Skip to main content
×
Home

Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes

  • Sandra Campbell (a1) (a2), Nicolette Roux (a3), Cilla Preece (a4), Eileen Rafter (a3), Bronwyn Davis (a5), Jackie Mein (a2), Jacqueline Boyle (a6), Bronwyn Fredericks (a7) and Catherine Chamberlain (a4)...
Abstract
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.

Background

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.

Methods

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.

Copyright
Corresponding author
Correspondence to: Sandra Campbell, Apunipima Cape York Health Council, 186 McCoombe Street, Bungalow, QLD 4870, Australia. Email: sandy.campbell@jcu.edu.au
Footnotes
Hide All
a

Wuchopperen Health Service, Manoora, QLD, Australia.

b

Judith Lumley Centre, LaTrobe University, Melbourne, VIC, Australia.

Footnotes
References
Hide All
Abdalla L. and Novis A. 2014: Uh Oh! I have received an unexpected visitor: the visitor’s name is chronic disease. A Brazilian family therapy approach. Australian and New Zealand Journal of Family Therapy 35, 100104.
Ahmad F., Mahmood S., Pietkiewicz I., McDonald L. and Ginsburg O. 2012: Concept mapping with South Asian immigrant women: barriers to mammography and solutions. Journal of Immigrant and Minority Health 14, 242250.
Aljohani N., Rempel B., Ludwig S., Morris M., Cheang M., Murray R., Bruce S. and Shen G. 2008: Impact of diabetes on maternal-fetal outcomes in Manitoba: relationship with ethnic and environmental factors. Clinical and Investigative Medicine 31, E338E345.
Anderson R. and Robins L. 1998: How do we know? Reflections on qualitative research in diabetes. Diabetes Care 21, 13871388.
Australian Government 2013: National Aboriginal and Torres Strait Islander health plan 2013–2023. Canberra: Department of Health and Ageing Commonwealth of Australia.
Australian Health Ministers’ Advisory Council 2008: Population based screening framework, updated September 2016. Retrieved 14 February 2017 from http://www.cancerscreening.gov.au/internet/screening/publishing.nsf/Content/16AE0B0524753EE9CA257CEE0000B5D7/$File/Final%20Population%20Based%20Screening%20Framework%202016.pdf.
Australian Institute of Health and Welfare 2010: Australia’s health 2010. Canberra: AIHW.
Bartholomew L., Parcel G. and Kok G. 1998: Intervention mapping: a process for developing theory and evidence-based health education programs. Health Education and Behaviour 25, 545563.
Bennett W., Ennen C., Carrese J., Hill-Briggs F., Levine D., Nicholson W. and Clark J. 2011: Barriers to and facilitators of postpartum follow-up care in women with recent gestational diabetes mellitus: a qualitative study. Journal of Women’s Health 20, 239245.
Carson M., Frank M. and Keely E. 2013: Postpartum testing rates among women with a history of gestational diabetes: systematic review. Primary Care Diabetes 7, 177186.
Cass A., Cunningham J., Snelling P., Wang Z. and Hoy W. 2003: Renal transplantation for Indigenous Australians: identifying the barriers to equitable access. Ethnicity and Health 8, 111119.
Chamberlain C., Banks E., Joshy G., Diouf I., Oats J., Gubhaju L. and Eades S. 2014: Prevalence of gestational diabetes mellitus among Indigenous women and comparison with non-Indigenous Australian women: 1990–2009. Australian and New Zealand Journal of Obstetrics and Gynaecology 54, 433440.
Chamberlain C., Fredericks B., McLean A., Oldenburg B., Mein J. and Wolfe R. 2015a: Associations with low rates of postpartum glucose screening after gestational diabetes among Indigenous and non-Indigenous Australian women. Australian and New Zealand Journal of Public Health 39, 6976.
Chamberlain C., McLean A., Oats J., Oldenburg B., Eades S., Sinha A. and Wolfe R. 2015b: Low rates of postpartum glucose screening among Indigenous and non-Indigenous women in Australia with gestational diabetes. Maternal and Child Health Journal 19, 651663.
Chamberlain C., McNamara B., Williams E., Yore D., Oldenburg B., Oats J. and Eades S. 2013: Diabetes in pregnancy among Indigenous women in Australia, Canada, New Zealand and the United States: a systematic review of the evidence for screening in early pregnancy. Diabetes/Metabolism Research and Reviews 29, 241256.
Chamberlain C., Oldenburg B., Wilson A., Eades S., O’Dea K., Oats J. and Wolfe R. 2015c: Type 2 diabetes after gestational diabetes: greater than a fourfold risk among Indigenous compared to non-Indigenous Australian women. Diabetes/Metabolism Research and Reviews 32, 217227.
Claesson R., Ekelund M., Ignell C. and Berntorp K. 2015: Role of HbA1c in post-partum screening of women with gestational diabetes mellitus. Journal of Clinical & Translational Endocrinology 2, 2125.
Dannenbaum D., Verronneau J., Torrier J., Smeja H., Robinson E., Dumont C., Kovitch I. and Webster T. 1999: Comprehensive computerized diabetes registry. Serving the Cree of Eeyou Istchee (eastern James Bay). Canadian Family Physician 45, 364370.
DeCosta C. and Child A. 1996: Pregnancy outcomes in urban Aboriginal women. Medical Journal of Australia 164, 523526.
Dyck R., Osgood N., Lin T., Gao A. and Stang M. 2010: Epidemiology of diabetes mellitus among First Nations and non-First Nations adults. Canadian Medical Association Journal 182, 249256.
