Campbell Sandra, Roux Nicolette, Preece Cilla, Rafter Eileen, Davis Bronwyn, Mein Jackie, Boyle Jacqueline, Fredericks Bronwyn, Chamberlain Catherine
1Centre for Chronic Disease Prevention,James Cook University,Smithfield,QLD,Australia.
3Wuchopperen Health Service,Manoora,QLD,Australia.
Prim Health Care Res Dev. 2017 Nov;18(6):549-562. doi: 10.1017/S1463423617000305. Epub 2017 Jul 17.
Aim To understand enablers and barriers influencing postpartum screening for type 2 diabetes following gestational diabetes in Australian Indigenous women and how screening might be improved.
Australian Indigenous women with gestational diabetes mellitus (GDM) are less likely than other Australian women to receive postpartum diabetes screening. This is despite a fourfold higher risk of developing type 2 diabetes within eight years postpartum.
We conducted interviews with seven Indigenous women with previous GDM, focus groups with 20 Indigenous health workers and workshops with 24 other health professionals. Data collection included brainstorming, visualisation, sorting and prioritising activities. Data were analysed thematically using the Theoretical Domains Framework. Barriers are presented under the headings of 'capability', 'motivation' and 'opportunity'. Enabling strategies are presented under 'intervention' and 'policy' headings. Findings Participants generated 28 enabling environmental, educational and incentive interventions, and service provision, communication, guideline, persuasive and fiscal policies to address barriers to screening and improve postpartum support for women. The highest priorities included providing holistic social support, culturally appropriate resources, improving Indigenous workforce involvement and establishing structured follow-up systems. Understanding Indigenous women's perspectives, developing strategies with health workers and action planning with other health professionals can generate context-relevant feasible strategies to improve postpartum care after GDM. Importantly, we need evidence which can demonstrate whether the strategies are effective.
目的是了解影响澳大利亚原住民妇女妊娠期糖尿病后2型糖尿病产后筛查的促进因素和障碍，以及如何改进筛查。
患有妊娠期糖尿病（GDM）的澳大利亚原住民妇女比其他澳大利亚妇女接受产后糖尿病筛查的可能性更小。尽管产后八年内患2型糖尿病的风险高出四倍。
我们对7名曾患GDM的原住民妇女进行了访谈，与20名原住民卫生工作者进行了焦点小组讨论，并与24名其他卫生专业人员举办了研讨会。数据收集包括头脑风暴、可视化、分类和排序活动。使用理论领域框架对数据进行了主题分析。障碍在“能力”、“动机”和“机会”标题下呈现。促进策略在“干预”和“政策”标题下呈现。结果参与者提出了28项促进性的环境、教育和激励干预措施，以及服务提供、沟通、指南、说服和财政政策，以解决筛查障碍并改善对妇女的产后支持。最优先事项包括提供全面的社会支持、符合文化习惯的资源、提高原住民劳动力的参与度以及建立结构化的随访系统。了解原住民妇女的观点、与卫生工作者制定策略以及与其他卫生专业人员制定行动计划，可以产生与背景相关的可行策略，以改善GDM后的产后护理。重要的是，我们需要证据来证明这些策略是否有效。
