Barriers and facilitators to diabetes screening and prevention after a pregnancy complicated by gestational diabetes.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Diabetes, Gestational*/diagnosis ; Diabetes, Gestational*/epidemiology ; Diabetes Mellitus, Type 2*/diagnosis ; Diabetes Mellitus, Type 2*/prevention & control ; Diabetes Mellitus, Type 2*/epidemiology; Humans ; Pregnancy ; Child ; Female ; United States ; Postpartum Period ; Mass Screening/adverse effects ; Qualitative Research

Objective: Gestational diabetes mellitus (GDM) is increasing in the United States, with higher rates among minoritized racial and ethnic populations and lower income populations. GDM increases risk for type 2 diabetes (T2DM), and postpartum diabetes screening and prevention are imperative. This qualitative study examines barriers and facilitators to postpartum T2DM screening and prevention among non-privately insured individuals with a history of GDM in a state prior to Medicaid expansion.
Methods: Thirty-six non-privately insured women with a history of GDM completed semi-structured interviews. Four focus groups and seven interviews were conducted with 30 nurse practitioners, physicians, physician assistants, nurses and registered dietitians from Federally Qualified Health Centers in St. Louis, MO. Interviews and focus groups were audio-recorded and transcribed. Data were analyzed using an integrative thematic analysis informed by the socio-ecological model.
Results: Barriers and facilitators to T2DM screening and prevention occur across multiple environments (society, healthcare system, interpersonal, and individual). Societal barriers include insurance issues, unemployment, and lack of transportation, childcare, safe housing, and healthy food access, while facilitators include government sponsored programs and community organizations. Healthcare system barriers include care fragmentation, scheduling policies and time constraints while facilitators include care coordination, pregnancy support groups, and education materials. Interpersonal barriers include negative care experiences, cultural differences, communication challenges, competing priorities, and lack of a social support network, while facilitators include family and friend support and positive care experiences. Individual barriers include health complications and unhealthy food and exercise patterns, while facilitators include child wellbeing, empowered attitudes and healthy food and exercise patterns.
Conclusions: The socioecological model highlights the societal and systemic determinants that encompass individual and interpersonal factors affecting postpartum T2DM screening and prevention. This framework can inform multi-level interventions to increase postpartum T2DM screening and prevention in this high-risk population, including policy changes to alleviate higher-level barriers.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2022 Sinha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

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P30 DK056341 United States DK NIDDK NIH HHS; T35 HL007815 United States HL NHLBI NIH HHS; KL2 TR002346 United States TR NCATS NIH HHS; P30 DK092950 United States DK NIDDK NIH HHS; K23 HD096204 United States HD NICHD NIH HHS; T32 DK007120 United States DK NIDDK NIH HHS

Date Created: 20221118 Date Completed: 20221122 Latest Revision: 20240729

20240729

PMC9674174

10.1371/journal.pone.0277330

36399472