Abstract
Aim: To refine and contextually adapt a postpartum lifestyle intervention for prevention of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM) in Bangladesh, India, and Sri Lanka.Materials and Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with women with current diagnosis of GDM, and health care professionals involved in their management, to understand relevant local contextual factors for intervention optimization and implementation. This paper describes facilitators and barriers as well as feedback from participants on how to improve the proposed intervention. These factors were grouped and interpreted along the axes of the three main determinants of behavior–capability, opportunity, and motivation. IDIs and FGDs were digitally recorded, transcribed, and translated. Data-driven inductive thematic analysis was undertaken to identify and analyze patterns and themes.Results: Two interrelated themes emerged from the IDIs and FGDs: (i) The lifestyle intervention was acceptable and considered to have the potential to improve the existing model of care for women with GDM; and (ii) Certain barriers such as reduced priority of self-care, and adverse societal influences postpartum need to be addressed for the improvement of GDM care. Based on the feedback, the intervention was optimized by including messages for family members in the content of the intervention, providing options for both text and voice messages as reminders, and finalizing the format of the intervention session delivery.Conclusion: This study highlights the importance of contextual factors in influencing postpartum care and support for women diagnosed with GDM in three South Asian countries. It indicates that although provision of postpartum care is complex, a group lifestyle intervention program is highly acceptable to women with GDM, as well as to health care professionals, at urban hospitals.
Highlights
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance first diagnosed in the second or third trimester of pregnancy and that is not clearly preexisting type 1 or type 2 diabetes [1]
This paper describes the results of the formative phase that included exploration of postpartum care for women with GDM in public and private health facilities, and deliberations on optimal approaches to deliver a type 2 diabetes mellitus (T2DM)-prevention intervention using the existing health system’s infrastructure and workforce, in Bangladesh, India, and Sri Lanka
The In-depth interviews (IDIs) included interviews with health care providers (HCPs) and postpartum women diagnosed with GDM in the previous 24 months
Summary
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance first diagnosed in the second or third trimester of pregnancy and that is not clearly preexisting type 1 or type 2 diabetes [1]. According to estimates from International Diabetes Federation (IDF), about one in every four pregnancies in IDF South East Asia region is affected by hyperglycemia, of which 90 percent is GDM. This compares with global estimates of one in every six pregnancies [2]. GDM is an established risk factor for future development of type 2 diabetes mellitus (T2DM), with high conversion rates within 5 years of childbirth, underscoring the need for urgent interventions to address risk factors and manage glucose metabolism in this population [8,9,10,11,12]. Though earlier studies with lifestyle interventions in women with GDM, have shown a reduction in T2DM risk, these were mostly conducted in high- and upper-middle-income countries and with smaller sample sizes [16, 17], with sparse information on the use of low intensity lifestyle interventions in South Asian countries
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