Barriers and Facilitators of Adherence to Anti-Diabetic Therapy in Pregnant Women with Diabetes: Health Care Workers’ Perspectives

Abstract

Global prevalence of hyperglycaemia in pregnancy in women of 20 -49 years was estimated to be 16.9% and affecting 21.4 million live births, in 2013, 90% of which occurred in developing countries. The cornerstone of anti-diabetic therapy is diet, physical activity and medications. The study utilized a qualitative descriptive design using key informant interviews from August 2016 to November 2016 to explore challenges of adherence to anti-diabetic therapy in pregnant women with diabetes at a central hospital in Harare, Zimbabwe. Permission to conduct the study was obtained from the respective local and national ethical review boards. All participants gave verbal and written informed consent. A sample of eight key informants directly involved in the care of pregnant women with diabetes was purposively selected for key informant interviews. Key informants should have worked with diabetic pregnant women for at least one year. Sample size was determined by data saturation. Interviews followed a semi structured questionnaire that had sections on the burden of diabetes in pregnancy, challenges of adherence, challenges in management and possible solutions to challenges faced. All interviews were conducted in a private room. Detailed notes were taken during the interviews which were also being audiotaped. Trustworthiness was achieved by observing credibility, dependability, transferability and confirmability. Thematic analysis was done. Thematic analysis was done manually. The stages of data analysis followed were data organization, familiarization, transcription, coding, developing a thematic framework, indexing, displaying and reporting. Major themes identified were barriers and facilitators of adherence to anti-diabetic therapy. Categories under barriers were financial barriers, lack of health edu- 161cation, lack of trained personnel, shortage of staff and lack of collaboration among practitioners. Categories under facilitators of adherence were subsidization of care, formal training of professionals, promoting collaboration and establishment of a unit dedicated to the care of pregnant women with diabetes. Barriers and solutions identified should be utilized to develop frameworks to promote adherence to anti-diabetic therapy incidence of adverse perinatal outcomes.

Adherence to Antidiabetic Medications among Women with Gestational Diabetes

“…The impact of social support and the potential to the use of a support network in improving diabetes medication adherence among pregnant women especially in low-and middle-income settings is highly recommended based on findings from this review. Some papers also showed that patients with high socioeconomic status (SES) had higher adherence rates [20,25,27], while another study showed the opposite [20]. Women with low socioeconomic status were often nonadherent due to financial constraints.…”

“…The dominant medications used in the management of gestational diabetes according to the papers reviewed were insulin [18,[20][21][22][23][24] and metformin [19,21,22,25]. Besides medications, adherence to lifestyle/behaviours like self-monitoring of blood glucose levels, dietary therapy, and physical activity were considered [18,20,[22][23][24][25][26][27][28]. Self-report measures were the recorded means of estimating adherence [18-26, 28, 29].…”

“…beliefs [20], fear of disease and medication complications [21], beliefs in abstaining from medication while pregnant despite being ill and belief in the use of herbal remedies when pregnant [29], concerns for the fetus health and wellbeing [21,23,29], poor socioeconomic status, lack of support from significant others and peers [22-24, 26, 28], poor health information [27,30], and financial barriers [26] (Table 3).…”

Development of an Adherence Promotion Framework for Women with Diabetes in Pregnancy to Improve Adherence to Anti-Diabetic Therapy and Perinatal Outcomes

“…Interviews were thematically analyzed and findings were reported as themes and categories. Findings of the key informant interviews have already been published [14].…”

Adherence to Anti-Diabetic Therapy in Women with Diabetes in Pregnancy

“…Health education should be customised to suit individual patient needs. More recommendations from the findings of the study have been published elsewhere [42,43]. Strict adherence to healthy lifestyle habits must be advocated in health policies particularly in developing countries where access to and quality of health care are problems.…”