Factors influencing timely initiation and completion of gestational diabetes mellitus screening and diagnosis - a qualitative study from Tamil Nadu, India

BMC Pregnancy and Childbirth

Research Article

Peter Damm¹  Thilde Rheinländer²  Ib C. Bygbjerg²  Karoline Kragelund Nielsen³  Veerasamy Seshiah⁴  Anil Kapur⁵ 

[1] Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark;Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen, Denmark;Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen, Denmark;Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark;Dr. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre, 729 Poonamallee High Road, Aminjikarai, 600029, Chennai, Tamil Nadu, India;World Diabetes Foundation, Brogaardsvej 70, 2820, Gentofte, Denmark;

关键词: Gestational diabetes;    Screening;    India;    Health care services;    Antenatal care;    Guidelines;    Qualitative research;   

DOI  :  10.1186/s12884-017-1429-y

 received in 2016-07-11, accepted in 2017-07-18,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn 2007, universal screening for gestational diabetes mellitus (GDM) was introduced in Tamil Nadu, India. To identify factors hindering or facilitating timely initiation and completion of the GDM screening and diagnosis process, our study investigated how pregnant women in rural and urban Tamil Nadu access and navigate different GDM related health services.MethodsThe study was carried out in two settings: an urban private diabetes centre and a rural government primary health centre. Observations of the process of screening and diagnosis at the health centres as well as semi-structured interviews with 30 pregnant women and nine health care providers were conducted. Data was analysed using qualitative content analysis.ResultsThere were significant differences in the process of GDM screening and diagnosis in the urban and rural settings. Several factors hindering or facilitating timely initiation and completion of the process were identified. Timely attendance required awareness, motivation and opportunity to attend. Women had to attend the health centre at the right time and sometimes at the right gestational age to initiate the test, wait to complete the test and obtain the test report in time to initiate further action. All these steps and requirements were influenced by factors within and outside the health system such as getting right information from health care providers, clinic timings, characteristics of the test, availability of transport, social network and support, and social norms and cultural practices.ConclusionsMinimising and aligning complex stepwise processes of prenatal care and GDM screening delivery and attention to the factors influencing it are important for further improving and expanding GDM screening and related services, not only in Tamil Nadu but in other similar low and middle income settings. This study stresses the importance of guidelines and diagnostic criteria which are simple and feasible on the ground.

【 授权许可】

CC BY   
© The Author(s). 2017