Reasons for women's non-participation in follow-up screening after gestational diabetes

Nielsen, Jane Hyldgaard; Olesen, Christinna Rebecca; Kristiansen, Tine Mechlenborg; Bak, Carsten Kronborg; Overgaard, Charlotte

doi:10.1016/j.wombi.2015.04.006

Cited by 36 publications

(64 citation statements)

References 22 publications

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“…Women were also confused because glucose monitoring and dietary restrictions stopped immediately: ‘I sat there in the hospital eating a big huge piece of chocolate cake …’ . Furthermore, some clinicians had ‘no time’ for glucose testing but focused on the baby or non‐diabetes maternal care at postpartum appointments. By contrast, clinicians ‘promoting’ follow‐up helped women to understand its importance, for example, ‘I think that [postnatal follow‐up] was explained to me both pre and post that that needed to happen.…”

Section: Resultsmentioning

confidence: 99%

“…Many were surprised to discover that it was their responsibility rather than doctors’ and that missed appointments were not chased. They often needed to act on generic information, such as ‘… [the leaflet] said it was something I was supposed to take care of myself…’ (screened) . Although many did arrange the test, some considered that invitations and reminders should come from the doctors: ‘Well, it would be a lot easier if I got a letter that said, now it's time – like they do for that cervix cancer screening’ [screened] ; proactive clinicians encouraged attendance: ‘… [my doctor] even wrote it down in my insurance booklet’ (screened) .…”

Section: Resultsmentioning

confidence: 99%

“…They often needed to act on generic information, such as ‘… [the leaflet] said it was something I was supposed to take care of myself…’ (screened) . Although many did arrange the test, some considered that invitations and reminders should come from the doctors: ‘Well, it would be a lot easier if I got a letter that said, now it's time – like they do for that cervix cancer screening’ [screened] ; proactive clinicians encouraged attendance: ‘… [my doctor] even wrote it down in my insurance booklet’ (screened) . Participants would be reassured to know that GPs were involved in this part of their care because ‘… You tend to forget … so much occurs after the childbirth’ .…”

Section: Resultsmentioning

confidence: 99%

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Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake

et al. 2019

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Aim Many women do not attend recommended glucose testing following a pregnancy affected by gestational diabetes (GDM). We aimed to synthesize the literature regarding the views and experiences of women with a history of GDM on postpartum glucose testing, focusing on barriers and facilitators to attendance. Methods We systematically identified qualitative studies that examine women's experiences following GDM relating to glucose testing (diabetes screening) or experience of interventions to promote uptake of testing. We conducted a thematic synthesis to develop descriptive and then analytical themes, then developed recommendations to increase uptake based on the findings. We evaluated the quality of each study and the confidence that we had in the recommendations using published checklists. Results We included 16 articles after screening 23 160 citations and 129 full texts. We identified four themes of influences relating to the healthcare system and personal factors that affected both ability and motivation to attend: relationship with health care, logistics of appointments and tests, family‐related practicalities and concern about diabetes. We developed 10 recommendations addressing diabetes risk information and education, and changes to healthcare systems to promote increased attendance at screening in this population, most with high or moderate confidence. Conclusions We have identified a need to improve women's understanding about Type 2 diabetes and GDM, and to adjust healthcare provision during and after pregnancy to decrease barriers and increase motivation for testing. Encouraging higher uptake by incorporating these recommendations into practice will enable earlier management of diabetes and improve long‐term outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake

et al. 2019

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“…Nielsen et al investigated reasons for low participation in follow‐up screening among Danish women with prior GDM. Major reasons included fragmented care; insufficient information; a lack of focus by healthcare workers involving women in postpartum care; and, diabetes risk seen as a low priority . These findings are much in line with our results.…”

Section: Discussionmentioning

confidence: 99%

What is the postpartum experience of Danish women following gestational diabetes? A qualitative exploration

Svensson

Nielsen

Maindal

2017

Scandinavian Caring Sciences

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“…Several studies have investigated the process of Type 2 diabetes testing after pregnancy and counselling of women with prior GDM in the healthcare system and shown that this follow-up does not occur routinely; that women with prior GDM find the received information on risks and recommendations inadequate; that care is not tailored to individual needs and preferences; and that coordination of services and responsibility is often unclear or lacking [31,44,45]. Several studies have investigated the process of Type 2 diabetes testing after pregnancy and counselling of women with prior GDM in the healthcare system and shown that this follow-up does not occur routinely; that women with prior GDM find the received information on risks and recommendations inadequate; that care is not tailored to individual needs and preferences; and that coordination of services and responsibility is often unclear or lacking [31,44,45].…”

Section: The Healthcare Systemmentioning

confidence: 99%

Prevention of Type 2 diabetes after gestational diabetes directed at the family context: a narrative review from the Danish Diabetes Academy symposium

2018

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In this review, we aim to summarize knowledge about gestational diabetes mellitus (GDM) after delivery; with special focus on the potential of preventing Type 2 diabetes in a family context. The review expands on the key messages from a symposium held in Copenhagen in May 2017 and highlights avenues for future research. A narrative review of the symposium presentations and related literature is given. GDM is associated with increased short- and long-term adverse outcomes including Type 2 diabetes for both mother and offspring. Interestingly, GDM in mothers also predicts diabetes in the fathers. Thus, although GDM is diagnosed in pregnant women, the implications seem to affect the whole family. Structured lifestyle intervention can prevent or delay the onset of Type 2 diabetes. In this review, we show how numerous challenges are present in the target group, when such interventions are sought and implemented in real-world settings. Although interlinked and interacting, barriers to maintaining a healthy lifestyle post-partum can be grouped into those pertaining to diabetes beliefs, the family context and the healthcare system. Health literacy level and perceptions of health and disease risk may modify these barriers. There is a need to identify effective approaches to health promotion and health service delivery for women with prior GDM and their families. Future efforts may benefit from involving the target group in the development and execution of such initiatives as one way of ensuring that approaches are tailored to the needs of individual women and their families.

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Reasons for women's non-participation in follow-up screening after gestational diabetes

Cited by 36 publications

References 22 publications

Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake

Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake

What is the postpartum experience of Danish women following gestational diabetes? A qualitative exploration

Prevention of Type 2 diabetes after gestational diabetes directed at the family context: a narrative review from the Danish Diabetes Academy symposium

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