A Qualitative Assessment of Post-Partum Screening After Gestational Diabetes, St. Louis, 2017-2018 (ICPSR 38543)
Version Date: Sep 12, 2022 View help for published
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Cynthia Herrick, Washington University in St. Louis. School of Medicine
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https://doi.org/10.3886/ICPSR38543.v1
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Summary View help for Summary
This study is a qualitative examination via in-depth interviews and focus groups of barriers and facilitators to receiving postpartum diabetes screenings. The target population is women aged 18-40 who had a history of gestational diabetes within the prior 10 years and received Medicaid during pregnancy. Perspectives from patients, health care providers, and health care staff were solicited for the study. Overall, the goal was to learn about the patient, provider, and staff experience after a pregnancy complicated by gestational diabetes in order to understand how health centers may better support patients receiving recommended follow-up screenings and preventing postpartum type 2 diabetes.
All healthcare providers and staff were recruited from federally qualified health centers (FQHCs) in Missouri and provided care for women during and after pregnancies with gestational diabetes. Patients were recruited via health care centers or other community sites in the St. Louis metropolitan area. Interview and focus group questions assessed understanding and education provided around gestational diabetes diagnosis and postpartum screening/prevention, as well as prominent barriers and facilitators to gestational diabetes management, postpartum diabetes screening, and diabetes prevention.
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The data for this collection will be made available at a future date.
Study Purpose View help for Study Purpose
The purpose of this study is to examine barriers and facilitators to postpartum type 2 diabetes screenings from the perspectives of women with a history of gestational diabetes during pregnancy and health care providers who work with this population.
Study Design View help for Study Design
The research team conducted in-depth interviews with participants. Interviews with patients took place on-site at either the Washington University School of Medicine or the patient's health care center. Interviews with providers and staff took place at their site of employment. All patients completed an individual interview, while providers and staff completed an individual interview or a focus group. Interviews were audio-recorded and lasted 60-90 minutes (30-45 minutes for staff). Patients were paid $50 in cash or grocery gift card as compensation and were provided with transportation and child care if needed.
The resulting interview transcripts were analyzed in NVivo. Team members used open coding to identify initial themes, then refined them through a collaborative creation of coding trees.
Sample View help for Sample
Convenience and snowball sampling methods were used to recruit participants. Patients, health care providers, and staff were recruited from multiple federally qualified health clinics (FQHCs) in Missouri. Additional recruitment for patients took place at social services organizations (e.g. WIC offices, infant and child care services) in the St. Louis metropolitan area via flyers, pamphlets, and provider referrals. Study advertisements were placed in local businesses, community buildings, public transportation, and local radio broadcasts. In addition to these methods, the research team used patient databases and census lists from REACH and Volunteers for Health to recruit participants and confirm eligibility. For the patient subsample, the research team aimed to recruit a stratified sample based on whether participants were screened for postpartum diabetes and length of time postpartum at recruitment (less than 12 months vs. 12 months and longer). The overall sample was reflective of the FQHC population in terms of race, ethnicity, income, and education.
The final sample consisted of 36 patients, 21 providers interviewed via focus group, and 9 providers/staff interviewed individually or in pairs. Providers and staff included physicians, nurses, nurse practitioners, physician assistants, and registered dietitians.
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Patient sample: Women aged 18-40 who had a pregnancy complicated by gestational diabetes within the prior 10 years and were not privately insured.
Provider and staff sample: Healthcare providers (physicians, nurse practitioners, physician assistants, registered dietitians and nurses) who provide care to women during and after pregnancy in federally qualified health centers.
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Patients: Interview questions focused on the main themes of patient understanding of diabetes, key barriers to follow-up screening, and key facilitators. Patient understanding touched on how participants comprehended and recalled their gestational diabetes diagnosis, any counseling/advice they received during pregnancy, impacts upon their postpartum health, and knowledge of diabetes prevention practices. Patients were then asked to describe factors that blocked and/or enabled their ability to be screened for diabetes after pregnancy.
Providers/staff: Providers and staff interviews focused on their role in the patient counseling process (e.g. what they tell patients about gestational diabetes and preventative care, how counseling sessions are conducted), their perceptions of patient understanding of gestational diabetes, and perceptions of key barriers/supports to patients receiving follow-up care.
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