Exploring healthcare delivery for women and people with diabetes in pregnancy in rural Australia

<p dir="ltr">Diabetes in pregnancy is a frequently occurring condition, with numerous potential adverse outcomes for parent and baby, if not managed appropriately. The management process is intensive, with guidelines indicating the involvement of multiple health professionals throughout the pregnancy, for those with gestational or pre-existing diabetes in pregnancy. There are additional challenges for people residing in rural areas to receiving the recommended care, due to the nature of healthcare resourcing in rural Australia. Current guidelines do not account for these deficits or the modifications that may be required when delivering care in rural Australia. The aim of this doctoral research was to investigate healthcare delivery for women with diabetes in pregnancy residing in rural areas, and to identify areas for improvement in this delivery.</p><p dir="ltr">Pragmatism was the theoretical paradigm underpinning this research, with a mixed methods approach used to answer the specific research questions. A four-level model of the healthcare system was used as the framework to understand the foundation of healthcare delivery for the target population. Following an initial systematic review to establish existing research findings, this doctoral research focused on obtaining the perspectives of two key stakeholder groups; people with a previous experience with diabetes in pregnancy (n=668), and health professionals involved in care delivery for people with diabetes in pregnancy (n=86). </p><p dir="ltr">This is the first body of work to specifically focus on overall healthcare delivery for people with diabetes in pregnancy in rural Australia. Comparisons of healthcare delivery between rural and metropolitan areas were made from the perspectives of both health professionals and people with previous diabetes in pregnancy. Both stakeholder groups identified key improvements to care delivery including: increased access to health professionals as part of rural care, and enhancing communication between both the members of the multidisciplinary healthcare team and with people with diabetes in pregnancy. Other factors highlighted included discrepancies in the implementation of guidelines for DIP and provision of service through the use of telehealth. Overall, this body of work provides the groundwork to identify the specific challenges for existing models of care for people with diabetes in pregnancy and to provide potential solutions for improving healthcare delivery for people with diabetes in pregnancy in rural Australia.</p>