PMID- 36213215 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221011 IS - 1568-4156 (Print) IS - 1568-4156 (Electronic) VI - 22 IP - 3 DP - 2022 Jul-Sep TI - Integrating Gestational Diabetes Screening and Care and Type 2 Diabetes Mellitus Prevention After GDM Into Community Based Primary Health Care in South Africa-Mixed Method Study. PG - 20 LID - 10.5334/ijic.5600 [doi] LID - 20 AB - BACKGROUND: Despite high gestational diabetes mellitus (GDM) prevalence in South Africa (9.1% in 2018), its screening and management are not well integrated into routine primary health care and poorly linked to post-GDM prevention of type 2 diabetes mellitus (T2DM) in South Africa's fragmented health system. This study explored women's, health care providers' and experts' experiences and perspectives on current and potential integration of GDM screening and prevention of T2DM post-GDM within routine, community-based primary health care (PHC) services in South Africa. METHODS: This study drew on the Behaviour Change Wheel (BCW) framework and used a mixed method, sequential exploratory design for data collection, analysis and interpretation. Individual semi-structured interviews were conducted with key informants (n = 5) from both national and provincial levels and health care providers (n = 18) in the public health system of the Western Cape Province. Additionally, focus group discussions (FGDs) with Community Health Workers (CHWs n = 15) working with clinics in the Western Cape province. A further four FGDs and brief individual exit interviews were conducted with women with GDM (n = 35) followed-up at a tertiary hospital: Groote Schuur Hospital (GSH). Data collection with women diagnosed and treated for GDM happened between March and August 2018.Thematic analysis was the primary analytical method with some content analysis as appropriate. Statistical analysis of quantitative data from the 35 exit interview questionnaires was conducted, and correlation with qualitative variables assessed using Cramer's V coefficient. RESULTS: Shortage of trained staff, ill-equipped clinics, socio-economic barriers and lack of knowledge were the major reported barriers to successful integration of GDM screening and postnatal T2DM prevention. Only 43% of women reported receiving advice about all four recommendations to improve GDM and decrease T2DM risk (improve diet, reduce sugar intake, physical exercise and regularly take medication). All participants supported integrating services within routine, community-based PHC to universally screen for GDM and to prevent or delay development of T2DM after GDM. CONCLUSION: GDM screening and post-GDM prevention of T2DM are poorly integrated into PHC services in South Africa. Integration is desired by stakeholders (patients and providers) and may be feasible if PHC resource, training constraints and women's socio-economic barriers are addressed. CI - Copyright: (c) 2022 The Author(s). FAU - Mutabazi, Jean Claude AU - Mutabazi JC AUID- ORCID: 0000-0002-1962-6949 AD - Departement de Medecine sociale et Preventive, Ecole de Sante Publique, Universite de Montreal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7, Canada. AD - Centre de Recherche en Sante Publique (CReSP), Universite de Montreal et CIUSSS du Centre-Sud-de-l'Ile-de-Montreal, Montreal, Canada. AD - Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montreal, H3T 1C5, QC, Canada. FAU - Bonong, Pascal Roland Enok AU - Bonong PRE AUID- ORCID: 0000-0002-9552-5365 AD - Departement de Medecine sociale et Preventive, Ecole de Sante Publique, Universite de Montreal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7, Canada. AD - Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montreal, H3T 1C5, QC, Canada. FAU - Trottier, Helen AU - Trottier H AUID- ORCID: 0000-0003-3293-7837 AD - Departement de Medecine sociale et Preventive, Ecole de Sante Publique, Universite de Montreal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7, Canada. AD - Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montreal, H3T 1C5, QC, Canada. FAU - Ware, Lisa Jayne AU - Ware LJ AUID- ORCID: 0000-0002-9762-4017 AD - SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, ZA. FAU - Norris, Shane AU - Norris S AUID- ORCID: 0000-0001-7124-3788 AD - SAMRC Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, ZA. FAU - Murphy, Katherine AU - Murphy K AD - Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape town, Western Cape, South Africa. FAU - Levitt, Naomi AU - Levitt N AUID- ORCID: 0000-0001-6480-8066 AD - Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, Cape town, Western Cape, South Africa. FAU - Zarowsky, Christina AU - Zarowsky C AUID- ORCID: 0000-0002-0850-6212 AD - Departement de Medecine sociale et Preventive, Ecole de Sante Publique, Universite de Montreal, Pavillon 7101, Avenue du Parc, Montreal, QC H3N 1X7, Canada. AD - Centre de Recherche en Sante Publique (CReSP), Universite de Montreal et CIUSSS du Centre-Sud-de-l'Ile-de-Montreal, Montreal, Canada. AD - School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville 7535, South Africa. LA - eng PT - Journal Article DEP - 20220921 PL - England TA - Int J Integr Care JT - International journal of integrated care JID - 101214424 PMC - PMC9503953 OTO - NOTNLM OT - GDM OT - South Africa OT - T2DM OT - Type 2 diabetes OT - gestational diabetes OT - integration OT - primary health care COIS- The authors have no competing interests to declare. EDAT- 2022/10/11 06:00 MHDA- 2022/10/11 06:01 PMCR- 2022/07/01 CRDT- 2022/10/10 04:27 PHST- 2020/08/07 00:00 [received] PHST- 2022/08/30 00:00 [accepted] PHST- 2022/10/10 04:27 [entrez] PHST- 2022/10/11 06:00 [pubmed] PHST- 2022/10/11 06:01 [medline] PHST- 2022/07/01 00:00 [pmc-release] AID - 10.5334/ijic.5600 [doi] PST - epublish SO - Int J Integr Care. 2022 Sep 21;22(3):20. doi: 10.5334/ijic.5600. eCollection 2022 Jul-Sep.