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. 2025 Oct 10;25(1):1069.
doi: 10.1186/s12884-025-08225-4.

Patient and contextual factors influence clinicians' decision making regarding universal screening for gestational diabetes: results of a factorial survey set in rural and remote Western Australia

Andrew B Kirke  1 , Julia V Marley  2 , David Atkinson  2 , Erica P Spry  2   3 , Craig Sinclair  4
Affiliations

Patient and contextual factors influence clinicians' decision making regarding universal screening for gestational diabetes: results of a factorial survey set in rural and remote Western Australia

Andrew B Kirke et al. BMC Pregnancy Childbirth. .

Abstract

Background: Universal screening of all pregnant women for gestational diabetes mellitus (GDM) with an oral glucose tolerance test (OGTT) is recommended in Australia, however in rural and remote areas substantial numbers are not tested. Rural and remote clinicians have considerable influence over the delivery of screening. To improve screening it is important to understand factors that might affect their approach to screening. This study explores the impact of a range of predictors on clinicians' decision making in relation to gestational diabetes screening.

Methods: We conducted a factorial survey of 67 rural and remote clinicians active in antenatal care in Western Australia between Jan 31st and June 4th, 2024. Clinicians were presented with vignettes of hypothetical patients presenting for antenatal care at 24 weeks gestation, which asked about the OGTT. Seven factors were manipulated in the vignettes, with varying levels of each factor presented. Demographic data on clinicians was collected. Survey data was analysed using Linear Mixed Effects Regression.

Results: Clinicians judged they were highly likely to request the OGTT (mean 86/100, standard deviation (SD) 23.5). Clinicians scored lower when judging how likely an OGTT was completed (59.5/100, SD 19.6) and how likely they would request an alternative test (52.7/100 SD 30.5). Patient contextual factors were a barrier to requesting the OGTT: nausea and vomiting (β=-6.2, 95% confidence interval (CI) -9.4 to -3.0); health beliefs (β=-7.0, 95% CI -10.2 to -3.8). Patient contextual factors were a barrier to completing the OGTT: nausea and vomiting (β=-13.5, 95%CI -16.9 to -10.1), Aboriginal ethnicity (β=-15.3, 95%CI -19.6 to -11.1), health beliefs (β=-16.0, 95%CI -19.6 to -12.4) and childcare (β=-3.8, 95%CI -6.8 to -0.8). General practitioner obstetricians were more likely than midwives to request the OGTT (β=8.9, 95%CI 1.3 to 16.5), and less likely to request alternative tests (β=-19.6, 95%CI -36.3 to -0.3). Risk factors for GDM (age, weight, family history) did not impact clinicians' judgement.

Conclusions: While sensitivity and specificity of screening tests are important, so too is being able to deliver that service to the whole population. In rural and remote settings patient contextual factors should be central to achieving truly universal screening for GDM.

Keywords: Clinician decision making; Factorial survey; Gestational diabetes; Oral glucose tolerance test; Rural and remote.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study forms part of a broader research project aimed at improving screening for and management of hyperglycaemia in pregnancy (ORCHID Study) in regional, rural and remote WA. Ethics approval for this sub-study was obtained from the Western Australian Aboriginal Health Ethics Committee WAAHEC Approval number 584. All participants in the study provided written consent. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Selection process for completed survey responses
Fig. 2
Fig. 2
Clinicians in Primary care and Hospital care. Overlap indicates those working in more than one setting. ACCHS Aboriginal Community Controlled Health Service, MGP  Midwifery Group Practice. Number (n) refers to number of participants in each setting
See this image and copyright information in PMC

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