A H B C Schepman, M Sahgal, V Duwel, A G Posthumus, S E Siegelaar, R C Painter
The study highlights persistent challenges in communication, cultural adaptation, and continuity of care, while recognising existing strengths and ongoing efforts towards culturally inclusive and responsive practice. Our findings provide specific directions for improvement of care.
BACKGROUND: Gestational diabetes mellitus (GDM) healthcare is additionally challenging in the growing group of migrant women (MW) in the Western world, due to language and socioeconomic barriers, and lower healthcare utilisation, resulting in higher perinatal morbidity. Limited awareness among healthcare professionals (HCP) and a lack of care individualisation, compounded by time shortages and understaffing, hamper mutual understanding between caregiver and patient.
AIM: This qualitative study examines how multidisciplinary care addresses the needs of MW with GDM in southeast Amsterdam, the Netherlands. Combining patient and provider perspectives, it identifies discrepancies in expectations and cultural responsiveness, and makes recommendations for inclusive, culturally tailored practices to improve alignment and health outcomes.
METHODS: Women with GDM from non-Western migrant population attending the outpatient department of a Dutch tertiary obstetric hospital and two community midwifery clinics, along with GDM care providers from the same institutions were recruited. Semi-structured interviews explored MW needs and culturally tailored care. Inductive and deductive coding and exploratory analysis identified recurring themes in patient-provider alignments and misalignments.
FINDINGS: Interviews with 16 MW and 16 HCP revealed four themes: incomplete GDM understanding, self-management challenges, cultural responsiveness, and recommendations for practice change. Alignments included shared belief in GDM care and overall service satisfaction. Misalignments involved delayed diagnosis explanation, insufficiently tailored diet advice, limited translator use and lack of continuity in care.
CONCLUSION: The study highlights persistent challenges in communication, cultural adaptation, and continuity of care, while recognising existing strengths and ongoing efforts towards culturally inclusive and responsive practice. Our findings provide specific directions for improvement of care.