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| Subtheme | Facilitator/barrier | Quotes |
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| Theme 1: guidelines and resources |
| — | Facilitator | “We use NDSS (National Diabetes Services Scheme) a lot for our general information. And ADIPS would be our biggest resource” (F-dietitian—52 yrs).
“Australian guidelines for gestational diabetes and counting carbohydrates, so around 30-45 grams of carbohydrates per main meal, 15-30 grams carbohydrates for a snack” (M-diabetes educator—53 yrs). |
| Barrier | “Those resources, they are developed by us [hospital], so they are our own resources that we created over the years….some of them are more just nutrition in pregnancy rather than specifically for gestational diabetes” (M-diabetes educator—53 yrs).
“I think it’s the diabetes nurse, or it could be the allied health assistance who puts together the packs” (F-diabetes educator—37 yrs).
“We’ve only got a narrow selection of interpreted resources….we have got that interpreted in three languages…in Chinese, Vietnamese and Arabic” (F-dietitian—32 yrs).
“…when I get a non-English speaking going my clinic, I look for the…[notes indicating her] language and quite often there is not that particular language on there” (F-diabetes educator—37 yrs). |
| Theme 2: dietary intervention |
| Culturally suitable advice | Facilitator | “I guess having an understanding of what cultural foods they might be having and then what carbohydrate content is in those foods…Indian background women will be having roti, chapati and that kind of stuff…” (F-dietitian—28 yrs).
“A good dietitian uses foods that they like and does not try to change their whole diet because then they’ll say this is too hard…” (F-dietitian—24 yrs). |
| Barrier | “…cultural background is very difficult, I’m from an Italian background and if your say no to eating a big plate of pasta you are offending” (F-dietitian—33 yrs).
“Cultural foods are very different to what our dieticians are used to…[they] have more difficulties making those adjustments” (M-diabetes educator—53 yrs). |
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| Restrictive eating | Barrier | “They feel a lot…of stress, and…need to…try and get these perfect sugar levels, they can put a lot of stress on themselves and feel a lot of guilty if they are not getting the numbers that they want” (F-diabetes educator—30 yrs).
“I think some women might be quite carb restrictive and so that’s why their sugar levels are appearing to all to be in normal range and babies measuring really quite small” (F-diabetes educator—30 yrs).
“…we do find that cut out all carbohydrates completely and then it’s really about re-educating and reinforcing” (F-dietitian—28 yrs). |
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| Insulin | Facilitator | “They can tend to find starting insulin a relieving experience because they start eating more and feeling more nourished…they see numbers that they want…” (F-diabetes educator—30 yrs).
“…if they have had insulin and things before that…I think they are just more aware of things and less anxious” (F-diabetes educator—39 yrs). |
| Barrier | “…depends on the women, if they are doing all of the recommended recommendation with diet and lifestyle… that’s when we have to go on medication” (M-diabetes educator—53 yrs).
“Some women expressed to me that they do not want to go on medication as well in the fear of medication” (F-dietitian—27 yrs).
“You’ll notice that they need to be on insulin, but they have not been contacting the diabetes educators to report their levels” (F-dietitian—28 yrs). |
| Theme 3: management delivery |
| Adequacy of appointment sessions | Facilitator | “It’s not so much timing, we have got plenty of time to go through that with them” (F-diabetes educator—29 yrs).
“I would say at least 45 minutes up to an hour if there’s lots of questions” (F-dietitian—32 yrs).
“I feel so because they get at least a minimum of weekly phone contact where we are able to actually follow up questions and ask so…they are getting quite regular contact with access to diabetes education” (F-diabetes educator—30 yrs). |
| Barrier | “…we see them in three to four weeks, the high BMIs. If they are in early diagnosis, we try and see them within about six weeks…” (F-dietitian—28 yrs).
“We do not even have spots. We’re meant to see these ladies within a week that are high risk and often we cannot even get them in within a week…” (F-diabetes educator—37 yrs).
“Not every English-speaking girl gets offered a review, the review is only after their sugars are high” (F-dietitian—32 yrs).
“No, it does not meet the Australian guidelines for what we should be doing in terms of follow up by any means, we are nowhere near it. And I do not think it meets the needs” (F-dietitian—27 yrs).
“We do not have any set routine for how much. Not everyone gets a follow-up, so it’s only if we feel that they need it” (F-dietitian—33 yrs).
“We have two pathways, if English speaking it is the group. If you are non-English speaking it is one-to-one” (F-dietitian—52 yrs). |
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| Delivery mode and resources | Facilitator | “We just speak and try and make it as interactive as we can…we try and not just have it as a PowerPoint and try and make it interactive” (F-dietitian—28 yrs).
“We have activities throughout as well, so a number of quizzes particularly covering blood sugar levels and what we are aiming for…we also have an activity about label reading” (F-dietitian—27 yrs). |
| Barrier | “…I’ll only get up to half, a quarter of the way through the education and I’ll see…that they are glazing over they are …just completely disengaged I’ll say” (F-dietitian—28 yrs). |
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| Individualised lifestyle counselling | Facilitator | “I sort of asked them how best do you learn? How can I accommodate what you need from this session” (F-diabetes educator—37 yrs).
“It’s just a more personalized approach, so you can go through their specific diet…you can count their carbohydrates….and personalize the plan” (F-dietitian—32 yrs). |
| Barrier | “We try to be as, I guess as holistic as possible, but sometimes need to rein it in to just the gestational diabetes issues” (F-dietitian—32 yrs).
“You just do not have the time and it’s really sad that you feel rushed…you have gotta keep reminding yourself that this is a patient who has a problem” (F-diabetes educator—37 yrs). |
| Theme 4: communication |
| Teamwork | Facilitator | “…We can email the obstetric medicine staff if we need to. We have our endocrine registrar who also helps us. And some of the key midwives in the clinic…the dietitian, if there’s a question or someone wants to be referred for an individual session” (F-diabetes educator—50 yrs).
“We are very much multidisciplinary team here…we work with the diabetes nurse educators…midwives…the diabetes educators and dietitians work pretty alongside each other” (F-dietitian—33 yrs). |
| Barrier | “I mean, I suppose sometimes you have got so many people who are involved and so people are always giving advice mostly from their professional perspective. But you are not getting that whole collaborative all in one go kind of…you miss things that are going on” (F-diabetes educator—30 yrs).
“Probably the obstetric team, because they will just do the OGTT and refer to us, often the patients that get referred to us either have not been told they have got gestational diabetes, or they have got no understanding of what happens next” (F-dietitian—52 yrs).
“The doctors lack of awareness on what is an appropriate BGL target for someone who is pregnant with GDM, not someone who is type 2 and not pregnant” (F-dietitian-32 yrs). |
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| Communication with patients | Facilitator | “Informing them and then feeling like [they are] empowered to self manage” (F-diabetes educator—39 yrs).
“Sometimes it’s just explaining why we are here.…” (F-diabetes educator—30 yrs). |
| Barrier | “There’s just been times where they have come to an appointment, but they are just not in the place where they can take on any real information. So, in those times I might just sit with them and chat about things generally to see how they are going” (F-dietitian—28 yrs).
“We go through two companies for interpreting but sometimes we have interpreters where their English is so poor that I do not even know if they are interpreting what I am saying to a patient” (F-dietitian—52 yrs).
“The interpreters might be on their phone, or not interpreting properly” (F-dietitian—52 yrs). |
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