Department of Public Health and Primary Care, LUMC, Leiden, the Netherlands.
Department of Public Health and Primary Care, LUMC, Leiden, the Netherlands
BMJ Open. 2023 Aug 17;13(8):e066198. doi: 10.1136/bmjopen-2022-066198.
Pregnancy is a predictor of women's health later in life. The risk of eventually developing cardiovascular disease (CVD) and/or type 2 diabetes (T2D) increases three to seven times, after pre-eclampsia, hypertension gravidarum or gestational diabetes. The Heart for Women in The Hague project was designed to offer targeted screening to this high-risk population. This research aimed to gather insight regarding the initial experiences of healthcare providers and women with pre-eclampsia, hypertension gravidarum or gestational diabetes.
This study applied a qualitative semistructured interview design using an interview guide based on 'The Consolidated Framework for Implementation Research (CFIR).' Interviews were recorded, transcribed and coded in accordance with the five main CFIR themes. The setting of the study was primary and secondary care in The Hague, the Netherlands. Interviews were carried out from December 2021 until February 2022. The language was Dutch or English.
Participants (n=13) were women of the target population (n=7) and relevant healthcare professionals (n=6).
Healthcare providers and women were generally positive concerning screening. Healthcare providers agreed that this forgotten group deserves attention and felt that the regional transmural agreement (RTA) provided a clear policy. Women stated that they would like screening to continue and were open-minded regarding lifestyle guidance. Reported barriers included current lack of an easy way of contacting the population after a year, lack of knowledge among the women concerning increased risk, unfamiliarity of new colleagues with the RTA and lack of evidence that screening actually prevents disease.
Implementation of screening programmes to prevent or delay the development of CVD and/or T2D after complicated pregnancies will likely improve awareness in both patients and healthcare providers. Healthcare providers considered the RTA important because it concerns a forgotten high-risk population. Future research should focus on the improved effectiveness of tailored interventions to delay or prevent CVD.
妊娠是女性晚年健康的预测因素。妊娠高血压、先兆子痫或妊娠期糖尿病会使女性患心血管疾病（CVD）和/或 2 型糖尿病（T2D）的风险增加 3 至 7 倍。海牙妇女心脏项目旨在为高危人群提供有针对性的筛查。本研究旨在深入了解先兆子痫、妊娠高血压或妊娠期糖尿病患者的医护人员和女性的最初体验。
本研究采用定性半结构式访谈设计，使用基于“实施研究综合框架（CFIR）”的访谈指南。根据 CFIR 的五个主要主题对访谈进行记录、转录和编码。该研究的地点是荷兰海牙的初级和二级保健机构。访谈于 2021 年 12 月至 2022 年 2 月进行。语言为荷兰语或英语。
参与者（n=13）为目标人群中的女性（n=7）和相关医护人员（n=6）。
医护人员和女性普遍对筛查持积极态度。医护人员一致认为，这个被遗忘的群体值得关注，并认为区域穿通协议（RTA）提供了明确的政策。女性表示希望继续进行筛查，并对生活方式指导持开放态度。报告的障碍包括目前缺乏一种简便的方式在一年后与人群联系，女性对风险增加缺乏了解，新同事对 RTA 不熟悉，以及缺乏筛查确实可以预防疾病的证据。
实施筛查计划以预防或延迟复杂妊娠后 CVD 和/或 T2D 的发展，可能会提高患者和医护人员的意识。医护人员认为 RTA 很重要，因为它涉及到一个被遗忘的高危人群。未来的研究应集中在提高针对 CVD 的延迟或预防的定制干预措施的有效性上。
