Facilitators and Barriers to Post-partum Diabetes Screening Among Mothers With a History of Gestational Diabetes Mellitus–A Qualitative Study From Singapore

Abstract

Introduction: Gestational Diabetes Mellitus (GDM) affects one in six births worldwide. Mothers with GDM have an increased risk of developing post-partum Type-2 Diabetes Mellitus (T2DM). However, their uptake of post-partum diabetes screening is suboptimal, including those in Singapore. Literature reports that the patient-doctor relationship, mothers' concerns about diabetes, and family-related practicalities are key factors influencing the uptake of such screening. However, we postulate additional factors related to local society, healthcare system, and policies in influencing post-partum diabetes screening among mothers with GDM. Aim: The qualitative research study aimed to explore the facilitators and barriers to post-partum diabetes screening among mothers with GDM in an Asian community. Methods: In-depth interviews were carried out on mothers with GDM at a public primary care clinic in Singapore. Mothers were recruited from those who brought their child for vaccination appointments and their informed consent was obtained. Both mothers who completed post-partum diabetes screening within 12 weeks after childbirth and those who did not were purposively recruited. The social ecological model (SEM) provides the theoretical framework to identify facilitators and barriers at the individual, interpersonal, organizational, and policy levels. Results: Twenty multi-ethnic Asian mothers with GDM were interviewed. At the individual and interpersonal level, self-perceived risk of developing T2DM, understanding the need for screening and the benefits of early diagnosis, availability of confinement nanny in Chinese family, alternate caregivers, emotional, and peer support facilitated post-partum diabetes screening. Barriers included fear of the diagnosis and its consequences, preference for personal attention and care to child, failure to find trusted caregiver, competing priorities, and unpleasant experiences with the oral glucose tolerance test. At the organizational and public policy level, bundling of scheduled appointments, and standardization of procedure eased screening but uptake was hindered by inconvenient testing locations, variable post-partum care practices and advice in the recommendations for diabetes screening. Conclusion: Based on the SEM, facilitators and barriers towards post-partum diabetes screening exist at multiple levels, with some contextualized to local factors. Interventions to improve its uptake should be multi-pronged, targeting not only at personal but also familial, health system, and policy factors to ensure higher level of success.

Life Experience of Pregnant Woman with Gestational Diabetes Mellitus in Maternal Role Attainment in Special Region of Yogyakarta

“…The results of this study also showed for mothers undergoing operative delivery in patients with lumbar anesthesia that there are communications between patients and doctors in the surgery process. Communication is what makes mothers have life experience so that delivery by way of operative delivery is not scary, but it is a labor that can be passed to either because the mother can see the baby's birth (Sunny et al, 2020).…”

“…The results of this study also show the triangulation of obstetricians and midwives, that the patient feeling satisfied and not satisfied is a relative thing and there are no specific indicators to measure satisfaction and dissatisfaction. It is emphasized that the team of healthcare providers, in carrying out its duties and obligations to patients, should be in accordance with SOP or the standard operating procedure that is in the hospital (Ashraf et al, 2019;Sunny et al, 2020). And every hospital is believed to have SOP and SOP in providing healthcare to mothers with GDM.…”

Self-administered oral glucose tolerance test with capillary glucose measurements for the screening of diabetes mellitus in high-risk adults: a feasibility study

“… 14–19 Local Asian women with GDM reported ‘unpleasant OGTT experience’ as a barrier to postpartum T2DM screening. 18 …”

“…12 13 OGTT is inconvenient, time-consuming, labourintensive, and relatively costly, and often perceived as unpleasant. [14][15][16][17][18][19] Local Asian women with GDM reported 'unpleasant OGTT experience' as a barrier to postpartum T2DM screening. 18 The challenges of conducting OGTT have prompted the WHO to publish a set of conversion values for capillary and venous plasma glucose values.…”

“…[14][15][16][17][18][19] Local Asian women with GDM reported 'unpleasant OGTT experience' as a barrier to postpartum T2DM screening. 18 The challenges of conducting OGTT have prompted the WHO to publish a set of conversion values for capillary and venous plasma glucose values. 9 Novel methods have been developed to screen T2DM using capillary glucose instead of plasma glucose.…”