Healthcare professionals' perceptions of barriers and facilitators to postpartum diabetes screening participation in women with gestational diabetes mellitus in China: A qualitative study

Abstract

Background: Women with a history of gestational diabetes mellitus (GDM) have a higher risk of developing type 2 diabetes (T2DM). Postpartum diabetes screening is usually recommended to identify glucose intolerance and introduce timely diabetes prevention strategies. However, the uptake of postpartum diabetes screening is suboptimal, especially in China, where GDM is prevalent. Healthcare professionals (HCPs) may offer unique insights into the challenges women face when attending screening, helping to develop interventions that improve uptake and fit in with routine clinical practice.

Aim: To explore HCPs' perceptions of barriers and facilitators to postpartum diabetes screening uptake.

Methods: Online semi-structured interviews were conducted with HCPs recruited via online networks. The data were analysed using framework analysis and the socio-ecological model.

Results: Eighteen HCPs, including obstetricians, midwives, nurses, nurse managers, and a dietician participated. Thirteen themes were generated across four levels (individual, interpersonal, organisational and policy). Individual level themes included: women's limited understanding, adherence and motivation; low diabetes risk awareness; and competing priorities. Interpersonal challenges involved communication and relationships between HCPs and women. Organizational barriers included workforce shortages, a lack of systemic GDM follow-up and care integration, and limited screening accessibility. At the policy level, GDM follow-up was not promoted nor prioritised.

Conclusion: HCPs have a vital role in improving patient education, postpartum follow-up and support after GDM to reduce long-term health risks. Strengthening HCP training in communication with women and improving continuity and integration of care could enhance GDM follow-up and prevent diabetes in women following GDM.

Keywords: Diabetes mellitus; Diabetes, Gestational; Postnatal care; Qualitative research; Type 2.