Barriers and enablers to translating gestational diabetes guidelines into practice

Abstract

AbstractReduced insulin requirements and improved blood glucose level (BGL) control in gestational diabetes mellitus (GDM) have been documented in a study validating American Nutrition Practice Guidelines that included a dietitian appointment schedule. No Australian nutrition practice guidelines exist and care differs across centres. Guideline dissemination alone does not change practice; assessment of barriers/enablers and implementation design must be theory‐driven. We describe this assessment and the planned intervention to implement a schedule of dietitian consults for GDM care.A barriers and enablers analysis was undertaken. Data sources included hospital records, clinic observation, and staff surveys. Dietetic visits were compared with the Nutrition Practice Guideline. Barriers were categorised into domains from the Theoretical Domains Framework.Of 44 clinic staff surveyed, most believed regular dietetic contact could influence diet, but fewer believed contact could influence BGLs, pharmacotherapy, and care costs, and only half felt contact could influence weight gain or macrosomia. Women's lack of awareness of the benefits of scheduled contact with a dietitian and staff's unfamiliarity with current practice were identified. There was a significant shortfall in dietitian resources. Other barriers included lack of dedicated clinic space and exclusion from the clinic care pathway.Identified barrier ‘domains’ were: Knowledge; Beliefs about consequences; Intentions; Social/professional role/identity; Social influences; Memory, attention, and decision processes; and Environmental context and resources. Effective change interventions have been mapped to domains. Outcomes of the evaluation will be uptake of the new dietetic schedule and its effect on requirement for pharmacotherapy. Copyright © 2014 John Wiley & Sons. Practical Diabetes 2014; 31(2): 67–72