Improving systems of prenatal and postpartum care for hyperglycemia in pregnancy: A process evaluation

• Published in: International journal of gynecology and obstetrics Vol. 155; no. 2; pp. 179 - 194
• Main Authors: MacKay, Diana, Freeman, Natasha, Boyle, Jacqueline A., Campbell, Sandra, McLean, Anna, Peiris, David, Corpus, Sumaria, Connors, Christine, Moore, Elizabeth, Wenitong, Mark, Silver, Bronwyn, McIntyre, H. David, Shaw, Jonathan E., Brown, Alex, Kirkham, Renae, Maple‐Brown, Louise, Chitturi, S., Eades, S., Inglis, C., Dempsey, K., Lynch, M., Skinner, T., Wright, R., O’Dea, K., Oats, J., Zimmett, P., Sinha, A., Hanley, A.J., Whitbread, C., Barzi, F., Davis, B., Mein, J., McDermott, R., Canuto, K.
• Format: Journal Article
• Language: English
• Published: 01.11.2021
• Subjects: diabetes in pregnancy; gestational diabetes; health systems; hyperglycemia in pregnancy; indigenous health; process evaluation; quality improvement
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.13850

Objective To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve prenatal and postpartum care and health outcomes for women with hyperglycemia in pregnancy in regional and remote Australia. Methods A qualitative evaluation, underpinned by the RE‐AIM framework (reach, effectiveness, adoption, implementation, maintenance), was conducted mid‐intervention. Semi‐structured interviews were conducted with the participants, who included clinicians, regional policymakers and managers, and study implementation staff. Results Interviewees (n = 45) reported that the early phase of the intervention had resulted in the establishment of a clinician network, increased clinician awareness of hyperglycemia in pregnancy, and improvements in management, including earlier referral for specialist care and a focus on improving communication with women. Enablers of implementation included existing relationships with stakeholders and alignment of the intervention with health service priorities. Challenges included engaging remote clinicians and the labor‐intensive nature of maintaining a clinical register of women with hyperglycemia in pregnancy. Conclusion The early phase of this health systems intervention has had a positive perceived impact on systems of care for women with hyperglycemia in pregnancy. Findings have informed modifications to the intervention, including the development of a communication and engagement strategy. Synopsis A complex health systems intervention resulted in perceived improvements in systems of care for women with hyperglycemia in pregnancy in regional and remote Australia.