Discipline: Social, Behavioral, and Economic Sciences
Subcategory: Physiology and Health
Samantha A. S. Williams - Washington University in St. Louis School of Medicine
Co-Author(s): Aimee James, PhD,Washington University, St. Louis, MO; Cynthia Herrick, MD, MPHS Washington University, St. Louis, MO
Gestational diabetes (GDM) affects around 5-9% of pregnancies in the U.S., with higher prevalence among lower socioeconomic minority populations. GDM increases a women’s lifelong risk of developing type 2 diabetes (T2D), with the highest risk being 5-10 years postpartum. Less than 50% of GDM afflicted women get the recommended screening for diabetes and this has not been well studied in underserved populations. To address this limitation, our study explored perspectives from providers regarding prenatal and postpartum care for women with GDM, with particular emphasis on the transition of care that occurs after delivery. Providers were recruited from local Federally Qualified Health Centers (FQHCs). Four audio recorded focus groups of 5-6 providers each were conducted between May and August 2017. Overall, we spoke with twenty one providers: eleven MDs, three PAs, and seven NPs, whose specialties included OBGYN (10), Family Practice (7) and Internal Medicine (4). Qualitative data analysis software (NVivo) was used for data management and analysis. Transcripts were initially open coded by two individuals to identify inductive codes and themes and develop an codebook. Subsequently, two raters read and coded transcripts with disagreement resolved between coders through discussion. Four major themes were identified: patient education, patient understanding, barriers, and supports. Providers indicate that education is given to women on meaning of test results, diet, exercise, blood sugar monitoring, weight, breast feeding, birth control, and future diabetes risk but the timing and depth of such education is variable. Patient understanding of the diagnosis is limited by motivation, health literacy, and language barriers. Providers found a dichotomy in level of interest and concern among their patients. The barriers that were identified were sub coded as clinic level and patient level. They included issues like lack of standard diabetes and nutrition education for providers and clinic staff, communication limitations through the electronic medical record (EMR), and patient specific barriers related to cultural differences and access to insurance, transportation, healthy food, safe neighborhoods, and appointments. Supports to address many of these barriers were also identified and sub coded as existing and potential. Our results are a start to better understanding this overlooked and undeserved population. We have started to interview patient participants who have had GDM and begun to gather their perspectives. At the end of this project, we plan work with the IHN to develop interventions or expand on supports already there based on this data to better support this population.Not Submitted
Funder Acknowledgement(s): University Institute of Clinical and Translational Sciences grant UL1TR000448, sub award KL2TR000450
Faculty Advisor: Cynthia Herrick, firstname.lastname@example.org
Role: I assisted the conduct of the focus groups (note took, consented participants, prompted when necessary, etc). I coded and analyzed the transcripts. I conducted the patient interviews.