Diabetes in pregnancy: Women's views of care in a multi-ethnic, low socioeconomic population with midwifery continuity-of-care.

BACKGROUND: Diabetes in pregnancy is diagnosed in 6% of pregnancies annually in Aotearoa-New Zealand, disproportionately affecting multi-ethnic, low socio-economic women. Little is known about the care experience of this population within the model of midwifery continuity-of-care, including views of telehealth care. AIM: Increase understanding of the experience of diabetes in pregnancy care, including telehealth, among multi-ethnic, low socio-economic women receiving midwifery continuity-of-care. METHODS: Qualitative interview study with primarily indigenous and migrant women who had diabetes in pregnancy and gave birth 6-18 months previously. Interviewers were matched with participants by ethnicity. Transcripts were analysed using Framework analysis. RESULTS: Participants were 19 women (5 Maori, 5 Pacific Peoples, 5 Asian, 4 European). Data analysis revealed three key themes: 1) 'shock, shame, and adjustment' to the diagnosis 2) 'learning to manage diabetes in pregnancy' and 3) 'preparation for birth and beyond' to the postpartum period. DISCUSSION: Receiving the diagnosis of diabetes in pregnancy was a shock. Managing diabetes during pregnancy was particularly challenging for indigenous and migrant women, who wished for better access to culturally appropriate dietary and lifestyle information. Women appreciated having options of telehealth and face-to-face consultations. Preparation for birth and postpartum diabetes follow-up were areas requiring significant improvement. Challenges were mitigated through care from a consistent diabetes specialist midwife and community-based midwifery continuity-of-care. CONCLUSION: Midwives were the backbone of diabetes in pregnancy care for this multi-ethnic, low socio-economic population. Care could be improved with more culturally appropriate diet and lifestyle information, better birth preparation, and expanded postpartum diabetes support.

Patients' and clinicians' views on shared decision making in cancer care: a qualitative study of Aotearoa New Zealand patients' and clinicians' perspectives.

AIMS: Oncology stakeholders' view on shared decision making (SDM) in Aotearoa New Zealand is not well described in the literature. This study aimed to explore the perspectives of patients, clinicians and other cancer care stakeholders on shared decision making, and how and why shared decision making in cancer care can be viable and appropriate for patients and healthcare providers. METHODS: Non-random, purposive sampling, combined with advertisement and snowball recruitment identified patient, whanau and healthcare provider participants for qualitative interviews. One-hour, semi-structured interviews were conducted to elicit perspectives on SDM. Data was analysed using Directed Content Analysis. RESULTS: Thirty-one participants were interviewed. SDM conceptualisations primarily concerned the sharing of information. Participants' stories highlighted patients' and whanau willingness to participate in making decisions about their care, to hold authority in this process, and to have their needs and preferences considered beyond the biomedical model. Patients and clinicians identified a range of factors moderating the extent of SDM, creating a gap between SDM expectations and practice. CONCLUSIONS: These data highlight the complexity of information needs in cancer care, and the discrepancy between patients' and their whanau and clinicians' views. This study increases our understanding of cancer stakeholders' expectations of SDM by highlighting various views on the meaning of SDM, informational needs and decision making engagement level. These findings can aid clinicians in creating space for patients to exercise their right to self-determination/rangatiratanga of health and wellbeing. Future work should explore approaches and implementations of SDM to facilitate an equitable experience of cancer care.

Teleclinics for the management of diabetes in pregnancy during COVID-19-maternal satisfaction and pregnancy outcomes.

AIMS: Diabetes in pregnancy (DiP) rates are increasing worldwide. Pasifika, Indian and Maori peoples have high rates of DiP any improvements in clinical care may be beneficial for these populations. During COVID-19 lockdowns, the DiP service in Counties Manukau Health (CMH) South Auckland switched from face-to-face appointments to teleclinics. This study aims to: determine satisfaction of pregnant people with teleclinics for DiP; compare clinical outcomes and attendance for those receiving care through teleclinics versus standard care; and compare rates of clinic attendance between face-to-face and teleclinic appointments. METHODS: A standardised questionnaire was completed by those who had attended a teleclinic. The primary outcome was a high score (4-5/5) for satisfaction and future use. A separate, retrospective study of clinical outcomes, and the number of appointments scheduled/attended were compared between all DiP patients who were scheduled an appointment during lockdown, and all of those who were scheduled appointments the year prior. RESULTS: Of the thirty-five participants who completed the survey (response rate 37%), 89% scored the clinic highly for satisfaction and future use. There were 179 patients scheduled to clinic during the period where teleclinics were the default model of care, and 187 patients scheduled to clinic the year prior. No differences in clinical outcomes were observed. Those receiving care during lockdown were offered more appointments, although attendance rates did not differ. CONCLUSION: Teleclinics for DiP are acceptable to the people we surveyed, but should be developed further so they better support the needs of those using them.

Measuring health consumers' engagement at the governance level: development and validation of the Middlemore Consumer Engagement Questionnaire.

AIM: To develop and validate a questionnaire to measure health CE at governance level. METHOD: This study used qualitative and quantitative methods (including focus groups, cognitive interviews and an international survey), and consisted of two phases. In Phase 1, an initial list of items was generated and refined with feedback from health consumer representatives. In Phase 2, a draft survey was distributed to n=227 consumers from New Zealand, Australia and Canada. The benefit and relevance of using the questionnaire was explored through face-to-face interviews with five CE leaders from New Zealand healthcare organisations. RESULTS: The proposed questionnaire comprises 25 statements relating to CE. Respondents indicate their level of agreement with the statements on a five-point Likert-type scale. Focus group and cognitive interview participants found the questionnaire relevant and easy to understand. The questionnaire scores correlated with the PPEET, another instrument measuring consumer engagement, and showed excellent internal consistency (Cronbach's alpha=0.97), unidimensionality and test-retest reliability (r=0.84). CONCLUSION: The proposed questionnaire measures CE at governance level and can be used for international comparisons and benchmarking. It showed sound psychometric properties and its value and relevance was recognised by health consumer representatives and leaders with CE roles in New Zealand healthcare organisations.