treatment in the postpartum period were unclear to healthcare professionals outside the hospital. More awareness should be given to structures that ease clear and transparent guidelines and tailored communication strategies for healthcare professionals who provide care to women with gestational diabetes under and after pregnancy.

scholarly journals Reducing risk of type 2 diabetes after gestational diabetes: a qualitative study to explore the potential of technology in primary care

2018 ◽  
Vol 68 (669) ◽  
pp. e260-e267 ◽  
Author(s):  
Brian McMillan ◽  
Katherine Easton ◽  
Elizabeth Goyder ◽  
Brigitte Delaney ◽  
Priya Madhuvrata ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Qualitative Study ◽  
Gestational Diabetes ◽  
Secondary Care ◽  
Future Research ◽  
Increased Risk ◽  
Risk Of Progression

BackgroundDespite the seven-fold increased risk of type 2 diabetes mellitus (T2DM) among females previously diagnosed with gestational diabetes (GD), annual rates of follow-up in primary care are low. There is a need to consider how to reduce the incidence of progression to T2DM among this high-risk group.AimTo examine the views of females diagnosed with GD to ascertain how to improve primary care support postnatally, and the potential role of technology in reducing the risk of progression to T2DM.Design and settingA qualitative study of a purposive sample of 27 postnatal females leaving secondary care with a recent diagnosis of GD.MethodSemi-structured interviews were conducted with 27 females, who had been previously diagnosed with GD, at around 6–12 weeks postnatally. Interviews were audiotaped, transcribed, and analysed thematically.ResultsFacilitators and barriers to engaging in a healthy postnatal lifestyle were identified, the most dominant being competing demands on time. Although females were generally satisfied with the secondary care they received antenatally, they felt abandoned postnatally and were uncertain what to expect from their GP in terms of follow-up and support. Females felt postnatal care could be improved by greater clarity regarding this, and enhanced by peer support, multidisciplinary input, and subsidised facilities. Technology was seen as a potential adjunct by providing information, enabling flexible and personalised self-management, and facilitating social support.ConclusionA more tailored approach for females previously diagnosed with GD may help reduce the risk of progression to T2DM. A need for future research to test the efficacy of using technology as an adjunct to current care was identified.

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