Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen, Denmark.
Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820, Gentofte, Denmark.
BMC Pregnancy Childbirth. 2017 Aug 1;17(1):255. doi: 10.1186/s12884-017-1429-y.
In 2007, universal screening for gestational diabetes mellitus (GDM) was introduced in Tamil Nadu, India. To identify factors hindering or facilitating timely initiation and completion of the GDM screening and diagnosis process, our study investigated how pregnant women in rural and urban Tamil Nadu access and navigate different GDM related health services.
The study was carried out in two settings: an urban private diabetes centre and a rural government primary health centre. Observations of the process of screening and diagnosis at the health centres as well as semi-structured interviews with 30 pregnant women and nine health care providers were conducted. Data was analysed using qualitative content analysis.
There were significant differences in the process of GDM screening and diagnosis in the urban and rural settings. Several factors hindering or facilitating timely initiation and completion of the process were identified. Timely attendance required awareness, motivation and opportunity to attend. Women had to attend the health centre at the right time and sometimes at the right gestational age to initiate the test, wait to complete the test and obtain the test report in time to initiate further action. All these steps and requirements were influenced by factors within and outside the health system such as getting right information from health care providers, clinic timings, characteristics of the test, availability of transport, social network and support, and social norms and cultural practices.
Minimising and aligning complex stepwise processes of prenatal care and GDM screening delivery and attention to the factors influencing it are important for further improving and expanding GDM screening and related services, not only in Tamil Nadu but in other similar low and middle income settings. This study stresses the importance of guidelines and diagnostic criteria which are simple and feasible on the ground.
2007 年，印度泰米尔纳德邦开始对妊娠期糖尿病（GDM）进行普遍筛查。为了确定阻碍或促进 GDM 筛查和诊断过程及时启动和完成的因素，我们的研究调查了农村和城市泰米尔纳德邦的孕妇如何获得和利用不同的 GDM 相关卫生服务。
该研究在两个环境中进行：城市私人糖尿病中心和农村政府初级保健中心。在卫生中心观察筛查和诊断过程，并对 30 名孕妇和 9 名卫生保健提供者进行半结构化访谈。使用定性内容分析对数据进行分析。
城乡环境中 GDM 筛查和诊断过程存在显著差异。确定了一些阻碍或促进及时启动和完成该过程的因素。及时就诊需要有就诊的意识、动机和机会。妇女必须在适当的时间、有时在适当的妊娠周数到卫生中心就诊，以启动测试、等待完成测试并及时获得测试报告，以便采取进一步行动。所有这些步骤和要求都受到卫生系统内外因素的影响，例如从卫生保健提供者获得正确的信息、诊所时间、测试特点、交通可用性、社会网络和支持，以及社会规范和文化习俗。
最小化和调整产前保健和 GDM 筛查提供的复杂分步过程，并关注影响其的因素，对于进一步改进和扩大 GDM 筛查和相关服务非常重要，不仅在泰米尔纳德邦，而且在其他类似的低收入和中等收入环境中也是如此。本研究强调了简单和可行的基于实地的指南和诊断标准的重要性。
