Health Care Providers’ Perspectives on Barriers and Facilitators to Care for Low-Income Pregnant Women With Diabetes

Abstract

OBJECTIVE | Treatment of gestational diabetes mellitus and type 2 diabetes during pregnancy can improve maternal and neonatal outcomes; yet, self-care burdens for pregnant women with diabetes are high, particularly for low-income and minority women. Although prior studies have investigated patient-perceived barriers and facilitators to diabetes selfmanagement during pregnancy, little work investigates the perspectives of health care providers (HCPs) on these factors. The objective of this study was to investigate HCPs' perspectives on patient barriers and facilitators to diabetes care during pregnancy.METHODS | In this qualitative investigation, focus groups were conducted using a semistructured interview guide designed to elicit HCPs' perceptions of patient barriers and facilitators to successful diabetes-related self-care. HCPs included physicians, nurses, health educators, and other personnel who care for low-income pregnant women with diabetes. Interviews were transcribed verbatim. Transcripts were analyzed using the constant comparative technique to identify themes and subthemes, using the Social Ecological Model as a theoretical framework.RESULTS | Participants (n 5 29) identified barriers and facilitators to women's achievement of optimal diabetes self-care according to six levels (environment, access, institution, interpersonal, knowledge, and individual). Example subthemes included inflexible work schedule, poor access to medication and supplies, overburdened clinic, perceived patient "policing," and low health literacy. Individual factors included self-efficacy, motivation, and engagement. HCPs identified barriers, but not facilitators, for each theme.CONCLUSION | HCPs described facilitators and barriers to diabetes care at all levels of the Social Ecological Model. These data can inform interventions to dismantle barriers patients face and thus create meaningful health care interventions to improve outcomes for low-income pregnant women with diabetes.

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

“…A range of teamwork communication barriers was identified. Consistent with previous studies among healthcare professionals [ 15 , 27 , 41 – 43 ], reported barriers included waiting time for appointments, the lack of continuity of care, and the discrepancy between who should and who does receive any follow-up care throughout the pregnancy. While dietitians and diabetes educators were reported to work well together and they were amongst a “multidisciplinary team,” there was a lack of effective communication for their particular role.…”

Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females

“…Multilevel social determinants influence the ability to access and consume nutritious food for weight management [ 70 ] and a healthy pregnancy [ 71 , 72 ]. Food insecurity has been shown to increase risk for GDM [ 39 ].…”

Primary Care Clinician Perspectives on Patient Navigation to Improve Postpartum Care for Patients with Low Income

“…Although it is a challenging period for many, individuals with low income face additional barriers in acquiring critical health and social services. 22 , 25 Patient navigation in the obstetrical setting is a potential patient-centered solution to barriers encountered during prenatal and postnatal care. 17 , 18 , 26 , 27 …”

“…The guide was designed by the research team who has previous experience with assessing obstetrics and gynecology clinician perspectives on patient navigation and barriers to care in the postpartum period. 20 , 22 , 23 Given the known health inequities in the postpartum period, our study focused on the experiences and care processes among birthing individuals with low income. Topics discussed included navigator services that would decrease burdens faced by patients with low income and their health care clinicians.…”