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Abstract：
BACKGROUND: Pregnancies in women with diabetes are associated with significant additional risks for the fetus, infant and mother such as, higher risk of stillbirths or congenital anomalies. Pre-pregnancy care can attenuate these risks. However, while women with Type 2 diabetes account for half of pregnancies in women with pre-existing diabetes, they are much less likely to receive pre-pregnancy care than women with Type 1 diabetes. This discrepancy may be related to the fact that most pre-pregnancy care is located in specialist diabetes centres where women with Type 1 diabetes are managed; whereas women with Type 2 diabetes are managed in primary care and reproductive care is not a routine element of diabetes care. Therefore, to improve pre-pregnancy care among women with Type 2 diabetes strategies need to be tailored to the specific needs of this group and the context of their diabetes care.
OBJECTIVE: This paper seeks to inform the development of an integrated pre-pregnancy care programme by presenting strategies identified by women with Type 2 diabetes and healthcare professionals that address some of the barriers they experience in relation to pre-pregnancy care.
METHODS: A qualitative study using semi-structured in-depth interviews with women of reproductive age with Type 2 diabetes (n=30) and diabetes healthcare professionals (n=22) from both primary and secondary care. Data were transcribed verbatim and analysed thematically using Framework Analysis. The identified themes were then mapped to create a theoretical intervention framework using Normalisation Process Theory and the Capabilities, Opportunity, and Motivation to perform a Behaviour model.
RESULTS: Six themes were identified expressing the need for a multimodal approach for improving the uptake of pre-pregnancy care in women with Type 2 diabetes. These themes were then mapped onto the constructs of Normalisation Process Theory as follows: coherence (enhancing understanding of reproductive needs among women and healthcare professionals); cognitive participation (constructing a positive narrative for pregnancy and Type 2 diabetes); collective action (increasing the visibly of the reproductive needs of women, integrating healthcare systems and utilising supportive technologies); and reflexive monitoring (using multi-modal approaches to support systemised care). The data were also modelled to identify target behaviours for intervention detailing what needs to be done by whom, when and where.
CONCLUSIONS: Women with Type 2 diabetes account for half of pregnancies in those with pre-existing diabetes; however, they are less likely to receive pre-pregnancy care than women with Type 1 diabetes. Pre-pregnancy care can reduce the maternal and fetal risks associated with Type 2 diabetes. This study presents strategies to improve the current low uptake of pre-pregnancy care for women with Type 2 diabetes. These strategies have been tailored to the specific needs of women and healthcare professionals and support integration within the woman\'s routine diabetes management.
OBJECTIVE: This paper seeks to inform the development of an integrated pre-pregnancy care programme by presenting strategies identified by women with Type 2 diabetes and healthcare professionals that address some of the barriers they experience in relation to pre-pregnancy care.
METHODS: A qualitative study using semi-structured in-depth interviews with women of reproductive age with Type 2 diabetes (n=30) and diabetes healthcare professionals (n=22) from both primary and secondary care. Data were transcribed verbatim and analysed thematically using Framework Analysis. The identified themes were then mapped to create a theoretical intervention framework using Normalisation Process Theory and the Capabilities, Opportunity, and Motivation to perform a Behaviour model.
RESULTS: Six themes were identified expressing the need for a multimodal approach for improving the uptake of pre-pregnancy care in women with Type 2 diabetes. These themes were then mapped onto the constructs of Normalisation Process Theory as follows: coherence (enhancing understanding of reproductive needs among women and healthcare professionals); cognitive participation (constructing a positive narrative for pregnancy and Type 2 diabetes); collective action (increasing the visibly of the reproductive needs of women, integrating healthcare systems and utilising supportive technologies); and reflexive monitoring (using multi-modal approaches to support systemised care). The data were also modelled to identify target behaviours for intervention detailing what needs to be done by whom, when and where.
CONCLUSIONS: Women with Type 2 diabetes account for half of pregnancies in those with pre-existing diabetes; however, they are less likely to receive pre-pregnancy care than women with Type 1 diabetes. Pre-pregnancy care can reduce the maternal and fetal risks associated with Type 2 diabetes. This study presents strategies to improve the current low uptake of pre-pregnancy care for women with Type 2 diabetes. These strategies have been tailored to the specific needs of women and healthcare professionals and support integration within the woman\'s routine diabetes management.
