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Table 1 Barriers to implementing healthcare according to local guidelines for women during and after a pregnancy complicated by diabetes in regional and remote Australia, identified in formative work with healthcare professionals and stakeholders

From: Improving systems of care during and after a pregnancy complicated by hyperglycaemia: A protocol for a complex health systems intervention

System factors

Lack of clarity around roles of healthcare providers in administering diabetes screening tests and providing follow-up care in the postpartum period

Insufficient involvement of medical specialists

Disjointed communication pathways between hospital and primary care

Inconsistent access to electronic health records

Reliance on handheld medical record, which women may not bring to appointments

Siloed approaches to provision of care

High staff turnover

Small Aboriginal health workforce

Lack of systematic processes for referrals

Unavailability of transport for women to attend for postpartum care

Reported low numbers of women presenting for preconception counselling

Requirement for many women to travel large distances to access care, with reluctance to leave other children behind

Long waiting times at hospital clinics

Healthcare practitioner factors

Inconsistency in use of local guidelines

Low health practitioner confidence in delivering care

Lack of consistency of practitioner knowledge regarding criteria for screening for hyperglycaemia in early pregnancy

Patient factors

Prioritising needs of family over women’s own postpartum health

Low perceived future risk of T2DM amongst women

Limited time or motivation for women to attend for postpartum care