Health Care Professionals’ Perspectives On Screening And Management Of Gestational Diabetes Mellitus In Public Hospitals Of South India – A Qualitative Study

Abstract Background Women developing Gestational Diabetes Mellitus are subsequently at a higher risk of developing Type 2 Diabetes later in life. Screening and effective management of women with GDM is essential in preventing progression to type 2 diabetes mellitus. Although the burden of Gestational Diabetes Mellitus is high in India, Gestational Diabetes Mellitus screening and management is suboptimal in public hospitals. We aimed to explore the perspectives of healthcare providers regarding the barriers and facilitators from the health system context that restrict the timely screening and effective management of Gestational Diabetes Mellitus. Methods We conducted six in-depth interviews of health care providers- four with nurses and two with obstetricians in the public hospitals in India's major city (Bengaluru). The interviews were conducted in the preferred language of the participants ( Kannada for nurses, English for the obstetricians) and audio-recorded. All Kannada interviews were transcribed and translated into English for analysis. The primary data were analyzed using grounded theory approach by NVivo 12 plus Results Health care providers recognized and supported the need for design and implementation of Gestational Diabetes Mellitus screening and management services. While obstetricians were aware of the national guidelines regarding screening and management; nurses mentioned that they had unmet training needs in health promotion. Barriers identified to timely screening and management of Gestational Diabetes Mellitus included unmet training needs of nurses regarding Gestational Diabetes Mellitus, delay in screening of pregnant women accessing antenatal care at private clinics initially and subsequently reporting at public hospital in late gestation, migration of pregnant women due to delivery of first born at natal home, lack of follow up system of deferred cases for gestational diabetes screening, resource deficit, and long waiting hours. Conclusion Provided the fact that there is effectiveness of Gestational Diabetes Mellitus screening and management services, there is a pressing need to develop and improve existing Gestational Diabetes Mellitus Screening and Management services to tackle the growing burden of Gestational Diabetes Mellitus in India. With the urgent need for these services, it needs to be extended to public hospitals.