Barriers and Facilitators of Adherence to Anti-Diabetic Therapy in Pregnant Women with Diabetes: Health Care Workers’ Perspectives

Global prevalence of hyperglycaemia in pregnancy inwomen of 20 - 49 years was estimated to be 16.9% and affecting 21.4 million livebirths, in 2013, 90% of which occurred in developing countries. The cornerstoneof anti-diabetic therapy is diet, physical activity and medications. The studyutilized a qualitative descriptive design using key informant interviews fromAugust 2016 to November 2016 to explore challenges of adherence toanti-diabetic therapy in pregnant women with diabetes at a central hospital inHarare, Zimbabwe. Permission to conduct the study was obtained from therespective local and national ethical review boards. All participants gaveverbal and written informed consent. A sample of eight key informants directlyinvolved in the care of pregnant women with diabetes was purposively selectedfor key informant interviews. Key informants should have worked with diabeticpregnant women for at least one year. Sample size was determined by data saturation.Interviews followed a semi structured questionnaire that had sections on theburden of diabetes in pregnancy, challenges of adherence, challenges inmanagement and possible solutions to challenges faced. All interviews wereconducted in a private room. Detailed notes were taken during the interviewswhich were also being audiotaped. Trustworthiness was achieved by observingcredibility, dependability, transferability and confirmability. Thematic analysiswas done. Thematic analysis was done manually. The stages of data analysisfollowed were data organization, familiarization, transcription, coding, developing a thematic framework, indexing,displaying and reporting. Major themes identified were barriers andfacilitators of adherence to anti-diabetic therapy. Categories under barrierswere financial barriers, lack of health education, lack of trained personnel,shortage of staff and lack of collaboration among practitioners. Categoriesunder facilitators of adherence were subsidizationof care, formal training of professionals, promoting collaboration andestablishment of a unit dedicated to the care of pregnant women with diabetes.Barriers and solutions identified should be utilized todevelop frameworks to promote adherence to anti-diabetic therapy incidence ofadverse perinatal outcomes.