Date of Award

1-10-2024

Degree Type

Thesis

Degree Name

MS in Public Health

First Advisor

Dr. Romaina Iqbal

Second Advisor

Dr. Narjis Rizvi

Third Advisor

Dr. Batool Fatima

Department

Community Health Sciences

Abstract

Introduction: Diabetes is one of the prominent health issues globally, particularly in LMICs, where the burden of the disease is increasing rapidly, with current estimates indicating that approximately 529 million adults are living with diabetes globally. Among women in LMICs the number of cases of GDM has risen from about 14% in the early 2000s to as high as 28% in recent years. GDM has serious immediate as well as long-term consequences, including an increased risk of developing type 2 diabetes (T2DM), urinary incontinence, and cardiovascular disease for mothers, as well as macrosomia, birth trauma, and long-term obesity and diabetes for their children, which can be averted by adopting a healthy diet and improving physical activity. In Pakistan, timely diagnosis and effective management of GDM are critical but often it is affected by many barriers related to healthcare system, limited patient knowledge about glycemic control, and societal attitudes toward diabetes self-management. Improving the immediate and long-term outcome of GDM patients could be achieved by appropriate management strategies, including a strong focus on diet and physical activity.
Methodology: A qualitative exploratory descriptive (QED) study design with a deductive approach, as outlined by Braun and Clarke (2006), was employed using the Donabedian model as a guiding framework. The study evaluated the health facilities at the input (e.g., the availability of resources and facilities), process (e.g., the adequacy of dietary and physical activity counseling provided), and output (e.g., patient satisfaction and health improvements) related to the management of GDM to determine whether such critical areas are being attended to and to identify potential areas for improvement in service delivery. This research was conducted in five tertiary care hospitals in Karachi, Pakistan, between June 2024 and August 2024, to assess the quality of care given to women with GDM, concerning dietary and physical activity counseling. A purposive sampling strategy was used to recruit participants from selected hospitals. The study included two administrative heads, 16 healthcare providers (gynecologists, viii endocrinologists, dietitians, physiotherapists, and nurses), and 14 women with GDM, ensuring a comprehensive representation of perspectives across different levels of care. In-depth interviews (IDIs) were conducted with all participants using semi-structured interview guides based on guidelines from the Society of Obstetricians & Gynaecologists of Pakistan, 2021.
Findings: The findings of the study revealed various challenges at the input, process, and output levels and, therefore affect the quality of care provided to women with GDM specifically in the context of diet and physical activity. At the input level critical shortages of essential resources, unavailability of specialists like dietitians and physiotherapists, poor facilities for physical activity, and outdated educational materials were identified as major challenges. At the process level difficulties in scheduling appointments and lack of collaboration between health providers are serious barriers to care delivery. While at the output level patient satisfaction was observed to be low with many patients demonstrating low awareness of GDM, resulting in passive compliance and myths surrounding the severity of the disease.
Conclusion: This study provides critical insights into the patient experiences and healthcare practices in tertiary care settings regarding diet and physical activity advice to women with GDM which are deficient. Considering the importance of diet and physical activity counselling for reducing immediate and long-term consequences of GDM, it is important to ensure provision of good services in the tertiary care hospitals. The outcome of this research will likely be beneficial for the improvement of policies and guidelines formulated for the management of GDM. The outcomes of this research underscore the need to implement standardized dietary and physical activity protocols and establish dedicated exercise facilities for GDM patients. The findings of this research are expected to contribute to the improvement of policies and guidelines formulated for the management of GDM, ensuring better care and outcomes for affected women

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1

Last Page

80

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