Biswamitra Sahu1, Giridhara R Babu2,3, Kaveri Siddappa Gurav2, Maithili Karthik2, Deepa Ravi2, Eunice Lobo2, Daisy Abu John2, Laura Oakley4,5, Eugene Oteng-Ntim6, Iliatha Papachristou Nadal4, Sanjay Kinra4. 1. Indian Institute of Public Health-Bengaluru, Public Health Foundation of India (PHFI), Magadi Rd 1st cross, Next to leprosy hospital, SIHFW premises, Bengaluru, Karnataka, 560023, India. biswamitra.sahu@iiphh.org. 2. Indian Institute of Public Health-Bengaluru, Public Health Foundation of India (PHFI), Magadi Rd 1st cross, Next to leprosy hospital, SIHFW premises, Bengaluru, Karnataka, 560023, India. 3. Wellcome Trust-DBT India Alliance Intermediate Research Fellow in Public Health, Bengaluru, India. 4. London School of Hygiene and Tropical Medicine, London, UK. 5. Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway. 6. Department of Women's Health, Guy's and St Thomas' NHS Foundation Trust (King's Health Partners), St Thomas' Hospital, Westminster Bridge Road, London, UK.
Abstract
BACKGROUND: Women developing Gestational Diabetes Mellitus (GDM) are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM are essential in preventing progression to type 2 diabetes mellitus. We aimed to explore the perspectives of healthcare providers regarding the barriers from the health system context that restrict the timely screening and effective management of GDM. METHODS: We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India's major city (Bengaluru). The interviews were conducted in the preferred language of the participants (Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using the grounded theory approach by NVivo 12 plus. The findings are put into perspective using the socio-ecological model. RESULTS: Health care providers identified delayed visits to public hospitals and stress on household-level responsibilities as barriers at the individual level for GDM screening. Also, migration of pregnant women to their natal homes during first pregnancy is a cultural barrier in addition to health system barriers such as unmet nurse training needs, long waiting hours, uneven power dynamics, lack of follow-up, resource scarcity, and lack of supportive oversight. The barriers for GDM management included non-reporting women to follow - up visits, irregular self-monitoring of drug and blood sugar, trained staff shortage, ineffective tracking, and lack of standardized protocol. CONCLUSION: There is a pressing need to develop and improve existing GDM Screening and Management services to tackle the growing burden of GDM in public hospitals of India.
BACKGROUND:Women developing Gestational Diabetes Mellitus (GDM) are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM are essential in preventing progression to type 2 diabetes mellitus. We aimed to explore the perspectives of healthcare providers regarding the barriers from the health system context that restrict the timely screening and effective management of GDM. METHODS: We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India's major city (Bengaluru). The interviews were conducted in the preferred language of the participants (Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using the grounded theory approach by NVivo 12 plus. The findings are put into perspective using the socio-ecological model. RESULTS: Health care providers identified delayed visits to public hospitals and stress on household-level responsibilities as barriers at the individual level for GDM screening. Also, migration of pregnant women to their natal homes during first pregnancy is a cultural barrier in addition to health system barriers such as unmet nurse training needs, long waiting hours, uneven power dynamics, lack of follow-up, resource scarcity, and lack of supportive oversight. The barriers for GDM management included non-reporting women to follow - up visits, irregular self-monitoring of drug and blood sugar, trained staff shortage, ineffective tracking, and lack of standardized protocol. CONCLUSION: There is a pressing need to develop and improve existing GDM Screening and Management services to tackle the growing burden of GDM in public hospitals of India.
Entities:
Keywords:
Gestational diabetes mellitus; Health care providers; India; Management; Public sector; Screening; Socio-ecological model
Authors: Linju Joseph; Sheila Greenfield; Anna Lavis; T R Lekha; Jeemon Panniyammakal; Semira Manaseki-Holland Journal: Front Public Health Date: 2022-07-08
Authors: Francesco Corrado; Antonino Di Benedetto; Giacoma Di Vieste; Laura La Fauci; Canio Martinelli; Rosario D'Anna; Basilio Pintaudi Journal: J Clin Med Date: 2022-06-28 Impact factor: 4.964