Health Care Professionals’ Perspectives On Screening And Management Of Gestational Diabetes Mellitus In Public Hospitals Of South India – A Qualitative Study

Abstract

Background Women developing Gestational Diabetes Mellitus are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM is essential in preventing progression to type 2 diabetes mellitus. Although the burden of Gestational Diabetes Mellitus is high in India, Gestational Diabetes Mellitus screening and management is suboptimal in public hospitals. We aimed to explore the perspectives of healthcare providers regarding the barriers and facilitators from the health system context that restrict the timely screening and effective management of Gestational Diabetes Mellitus. Methods We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India's major city (Bengaluru). The interviews were conducted in the preferred language of the participants ( Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using grounded theory approach by NVivo 12 plus Results Health care providers recognized and supported the need for design and implementation of Gestational Diabetes Mellitus screening and management services. While obstetricians were aware of the national guidelines regarding screening and management; nurses mentioned that they had unmet training needs in health promotion. Barriers identified to timely screening and management of Gestational Diabetes Mellitus included unmet training needs of nurses regarding Gestational Diabetes Mellitus, delay in screening of pregnant women accessing antenatal care at private clinics initially and subsequently reporting at public hospital in late gestation, migration of pregnant women due to delivery of first born at natal home, lack of follow up system of deferred cases for gestational diabetes screening, resource deficit, and long waiting hours. Conclusion Provided the fact that there is effectiveness of Gestational Diabetes Mellitus screening and management services, there is a pressing need to develop and improve existing Gestational Diabetes Mellitus Screening and Management services to tackle the growing burden of Gestational Diabetes Mellitus in India. With the urgent need for these services, it needs to be extended to public hospitals.

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

“…Among health professionals in New Zealand, despite their understanding of the importance of nutrition for GDM, there were challenges around the nutrition guidelines for women with a lower body mass index [28] and regarding minimum carbohydrate intake [29]. Furthermore, in lowresource settings, there are limited healthcare professionals who uniformly adhere to national recommendations of the management of GDM, mainly due to the lack of a qualified workforce [18], with diabetes educators looking for ways to make the guidelines accessible and meaningful [17]. The lack of cultural-specific resources and the limited access to interpreters described in our study likely impact the uptake of knowledge among women from ethnic minorities.…”

“…A small study of 6 diabetes educators which focused on their experiences of disadvantaged women with GDM highlighted that low socioeconomic status, low levels of education and literacy, and poor dietary habits significantly impacted on their understanding of GDM information, with a demonstrated need to target educational programs for women with low literacy [17]. Studies among health professionals internationally echo these findings, both in relation to women from resourcelimited settings in South India [18] and in higher socioeconomic women in Singapore [19]. The experiences and perceptions of diabetes educators and dietitians, who are integral in providing education and promoting behaviour change, have not so far received a lot of attention.…”