67 Using deliberative priority-setting to improve gestational diabetes education

Abstract

Objectives Gestational diabetes mellitus (GDM) education is an important component of GDM management. While pregnancy is thought to be a generally positive experience for women, those with GDM are asked to manage their pregnancy under constant self-discipline to avoid pregnancy complications from hyperglycemia. For many with GDM, this experience is overwhelming. The guidance provided by a multidisciplinary health care team in delivering gestational diabetes education and acknowledging the emotional impact of a diagnosis has shown to improve self-care behaviours and subsequent birth outcomes. This study aims to explore GDM education and care experiences amongst women diagnosed with GDM attending publicly provided education classes at diabetes clinics in Edmonton, Alberta, Canada. Method Deliberative priority-setting was the methodology used as described by the Canadian Institute of Health Research (CIHR) to establish a dialogue throughout six working sessions with 5 women with GDM and 7 diabetes health care providers. Iterative working sessions assessed opinions on educational material provided in classes, feelings and emotions surrounding GDM, and how the healthcare system can improve to better meet their needs. Each session was transcribed and a priority-setting and website assessment surveys were conducted. Results We identified twelve priorities from the priority-setting survey that women wanted to be addressed beyond the existing GDM classes. These include future impacts of GDM on mother and child, blood glucose number interpretation; insulin administration instruction; GDM pathophysiology; how to manage GDM when basic necessities and support are unavailable; language and culture-specific materials; mental health and emotional management and ensuring consistent communication and messaging from health care providers. The working sessions also revealed that the www.diabetes-pregnancy.ca website is a commonly used resource across clinics in this region, however, not all clinicians provided or recommended women visit this site. Through the website assessment survey, women identified inconsistencies within content compared to what was delivered in class and were more interested in having access to site content that focus on patient narrative through text and videos that is relatable to with practical advice that can be applied to daily self-management. Conclusions A priority-setting partnership between women with GDM, healthcare providers, and researchers allowed for honest dialogue on issues relevant to health care providers and women living with GDM. This identified issues that were not adequately addressed in the existing standard GDM education. Women with GDM and health care providers identified the need for consistent and readily accessible information and determined a priority list of items that they would find most helpful. The use of an online resource that women can access before and after attending a GDM education class may help solidify learning and improve self-care behaviours.