Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark.
J Eval Clin Pract. 2023 Jun;29(4):591-601. doi: 10.1111/jep.13805. Epub 2022 Dec 30.
RATIONALE, AIMS AND OBJECTIVES: Women with previous gestational diabetes mellitus (GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow-up T2DM-screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow-up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision-making and informed choice regarding participation in follow-up screening.
A qualitative process evaluation informed by a critical realistic perspective. Data consisted of 20 semi-structured interviews with women previously diagnosed with GDM who had received the reminder. Interviews were analyzed using reflexive thematic analysis.
The reminder affected women's decision-making and informed choices through a range of mechanisms. Its personalized design prompted feelings of co-responsibility and care from the healthcare system, supported continuity in women's care pathways, and helped women bridge the gap between healthcare sectors. Women's perception of diabetes risk and the importance of follow-up influenced their decision-making. Participation in follow-up screening was influenced by several contextual factors, as women's everyday life impeded their prioritizing follow-up screening. Women who experienced being met by their general practitioner (GP) with acknowledgement rather than stigmatization and received supportive information tailored to their life situation were more motivated to participate in future follow-up screenings.
The reminder indicated both concern and co-responsibility for women's follow-up care after GDM and was well received by the women. It supported participation in follow-up screening through an emphasis on shared decision-making and informed choice. Women's interaction with their GP played a significant role.
背景、目的和目标：与无 GDM 的女性相比，患有既往妊娠糖尿病（GDM）的女性发生 2 型糖尿病（T2DM）的风险高出 8 倍以上。建议对 GDM 女性进行年度 T2DM 筛查随访，但第一年过后，参与率迅速下降。在丹麦北部地区，曾测试过电子提醒以改善既往 GDM 女性的随访护理。本研究旨在探讨女性对接受电子提醒的看法，以及提醒在女性参与随访筛查的决策和知情选择中的作用。
一项基于批判现实主义观点的定性过程评估。数据来自 20 名曾被诊断为 GDM 并收到提醒的女性的半结构化访谈。使用反思性主题分析对访谈进行分析。
提醒通过一系列机制影响女性的决策和知情选择。其个性化设计唤起了女性对医疗保健系统的共同责任和关怀，支持了女性护理路径的连续性，并帮助女性弥合医疗保健部门之间的差距。女性对糖尿病风险的感知以及随访的重要性影响了她们的决策。参与随访筛查受到多种环境因素的影响，因为女性的日常生活妨碍了她们优先进行随访筛查。那些感受到自己的全科医生（GP）给予认可而不是污名化，并收到针对自己生活情况量身定制的支持信息的女性，更有动力参与未来的随访筛查。
该提醒表明了对 GDM 后女性随访护理的关注和共同责任，受到了女性的欢迎。它通过强调共同决策和知情选择来支持参与随访筛查。女性与 GP 的互动起着重要作用。
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