Experiences of women, hospital clinicians and general practitioners with gestational diabetes mellitus postnatal follow-up: A mixed methods approach

Diabetes Res Clin Pract. 2019 Feb;148:32-42. doi: 10.1016/j.diabres.2018.12.005. Epub 2018 Dec 21.

Abstract

Problem: Postnatal screening rates to detect type two diabetes following gestational diabetes are low. The quality of communication is an important element to consider in developing targeted strategies that support women in completing recommended follow-up care.

Aims: To explore the communication perspectives, practices and preferences of women, hospital clinicians and general practitioners, to determine strategies that may promote completion of recommended postnatal GDM follow-up, in Queensland Australia.

Method: We used an exploratory, three-phase, mixed-methods approach, interpreted through intergroup communication theory. Phase one: convergent interviews explored perspectives of the communication experience in GDM care among new mothers (n = 13), hospital clinicians (n = 13) and general practitioners (n = 16). Phase two: a retrospective chart audit assessed current practice in postnatal discharge summaries of women (n = 86). Phase three: an online survey identified the preferences of general practitioners and hospital clinicians who provide maternity care in Queensland. Triangulation of the findings from the interviews, audit and surveys was used to clarify results and increase the robustness of the findings.

Results: Three themes: Seeking information, Written hospital discharge summary (discharge summary) and Clarity of follow-up requirements, provide direction for pragmatic strategies to promote follow-up. Practical recommendations include continued discussion about care with women from the point of GDM diagnosis into the postnatal period; discharge summaries that give primacy to diagnosis and ongoing treatment; and provision of explicit directions for recommended testing and timing.

Implications: This research informs seven practical recommendations to help promote completion of recommended postnatal GDM follow-up.

Keywords: Communication theory; General practitioners; Gestational diabetes; Midwives; Postnatal care.

MeSH terms

  • Adolescent
  • Adult
  • Aftercare* / methods
  • Aftercare* / psychology
  • Aftercare* / standards
  • Aftercare* / statistics & numerical data
  • Australia / epidemiology
  • Communication
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Diabetes, Gestational / epidemiology
  • Diabetes, Gestational / psychology
  • Diabetes, Gestational / rehabilitation
  • Diabetes, Gestational / therapy*
  • Female
  • General Practitioners* / psychology
  • General Practitioners* / statistics & numerical data
  • Humans
  • Male
  • Medical Staff, Hospital* / psychology
  • Medical Staff, Hospital* / statistics & numerical data
  • Middle Aged
  • Midwifery / standards
  • Midwifery / statistics & numerical data
  • Mothers* / psychology
  • Mothers* / statistics & numerical data
  • Patient Discharge / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Postnatal Care* / methods
  • Postnatal Care* / psychology
  • Postnatal Care* / standards
  • Postnatal Care* / statistics & numerical data
  • Pregnancy
  • Professional-Patient Relations
  • Retrospective Studies
  • Surveys and Questionnaires
  • Young Adult