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 |