Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes
Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes
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DOI：
10.1017/s1463423617000305
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发表时间：
2017-11-01
影响因子：
1.6
通讯作者：
Chamberlain, Catherine
中科院分区：
文献类型：
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作者：
Campbell, Sandra;Roux, Nicolette;Chamberlain, Catherine
目的：了解影响澳大利亚土著妇女妊娠糖尿病后2型糖尿病产后筛查的因素和障碍，以及如何改进筛查。背景：患有妊娠糖尿病（GDM）的澳大利亚土著妇女接受产后糖尿病筛查的可能性低于其他澳大利亚妇女。尽管产后八年内患2型糖尿病的风险要高出四倍。方法：我们对7名曾患GDM的土著妇女进行了访谈，对20名土著卫生工作者进行了焦点小组访谈，并对24名其他卫生专业人员进行了讲习班访谈。数据收集包括头脑风暴、可视化、分类和优先排序活动。使用理论领域框架对数据进行主题分析。障碍被分为“能力”、“动机”和“机会”。赋能策略在“干预”和“政策”标题下提出。研究结果：参与者制定了28项有利的环境、教育和激励干预措施，以及服务提供、沟通、指导、说服和财政政策，以解决筛查障碍，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助、文化上适当的资源、改善土著劳动力的参与和建立有组织的后续系统。了解土著妇女的观点，与卫生工作者一起制定战略，并与其他卫生专业人员一起制定行动计划，可以制定与具体情况相关的可行战略，以改善产后糖尿病后的产后护理。重要的是，我们需要证据来证明这些策略是否有效。
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.