1222: Healthcare provider perspectives on barriers and facilitators to care for low-income pregnant women with diabetes

Abstract

Treatment of gestational diabetes mellitus and type 2 diabetes mellitus during pregnancy can improve maternal and neonatal outcomes, yet self-care burdens for pregnant women with diabetes are high, particularly for low-income and minority women. Though prior studies have investigated patient-perceived barriers and facilitators to diabetes self-management during pregnancy, little work investigates healthcare providers’ perspectives. The objective was to investigate healthcare providers’ perspectives on barriers and facilitators of diabetes care during pregnancy. In this qualitative investigation, focus groups were conducted using a semi-structured interview guide designed to elicit provider perspectives on patient barriers and facilitators to successful diabetes-related self-management during pregnancy and their experiences of providing care. Providers included physicians, nurses, health educators, and other personnel who care for low-income pregnant women with diabetes. Transcripts were analyzed using the constant comparative technique to identify themes and subthemes, using the Social Ecological Model as a theoretical framework. Participants (N=29) identified barriers and facilitators to women’s achievement of optimal diabetes self-care according to five levels: environment, access, institution, interpersonal, knowledge, and individual (Figure). Example subthemes include inflexible work schedule (environment), poor medication and supply access (access), overburdened clinic (institution), perceived patient “policing” (interpersonal), and low health literacy (knowledge) (Table). Individual factors that influenced barriers and facilitators included self-efficacy, motivation, and engagement. Providers identified barriers, but not facilitators, for each theme. Providers described facilitators and barriers to diabetes care at all levels of the Social Ecological Model. These data can inform interventions to dismantle barriers patients face in order to create meaningful healthcare interventions to improve outcomes for low-income pregnant women with diabetes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)