Gestational diabetes in Uganda and India: Design and Evaluation of Educational Films for improving Screening and Self-management (GUIDES)

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Gestational diabetes mellitus (GDM) is a condition in which the body of pregnant women cannot control the levels of blood sugar. This can result in a number of short- and long-term health problems for both the mother and her child. This condition is now becoming much more common in developing countries, yet most women are not diagnosed on time, and those who are diagnosed do not usually receive appropriate care. This is because the doctors and pregnant women in these countries don't know enough about this condition, as it is a relatively new experience for these societies. The aim of our research is to assess whether an educational and behavioural intervention, delivered primarily through film, can improve the care of women with GDM. Films are a simple and low-cost way of delivering health interventions, and they are particularly suitable for people who are not very literate. So far, films have been shown to be useful in imparting health education and changing health-related behaviours in developed countries, but not in developing countries, which is a primary motivation for our research. We will develop and evaluate an intervention with three different components. The first will be a training programme for doctors and nurses. Films will cover how to identify and treat GDM, and how to support women to make changes to their lifestyle (healthy eating, more physical activity). Secondly, a short film for pregnant women and their families, designed to raise awareness of GDM, will be shown in the waiting areas where women receive antenatal care (routine health care in pregnancy). Thirdly, a programme for women diagnosed with GDM to help them manage their condition. These films will educate them about treatment, and will support them to make changes for a healthier lifestyle. Films will be supplemented by Q&A sessions run by a trained nurse. We will carry out our research in Uganda (Entebbe) and India (Bengaluru) because they are at different stage of economic development. First, we will carry out research to understand people's daily lives in these countries to develop an intervention that is suitable for their culture. Then we will test and refine it further until it is fit-for-purpose. We will then assess whether the intervention improves care for women with GDM in independent studies in both sites. In each site, thirty maternity units will be selected, from which half will be randomly chosen to receive the new intervention. Women visiting the participating clinics during pregnancy will be invited to join the study. To evaluate whether the interventions are successful, we will measure three things. Firstly, whether women have been screened for and/or diagnosed with GDM. Secondly, we will invite women who tell us that have been diagnosed with GDM to visit clinics so we can take a blood sample. We will test this blood to see how well their blood sugar is being controlled. Thirdly, we will calculate how many women have experienced a negative birth outcome which could be because of GDM (for example, having a baby who is larger than average, or giving birth by caesarean section). We will also conduct interviews with women and health providers to help us understand how and why the intervention may be (or may not be) successful. If the intervention is successful in improving the detection and management of GDM, we expect there to be financial savings from a reduction in maternal and infant complications associated with GDM. We also think that the intervention may reduce the number of women who are diagnosed with type 2 diabetes later in life. In the longer term, it is hoped that the intervention will encourage the provision and quality of GDM screening and care across all LMICs.