Follow-up after gestational diabetes: a qualitative study of perspectives from general practices

Abstract:
Background: Women whose pregnancies are complicated by gestational diabetes mellitus are approximately eight times more likely to develop type 2 diabetes. Although regular participation in follow-up screening increases the chance of early detection of diabetes, participation rates are often suboptimal. A better understanding of general practice as a key contextual setting for screening could help inform the development and adoption of, for example, electronic reminder interventions to support women’s participation.
Aim: To explore the perspectives of general practitioners and relevant staff members engaged in early detection of diabetes after gestational diabetes in order to identify barriers to and facilitators of follow-up screening.
Design: A qualitative interview study undertaken in general practices in the North Denmark Region.
Methods: Based on a purposive sample strategy, 18 semi-structured interviews of 12 general practitioners and six staff members, who were either nurses or midwives, were analyzed using a reflexive thematic analytical approach.
Results: Three main themes were formulated: (1) Challenges of addressing women’s risk; (2) Prioritization of early detection of diabetes; (3) System influence on clinical procedures.
Conclusion: Follow-up screening was facilitated by knowledge of guidelines. We found professional collaboration and adaptation support to lead to successful implementation of guidelines in general practice. Supporting GPs and their staff’s reflection and discussion of ways to engage in communication and decision-making processes with women is however important, hence it was found to create an important barrier to follow-up screening. Overall, our findings can help inform the future development of interventions to increase uptake.