Pennington Andrew V R, O'Reilly Sharleen L, Young Doris, Dunbar James A
Department of General Practice, University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia.
Aust J Prim Health. 2017 Apr;23(1):66-74. doi: 10.1071/PY15177.
This paper investigates factors influencing women's engagement with diabetes preventative care after a pregnancy with gestational diabetes (GDM) from the perspectives of GPs and women and explores the role of the GP in that care. Qualitative research using semi-structured interviews with women who had experienced GDM (n=16) and GPs (n=18) were conducted and a thematic content analysis conducted. Women's interviews explored their experience of GDM, factors influencing, and engagement with, follow-up care for diabetes prevention and role of the GP in that care. GP interviews explored postnatal care provided to women with GDM, the role of the GP in that care and perceived factors influencing a mother's engagement in her self-care. Three themes were identified: (1) advice and testing; (2) role of the GP; and (3) barriers and enablers to care. Significant consensus about the role of the GP and barriers and enablers to care existed. Both groups believed post GDM follow-up is best done by GPs and suggested recall and reminders would improve care. GPs gave consistent exercise advice, but lacked consensus on follow-up testing, dietary and weight-loss advice. Women's health literacy influenced how they viewed their GPs role. Consensus guidelines on follow-up testing and diabetes prevention advice, tailored advice according to health literacy and addressing barriers to care would likely improve the capacity of GPs to prevent unnecessary conversion to type 2 diabetes in these at-risk women.
本文从全科医生（GP）和女性的角度，调查了影响妊娠糖尿病（GDM）孕妇产后参与糖尿病预防护理的因素，并探讨了全科医生在该护理中的作用。通过对患有GDM的女性（n = 16）和全科医生（n = 18）进行半结构化访谈开展定性研究，并进行了主题内容分析。对女性的访谈探讨了她们患GDM的经历、影响糖尿病预防后续护理参与度的因素以及全科医生在该护理中的作用。对全科医生的访谈探讨了为患有GDM的女性提供的产后护理、全科医生在该护理中的作用以及影响母亲自我护理参与度的感知因素。确定了三个主题：（1）建议与检测；（2）全科医生的作用；（3）护理的障碍与促进因素。在全科医生的作用以及护理的障碍与促进因素方面存在显著共识。两组都认为GDM后的随访最好由全科医生进行，并建议召回和提醒将改善护理。全科医生给出了一致的运动建议，但在后续检测、饮食和减肥建议方面缺乏共识。女性的健康素养影响了她们对全科医生作用的看法。关于后续检测和糖尿病预防建议的共识指南、根据健康素养提供的量身定制建议以及解决护理障碍可能会提高全科医生预防这些高危女性不必要地转化为2型糖尿病的能力。
