Barriers to and enablers of type 2 diabetes screening among women with prior gestational diabetes: A qualitative study applying the Theoretical Domains Framework.

Frontiers in clinical diabetes and healthcare Pub Date : 2023-02-24 eCollection Date: 2023-01-01 DOI:10.3389/fcdhc.2023.1086186
Amelia J Lake, Amelia Williams, Adriana C H Neven, Jacqueline A Boyle, James A Dunbar, Christel Hendrieckx, Melinda Morrison, Sharleen L O'Reilly, Helena Teede, Jane Speight
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Abstract

Introduction: Women with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content.

Research design and methods: Semi-structured interviews with participants recruited via Australia's National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify 'important' domains which we then mapped to the Capability, Opportunity, Motivation-Behavior (COM-B) model.

Results: Nineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: 'knowledge', 'memory, attention, and decision-making processes', 'environmental context and resources', 'social influences', 'emotion', 'beliefs about consequences', 'social role and identity', and 'beliefs about capabilities'. Study strengths include a methodologically rigorous design; limitations include low recruitment and homogenous sample.

Conclusions: This study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM. .

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曾患妊娠糖尿病的妇女进行 2 型糖尿病筛查的障碍和促进因素:应用理论领域框架的定性研究。
导言:曾患妊娠糖尿病(GDM)的妇女罹患 2 型糖尿病(T2D)的风险更高。指南建议产后糖尿病筛查(口服葡萄糖耐量试验或 HbA1c)一般在婴儿出生后 6-12 周进行,并在此后定期进行筛查。尽管如此,仍有一半左右的妇女没有接受筛查,这意味着错过了早期识别糖尿病前期或 2 型糖尿病的重要机会。虽然政策和实践层面的建议是全面的,但个人层面的建议主要侧重于提高筛查知识和风险意识,可能会忽略其他有影响力的行为决定因素。我们的目的是找出影响曾患妊娠糖尿病的澳大利亚妇女产后 2 型糖尿病筛查的可改变的个人层面因素,并推荐干预功能和行为改变技术,作为干预内容的基础:采用基于理论领域框架(TDF)的指南,对通过澳大利亚国家妊娠糖尿病登记处招募的参与者进行半结构式访谈。我们采用归纳-演绎法,根据 TDF 领域对数据进行编码。我们使用既定标准确定 "重要 "领域,然后将其映射到能力、机会、动机-行为(COM-B)模型中:结果:19 名妇女参加了调查:年龄(34 ± 4)岁,产后(19 ± 4)个月,63%在澳大利亚出生,90%居住在大都市,58%根据指南筛查出患有 T2D。确定了八个 TDF 领域:知识"、"记忆、注意力和决策过程"、"环境背景和资源"、"社会影响"、"情绪"、"对后果的信念"、"社会角色和身份 "以及 "对能力的信念"。研究的优点包括方法严谨;不足之处包括招募人数少和样本单一:本研究为曾患 GDM 的妇女产后筛查 T2D 找出了许多可改变的障碍和促进因素。通过与 COM-B 的映射,我们确定了干预功能和行为改变技术,为干预内容奠定了基础。这些发现为制定信息和干预措施提供了宝贵的证据基础,这些信息和干预措施针对的是最有可能优化曾患 GDM 的妇女接受 T2D 筛查的行为决定因素。.
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