Women's views on screening for Type 2 diabetes after gestational diabetes: a systematic review, qualitative synthesis and recommendations for increasing uptake

R A Dennison, R A Fox, R J Ward, S J Griffin, J A Usher-Smith, R A Dennison, R A Fox, R J Ward, S J Griffin, J A Usher-Smith

Abstract

Aim: Many women do not attend recommended glucose testing following a pregnancy affected by gestational diabetes (GDM). We aimed to synthesize the literature regarding the views and experiences of women with a history of GDM on postpartum glucose testing, focusing on barriers and facilitators to attendance.

Methods: We systematically identified qualitative studies that examine women's experiences following GDM relating to glucose testing (diabetes screening) or experience of interventions to promote uptake of testing. We conducted a thematic synthesis to develop descriptive and then analytical themes, then developed recommendations to increase uptake based on the findings. We evaluated the quality of each study and the confidence that we had in the recommendations using published checklists.

Results: We included 16 articles after screening 23 160 citations and 129 full texts. We identified four themes of influences relating to the healthcare system and personal factors that affected both ability and motivation to attend: relationship with health care, logistics of appointments and tests, family-related practicalities and concern about diabetes. We developed 10 recommendations addressing diabetes risk information and education, and changes to healthcare systems to promote increased attendance at screening in this population, most with high or moderate confidence.

Conclusions: We have identified a need to improve women's understanding about Type 2 diabetes and GDM, and to adjust healthcare provision during and after pregnancy to decrease barriers and increase motivation for testing. Encouraging higher uptake by incorporating these recommendations into practice will enable earlier management of diabetes and improve long-term outcomes.

© 2019 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

Figures

Figure 1
Figure 1
Example of the development of the analytical theme ‘Relationship with health care’ within the thematic synthesis. Not all codes were presented for simplicity. GDM, gestational diabetes.
Figure 2
Figure 2
PRISMA diagram showing number of studies included at each stage of the literature review. *Two of these publications report the same set of interviews using different approaches to the analysis.
Figure 3
Figure 3
Summary of the themes and subthemes of influences on attendance at postpartum glucose testing after gestational diabetes. GDM, gestational diabetes.

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Source: PubMed

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