Farrell T., Neale L. and Cundy T. 2002: Congenital anomalies in the offspring of women with type 1, type 2 and gestational diabetes. Diabetic Medicine 19, 322326.
Ferrara A. 2007: Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care 30, S141S146.
Gabbe S., Landon M., Warren-Boulton E. and Fradkin J. 2011: Promoting health after gestational diabetes: a National Diabetes Education Program call to action. Obstetrics and Gynecology 119, 171176.
HAPO Study Cooperative Research Group (HAPO) 2008: Hyperglycaemia and adverse pregnancy outcomes. New England Journal of Medicine 358, 19912002.
Hunt K. and Conway D. 2008: Who returns for postpartum glucose screening following gestational diabetes mellitus? American Journal of Obstetrics and Gynecology 198, 404.e1404.e6.
Jones E., Appel S., Eaves Y., Moneyham L., Oster R. and Ovalle F. 2012: Cardiometabolic risk, knowledge, risk perception, and self-efficacy among American Indian women with previous gestational diabetes. Journal of Obstetric, Gynecologic, and Neonatal Nursing 41, 246257.
Keely E. 2012: An opportunity not to be missed – how do we improve postpartum screening rates for women with gestational diabetes? Diabetes/Metabolism Research and Reviews 28, 312316.
Kim C. 2002: Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care 25, 18621868.
Ko J., Dietz P., Conrey E., Rodgers L., Shellhass C., Farr S. and Robbins C. 2013: Strategies associated with higher postpartum glucose tolerance screening rates for gestational diabetes mellitus patients. Journal of Women’s Health 22, 681686.
Michie S., van Stralen M. and West R. 2011: The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science 6, 42. https://doi.org/10.1186/1748-5908-6-42.
Nankervis A., McIntyre H., Moses R., Ross G., Callaway L., Porter C., Jeffries W., Boorman C., De Vries B. and McElduff A. 2013: Consensus guidelines for the testing and diagnosis of gestational diabetes in Australia. Retrieved 14 February 2017 from http://adips.org/downloads/2014ADIPSGDMGuidelinesV18.11.2014_000.pdf.
Nilsen P. 2015: Making sense of implementation theories, models and frameworks. Implementation Science 10, 5365.
Ornoy A. 2011: Prenatal origin of obesity and their complications: gestational diabetes, maternal overweight and the paradoxical effects of fetal growth restriction and macrosomia. Reproductive Toxicology 32, 205212.
Osgood N., Dyck R. and Grassmann W. 2011: The inter- and intragenerational impact of gestational diabetes on the epidemic of type 2 diabetes. American Journal of Public Health 101, 173179.
Popova L. 2012: The extended parallel process model: illuminating the gaps in research. Health Education and Behavior 39, 455473.
Queensland Government 2013: Queensland Government Statistician’s Office population estimates by Indigenous status, 2013. Retrieved 14 February 2017 from http://www.qgso.qld.gov.au/subjects/demography/atsi-people/tables/pop-est-indigenous-status/index.php.
Rigney L. 1997: Internationalisation of an Indigenous anti-colonial cultural critique of research methodologies: a guide to Indigenist research methodology and its principles. Journal for Native American Studies 14, 109121.
Stasenko M., Liddell J., Cheng Y., Sparks T., Killion M. and Caughey A. 2011: Patient counseling increases postpartum follow-up in women with gestational diabetes mellitus. American Journal of Obstetrics and Gynecology 24, 522.e1522.e6.
Sterne V., Logan T. and Palmer M. 2011: Factors affecting attendance at postpartum diabetes screening in women with gestational diabetes mellitus. Practical Diabetes International 28, 6468.
Taylor N., Sahota P., Sargent J., Barber S., Lach J., Louch G. and Wright J. 2013: Using intervention mapping to develop a culturally appropriate intervention to prevent childhood obesity: the HAPPY (Healthy and Active Parenting Programme for Early Years) study. International Journal of Behavioral Nutrition and Physical Activity 10, 142.
Taylor S. and McDermott R. 2010: What do we know about health literacy and diabetes care, and what does this mean for Aboriginal and Torres Strait Islander peoples with diabetes? Aboriginal and Islander Health Worker Journal 34, 2830.
Vesco K., Dietz P., Bulkley J., Bruce C., Callaghan W., England L., Kimes T., Bachman D., Hartinger K. and Hornbrook M. 2012: A system-based intervention to improve postpartum diabetes screening among women with gestational diabetes. American Journal of Obstetrics and Gynecology 207, 283.e1283.e6.
Witte K., Meyer G. and Martell D. 2001: The extended parallel process model, in effective health risk messages. A step-by-step guide. Thousand Oaks, CA: Sage Publications.
World Health Organization 2013: Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: WHO Press.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Type Description Title
WORD
Supplementary Materials

Campbell supplementary material
Table S3

 Word (18 KB)
18 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 21
Total number of PDF views: 64 *
Loading metrics...

Abstract views

Total abstract views: 374 *
Loading metrics...

* Views captured on Cambridge Core between 17th July 2017 - 14th December 2017. This data will be updated every 24 hours.