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Understanding Why Some Women with a History of Gestational Diabetes Do Not Get Tested for Diabetes

      Abstract

      Background

      The proportion of women with previous gestational diabetes mellitus (GDM) receiving postpartum diabetes testing is far less than desired. Even in health care systems with high testing rates, some women remain untested. We explored what helps and what hinders women to obtain recommended testing.

      Methods

      In this mixed methods study, we recruited 139 patients with a history of GDM in their most recent pregnancy (6 months to 4.5 years before study enrollment) from a delivery system that had instituted a quality improvement program to increase postpartum diabetes testing rates. We determined whether they had received a postpartum diabetes test according to American Diabetes Association guidelines. Using survey data, we ran logistic regression models to assess correlates of testing status, and we conducted in-depth interviews with 22 women to provide greater context to their survey responses.

      Results

      Of the 139 women, 21 women (15%) did not complete recommended diabetes testing. From the survey data, women who visited a primary care provider had 72% (95% CI, 0.09–0.83) lesser odds of not having been tested. From the qualitative interviews, difficulty fitting testing around work and caregiver demands were the most common reasons for not testing. Untested women interpreted providers' reassurances that diabetes would resolve after delivery and lack of reminders to reschedule missed appointments and to complete diabetes testing as indicators that their physicians were not concerned about their diabetes risk.

      Conclusions

      Among hard-to-reach women, multiple demands on their time were common explanations for not receiving a postpartum diabetes test. Consistent messages regarding long-term diabetes risk during pregnancy, access to postpartum primary care and convenient lab appointments, and systematic reminders to providers and patients are approaches that, in combination, may influence more resistant women to test.
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      Biography

      Kathryn A. Paez, RN, PhD, is a principal researcher in Health Policy and Research at the American Institutes for Research. Her research interests concern improving quality of care and access to care to improve population health.

      Biography

      Emma M. Eggleston, MD, MPH, is an instructor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute. Her clinical and research interests are in diabetes, pregnancy, and vascular disease.

      Biography

      Susan J. Griffey, DrPH, BSN, directs the Evaluation Center at Social & Scientific Systems. She researches public health interventions and programs in the US and in global development settings in primary and reproductive health care, HIV/AIDS, and chronic diseases.

      Biography

      Brandy Farrar, PhD, is a researcher in Health Policy and Research at the American Institutes for Research. The majority of Ms. Farrar's research involves evaluating the effectiveness, viability, and impact of innovative programs designed to improve quality, access, and capacity of health care services.

      Biography

      Jacquelyn Smith, MA, is a senior survey manager at Social & Scientific Systems. She applies her 20 years of experience in survey methodology and survey operational management to numerous public health studies in both acute and chronic disease topics.

      Biography

      Jennifer Thompson, MPP, is a project manager in the Obesity Prevention Program in the Department of Population Medicine at the Harvard Pilgrim Health Care institute and Harvard Medical School. Her projects focus on diabetes, early childhood nutrition, and obesity.

      Biography

      Matthew Gillman, MD, SM, is a Professor and Director of the Obesity Prevention Program, which seeks to lessen the burden of obesity and its consequences, in the Department of Population Medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School.