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

Luo, Sihui; Yan, Jinhua; Yang, Daizhi; Xiong, Sidong; Wang, Chaofan; Guo, Yan; Yao, Bin; Weng, Jianping; Zheng, Xueying

doi:10.1136/bmjopen-2022-061657

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…This awareness could be promoted through public enlightenment via technological services, school health teaching, and the use of flyers, pamphlets, and banners to disseminate information about PCC services. These findings correspond to those of Luo et al (2022), who recommended online smartphone applications to assess educational material for promoting PCC awareness among women with diabetes. Additionally, patient-facing educational materials provided in the hospital waiting area (Marshall & Britton, 2020) and school curricula (Stephenson et al, 2021;Bhatta, Upreti & Kalikotay, 2021) can be adopted to promote PCC awareness.…”

Section: Discussionsupporting

confidence: 87%

Healthcare Providers’ Perceptions on The Provision of Preconception Care for Women with Diabetes in Nigeria

Omowunmi,

Binti Muda,

Hasan

et al. 2023

MJN

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Background: One of the 1989 goals declared by St. Vincent's, which focused on achieving good pregnancy outcomes for diabetic women that should be similar to those for non-diabetic women, has not been achieved among Nigerian childbearing women (CW) due to a lack of preconception care (PCC). Literature indicates an increased prevalence of diabetes, diabetes during pregnancy, and pregnancyrelated complications across the country's geopolitical zones. The persistence of pregnancy complications can be catastrophic if PCC is not adequately established and integrated into the national healthcare sector. Healthcare providers (HCPs) offer diabetes care (DC) and PCC to CW to mitigate adverse pregnancy outcomes. This study aimed to explore HCPs' perceptions of PCC and strategies towards its provision for Nigerian diabetic CW. Design: This qualitative study used an exploratory approach. Methods: Data were collected using in-depth semi-structured interviews, transcribed verbatim, and thematically analyzed. Results: Four themes emerged from the data: relevance of PCC, redesign of DC practices, awareness creation, and necessity of diabetes PCC. Conclusion: The findings imply that there is an urgent need for upgraded obstetric care for pregnant women to accommodate PCC for diabetic CW to reduce pregnancy complications related to diabetes, improve glycemic control, augment folic acid intake, and ensure proper pregnancy planning. The findings of this research can serve as an evidence-based document to enhance HC policies that would accommodate PCC in existing obstetric care.

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Section: Discussionsupporting

confidence: 87%

Healthcare Providers’ Perceptions on The Provision of Preconception Care for Women with Diabetes in Nigeria

Omowunmi,

Binti Muda,

Hasan

et al. 2023

MJN

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“…The qualitative findings, in contrast, show a different perspective: women appeared to be in significant mental distress and wanted support during pregnancy from peers and professionals. The finding of the need for peer support among those with diabetes in pregnancy has also been found in existing literature [ 27 , 28 ]. Thus, integrating both findings resulted in an apparent discordance: women may be confident in diabetes self-management, yet, they still desired support during a challenging pregnancy.…”

Section: Discussionsupporting

confidence: 64%

Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study

Sushko,

Strachan,

Butt

et al. 2024

BMC Nurs

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Introduction Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes. Research design and methods This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration. Results The quantitative results found that women achieved “at target” glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery. Conclusions The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women’s mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences.

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Towards an integrated type 1 diabetes management in low-resource settings: barriers faced by patients and their caregivers in healthcare facilities in Ghana

Owusu,

Doku

2024

BMC Health Serv Res

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Background In Low-Middle-Income Countries (LMICs), young people living with Type 1 Diabetes Mellitus (T1DM) face structural barriers which undermine adequate T1DM management and lead to poor health outcomes. However, research on the barriers faced by young people living with T1DM have mostly focused on patient factors, neglecting concerns regarding plausible barriers that may exist at the point of healthcare service delivery. Objective This study sought to explore barriers faced by young people living with T1DM and their caregivers at the point of healthcare service delivery. Methods Data were drawn from a qualitative research in southern Ghana. The research was underpinned by a phenomenological study design. Data were collected from 28 young people living with T1DM, 12 caregivers, and six healthcare providers using semi-structured interview guides. The data were collected at home, hospital, and support group centres via face-to-face interviews, telephone interviews, and videoconferencing. Thematic and framework analyses were done using CAQDAS (QSR NVivo 14). Results Eight key barriers were identified. These were: shortage of insulin and management logistics; healthcare provider knowledge gaps; lack of T1DM care continuity; poor healthcare provider-caregiver interactions; lack of specialists’ care; sharing of physical space with adult patients; long waiting time; and outdated treatment plans. The multiple barriers identified suggest the need for an integrated model of T1DM to improve its care delivery in low-resource settings. We adapted the Chronic Care Model (CCM) to develop an Integrated Healthcare for T1DM management in low-resource settings. Conclusion Young people living with T1DM, and their caregivers encountered multiple healthcare barriers in both in-patient and outpatient healthcare facilities. The results highlight important intervention areas which must be addressed/improved to optimise T1DM care, as well as call for the implementation of a proposed integrated approach to T1DM care in low-resource settings.

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

Cited by 3 publications

References 37 publications

Healthcare Providers’ Perceptions on The Provision of Preconception Care for Women with Diabetes in Nigeria

Healthcare Providers’ Perceptions on The Provision of Preconception Care for Women with Diabetes in Nigeria

Supporting self-management in women with pre-existing diabetes in pregnancy: a mixed-methods sequential comparative case study

Towards an integrated type 1 diabetes management in low-resource settings: barriers faced by patients and their caregivers in healthcare facilities in Ghana

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