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

Abstract

OBJECTIVE: To identify successes to date and opportunities for improvement in the implementation of a complex health systems intervention aiming to improve antenatal 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 45 participants, including clinicians; regional policymakers and managers; and study implementation staff. RESULTS: Interviewees reported the early phase of the intervention had resulted in 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 development of a communication and engagement strategy.