Barriers and facilitators to diabetes screening and prevention after a pregnancy complicated by gestational diabetes

OBJECTIVE: Gestational diabetes mellitus (GDM) is increasing in the United States, with higher rates among minoritized racial and ethnic populations and lower income populations. GDM increases risk for type 2 diabetes (T2DM), and postpartum diabetes screening and prevention are imperative. This qualitative study examines barriers and facilitators to postpartum T2DM screening and prevention among non-privately insured individuals with a history of GDM in a state prior to Medicaid expansion. METHODS: Thirty-six non-privately insured women with a history of GDM completed semi-structured interviews. Four focus groups and seven interviews were conducted with 30 nurse practitioners, physicians, physician assistants, nurses and registered dietitians from Federally Qualified Health Centers in St. Louis, MO. Interviews and focus groups were audio-recorded and transcribed. Data were analyzed using an integrative thematic analysis informed by the socio-ecological model. RESULTS: Barriers and facilitators to T2DM screening and prevention occur across multiple environments (society, healthcare system, interpersonal, and individual). Societal barriers include insurance issues, unemployment, and lack of transportation, childcare, safe housing, and healthy food access, while facilitators include government sponsored programs and community organizations. Healthcare system barriers include care fragmentation, scheduling policies and time constraints while facilitators include care coordination, pregnancy support groups, and education materials. Interpersonal barriers include negative care experiences, cultural differences, communication challenges, competing priorities, and lack of a social support network, while facilitators include family and friend support and positive care experiences. Individual barriers include health complications and unhealthy food and exercise patterns, while facilitators include child wellbeing, empowered attitudes and healthy food and exercise patterns. CONCLUSIONS: The socioecological model highlights the societal and systemic determinants that encompass individual and interpersonal factors affecting postpartum T2DM screening and prevention. This framework can inform multi-level interventions to increase postpartum T2DM screening and prevention in this high-risk population, including policy changes to alleviate higher-level barriers

Quantitative Evaluation of the Community Research Fellows Training Program

Context: The Community Research Fellows Training (CRFT) program is a community-based participatory research (CBPR) initiative for the St. Louis area. This fifteen week program, based on a Master in Public Health curriculum, was implemented by the Division of Public Health Sciences at Washington University School of Medicine in partnership with the Siteman Cancer Center. Objectives: We measure the knowledge gained by participants and evaluate participant and faculty satisfaction of the CRFT program both in terms of meeting learning objectives and actively engaging the community in the research process.Participants: We conducted analyses on 44 community members who participated in the CRFT program and completed the baseline and follow-up knowledge assessments.Main Outcome Measures: Knowledge gain is measured by a baseline and follow-up assessment given at the first and final session. Additionally, pre- and post-tests are given after the first 12 sessions. To measure satisfaction, program evaluations are completed by both the participants and faculty after each topic. Mid-way through the program, a mid-term assessment was administered to assess the program’s community engagement. We analyzed the results from the assessments, pre- and post-tests, and evaluations.Results: The CRFT participants’ knowledge increased at follow-up as compared with baseline on average by a 16.5 point difference (p<0.0001). Post-test scores were higher than pre-test scores for 11 of the 12 sessions. Both participants and faculty enjoyed the training and rated all session well.Conclusions: The CRFT program was successful in increasing community knowledge, in participant satisfaction, and in faculty satisfaction. This success has enhanced the infrastructure for CBPR as well as led to CBPR pilot projects that address health disparities in the St. Louis Greater Metropolitan Area

Interpersonal level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.

Interpersonal level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.</p

Key points.

Key points.</p

Societal level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.

Societal level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.</p

Interview guides.

(DOCX)</p

Healthcare system level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.

Healthcare system level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.</p

Individual (patient) level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.

Individual (patient) level barriers and facilitators to postpartum diabetes screening and prevention: Exemplar quotes.</p