Electronic reminders to women with previous pregnancy complicated by gestational diabetes mellitus: are they effective and how can knowledge from process evaluation strengthen implementation?

BACKGROUND
Gestational diabetes Mellitus (GDM) is associated with a higher risk of developing type 2 diabetes later in life. Women’s participation in follow- up screening after birth are however often insufficient. Reminder systems are found to have the potential to be effective in supporting this screening. However, the effect varies and no knowledge on the use of reminder beyond the first year after birth have been identified.
OBJECTIVES
Two studies therefore aimed to determine the effectiveness of an electronic reminder on participation in screening within 1–8 year after birth and at the same time evaluate which mechanisms are triggered within the process.
METHODS
Knowledge form at registry-based, randomized controlled trial and an adjunct process evaluation are combined. The randomized controlled trial included seven groups stratified by the child’s birth year (2012–2018). The control group received standard care (n = 732), while the intervention group received both standard care and an electronic reminder (n = 731). The process evaluation explored how reminders affected women’s decision-making concerning participation in follow-up screening. 20 semi-structured interviews with women previously diagnosed with GDM and had received the reminder were conducted and analyzed using reflexive thematic analysis.
RESULTS
The reminder increased participation in screening (35.1% in the intervention group and 29.2% in the control group were screened) and was found to affect women’s decision-making and informed choice through a range of mechanisms which were related to the design of the reminder, contextually factors and clinician-patient relationships.
CONCLUSIONS
Reminders to women have been shown to support life-long participation in follow-up screening. Nonetheless, attempts to further stimulation of coverage could however be considered. This include analyzing conditions for
implementation, some of which can be learned from these studies.
KEY MESSAGE
Reminders to women, based on the principles of informed choice and patient-centered care, can support life-long participation in screening.