摘要：
背景：糖尿病妇女的怀孕与胎儿的重大额外风险有关，婴儿和母亲，如，死产或先天性异常的风险较高。孕前护理可以减轻这些风险。然而,虽然患有2型糖尿病的女性占先前患有糖尿病的女性怀孕的一半，与1型糖尿病女性相比，她们接受孕前护理的可能性要小得多。这种差异可能与以下事实有关：大多数孕前护理都位于糖尿病专科中心，对1型糖尿病妇女进行管理；而2型糖尿病妇女则在初级保健中进行管理，生殖护理不是糖尿病护理的常规内容。因此,为了改善2型糖尿病女性的孕前保健策略,需要根据该群体的具体需求和糖尿病护理的背景进行调整.
目的：本文旨在通过提出由2型糖尿病妇女和医疗保健专业人员确定的策略来解决他们在孕前护理方面遇到的一些障碍，从而为综合孕前护理计划的发展提供信息。
方法：一项定性研究，采用半结构化的深度访谈方法，对2型糖尿病育龄妇女（n=30）和来自初级和二级保健的糖尿病保健专业人员（n=22）进行访谈。数据被逐字转录，并使用框架分析进行主题分析。然后将确定的主题映射为使用规范化过程理论和能力创建理论干预框架，机会,和执行行为模型的动机。
结果：确定了六个主题，表明需要采用多模式方法来改善2型糖尿病妇女的孕前护理。然后将这些主题映射到标准化过程理论的结构中，如下所示：连贯性（增强妇女和医疗保健专业人员对生殖需求的理解）；认知参与（为怀孕和2型糖尿病建立积极的叙述）；集体行动（增加妇女的明显生殖需求，整合医疗保健系统并利用支持性技术）；和反身监测（使用多模式方法支持系统化护理）。还对数据进行了建模，以确定干预的目标行为，详细说明需要由谁来做什么，何时何地.
结论：患有2型糖尿病的女性占先前患有糖尿病的孕妇的一半；然而，与1型糖尿病女性相比，她们接受孕前护理的可能性较小。孕前护理可以降低与2型糖尿病相关的母体和胎儿风险。这项研究提出了改善目前2型糖尿病妇女孕前护理低摄取的策略。这些策略是根据女性和医疗保健专业人员的具体需求量身定制的，并支持女性常规糖尿病管理中的整合。
目的：本文旨在通过提出由2型糖尿病妇女和医疗保健专业人员确定的策略来解决他们在孕前护理方面遇到的一些障碍，从而为综合孕前护理计划的发展提供信息。
方法：一项定性研究，采用半结构化的深度访谈方法，对2型糖尿病育龄妇女（n=30）和来自初级和二级保健的糖尿病保健专业人员（n=22）进行访谈。数据被逐字转录，并使用框架分析进行主题分析。然后将确定的主题映射为使用规范化过程理论和能力创建理论干预框架，机会,和执行行为模型的动机。
结果：确定了六个主题，表明需要采用多模式方法来改善2型糖尿病妇女的孕前护理。然后将这些主题映射到标准化过程理论的结构中，如下所示：连贯性（增强妇女和医疗保健专业人员对生殖需求的理解）；认知参与（为怀孕和2型糖尿病建立积极的叙述）；集体行动（增加妇女的明显生殖需求，整合医疗保健系统并利用支持性技术）；和反身监测（使用多模式方法支持系统化护理）。还对数据进行了建模，以确定干预的目标行为，详细说明需要由谁来做什么，何时何地.
结论：患有2型糖尿病的女性占先前患有糖尿病的孕妇的一半；然而，与1型糖尿病女性相比，她们接受孕前护理的可能性较小。孕前护理可以降低与2型糖尿病相关的母体和胎儿风险。这项研究提出了改善目前2型糖尿病妇女孕前护理低摄取的策略。这些策略是根据女性和医疗保健专业人员的具体需求量身定制的，并支持女性常规糖尿病管理中的整合。
