ORCID Profile
0000-0003-0866-4365
Current Organisations
Royal College of Physicians of Edinburgh
,
Royal College of General Practitioners
,
Royal Australian College of General Practitioners
,
Deakin University
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Publisher: Wiley
Date: 08-09-2022
DOI: 10.1111/DME.14945
Abstract: Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from erse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability , Opportunity , Motivation‐Behaviour (COM‐B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from erse cultural backgrounds with prior GDM and identify relevant intervention components. Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive–deductive model, themes were mapped to the TDF and COM‐B model. After screening 5148 citations and 139 full texts, we included 35 studies ( N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence‐based recommendations for communications to support behaviour change. We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from erse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.
Publisher: Oxford University Press (OUP)
Date: 18-09-2022
Abstract: Shared medical appointments (SMAs) may help mitigate some of the barriers for managing obesity in primary care. The primary aim of this systematic review was to measure the effect of weight loss SMAs. Systematic searches using keywords and Medical Subject Headings for overweight, obesity, and SMAs were conducted in the CENTRAL, Medline Complete, PsycINFO, Scopus, CINAHL, EMBASE, and Web of Science databases with no date limits. Risk of bias was assessed using the Effective Health Practice Project Quality Assessment Tool for Quantitative Studies. Fifteen studies involving weight loss SMAs in adults and children were identified. Six studies had controls. Inconsistency in reporting weight loss or weight change in controlled studies meant that data could not be pooled for meta-analysis. Results from in idual studies indicated that SMAs can support adult patients to achieve significant weight loss. Women and older adults were more likely to take up SMA invitations. Results from the 5 studies involving children were less conclusive. Studies involving participants of a higher socioeconomic status tended to report lower attrition than studies involving participants who experienced disadvantage. These findings should be interpreted with caution as all but 1 included study was assessed as being weak in quality. Overall, SMAs may be of benefit to address obesity in primary care, particularly for women and older adults. Appropriately designed prospective and controlled studies are required to engage their target audience and to assess whether SMAs are superior to other weight loss options in primary care.
Publisher: MDPI AG
Date: 24-04-2019
DOI: 10.3390/NU11040922
Abstract: Weight gain after childbirth is a significant risk factor for type 2 diabetes (T2DM) development after gestational diabetes mellitus (GDM). The level of weight loss achieved in diabetes prevention programs for women after GDM is often low but its effects on the cardiometabolic risk are not known. In a secondary analysis of a diabetes prevention program in postpartum women with history of gestational diabetes, we evaluated the effect of weight change on the cardiometabolic outcomes at 1-year follow-up. Of the 284 women randomized to the intervention arm, 206 with the final outcome measurements were included in the analyses. Participants were categorized into weight loss ( kg, n = 74), weight stable (±2 kg, n = 74) or weight gain ( kg, n = 58) groups. The weight loss group had significantly greater decrease in glycated hemoglobin (HbA1c) than the weight gain group (−0.1 + 0.4% vs. 0 + 0.4%, p = 0.049). The weight loss group had significantly greater decrease in total cholesterol and low-density lipoprotein cholesterol cholesterol than the other two groups (p 0.05). The weight gain group had significantly greater increase in triglyceride and triglyceride:high-density lipoprotein cholesterol ratio compare with the other groups (p 0.01). Overall, a small amount of weight loss and prevention of further weight gain was beneficial to the cardiometabolic outcomes of postpartum women after GDM.
Publisher: Public Library of Science (PLoS)
Date: 08-08-2018
Publisher: Wiley
Date: 12-2019
DOI: 10.1111/AJR.12594
Publisher: Wiley
Date: 16-01-2022
DOI: 10.1111/DME.14772
Abstract: Women with prior gestational diabetes have nearly 10 times the risk of developing type 2 diabetes. Postpartum screening for type 2 diabetes is recommended for early diagnosis and management, yet uptake is low. This work updates a previous systematic review and advances it through the application of the Theoretical Domains Framework (TDF) to synthesise personal‐level factors impacting type 2 diabetes screening and the Capability, Opportunity, Motivation‐Behaviour model (COM‐B), to develop messaging recommendations for use in clinical practice and screening promotion interventions. We searched seven academic databases from September 2017 (prior review) to April 2021, reference lists and grey literature. Two reviewers independently screened articles against inclusion criteria (qualitative studies exploring factors impacting postpartum diabetes screening, any language) and extracted data. Using an inductive‐deductive model, we coded determinants to the TDF and mapped onto the COM‐B model. We identified 38 eligible papers from 34 studies ( N = 1291 participants). Most (71%) reported s le sizes of N ≥ 16. The ratio of barriers to enablers was three to one. Eight key TDF domains were identified. Evidence‐based recommendations include addressing knowledge, risk perception, fear of diabetes diagnosis, low prioritisation of personal health and fatalism. The risk of bias was low and confidence in findings was moderate to high. A limitation was conceptual overlap between TDF domains, which we addressed via the study procedure. The theoretical categorisation of determinants enables the development of messaging and interventions at the personal level, to promote women's uptake of postpartum type 2 diabetes screening.
Publisher: Public Library of Science (PLoS)
Date: 26-07-2016
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.DIABRES.2017.02.026
Abstract: To explore the acceptability of a telephone- or a group-delivered diabetes prevention program for women with previous gestational diabetes and to compare the characteristics associated with program engagement. Postpartum women participated in a lifestyle modification program delivered by telephone (n=33) or group format (n=284). Semi-structured interviews on barriers and enablers to program engagement (defined as completing≥80% sessions) were conducted before (Group) and after (Group and Telephone) interventions. The Health Action Process Approach theory was used as the framework for inquiry. Psychological measures were compared between engagement subgroups before and after group-delivered intervention. In the telephone-delivered program 82% participants met the engagement criteria compared with 38% for the group-delivered program. Engaged participants (Group) had significantly higher risk perception, outcome expectancy, and activity self-efficacy at baseline (P<0.05). There was a greater decrease in body weight (-1.45±3.9 vs -0.26±3.5, P=0.024) and waist circumference (-3.56±5.1 vs -1.24±5.3, P=0.002) for engaged vs non-engaged participants following group program completion. Telephone delivery was associated with greater engagement in postpartum women. Engagement was associated with greater reduction in weight and waist circumference. Further studies are required to confirm the effectiveness of telephone-delivered program for diabetes prevention in postpartum women.
Publisher: Oxford University Press (OUP)
Date: 12-04-2022
Abstract: The implementation of diabetes prevention for women with previous gestational diabetes (GDM) has been stymied by many barriers that are located within routine general practice (GP). We aimed to unpack the GP factors and understand the mechanisms that explain why a diabetes prevention intervention for this population succeeds or fails. We performed a mixed-methods study with a Normalization Process Theory framework that included clinical audits, semistructured interviews, and focus groups within mixed urban and rural primary care practices in Victoria, Australia. Staff of primary care practices and external support staff who provide services to women with previous GDM participated in a 12-month quality improvement collaborative intervention. We compared diabetes screening and prevention activity planning with the strategies and factors identified through a process evaluation of full-, moderate-, and low-active participating practices. The intervention doubled screening rates (26%–61%) and 1-in-10 women received a diabetes prevention planning consultation. Critical improvement factors were: mothers being seen as participants in the quality improvement work staff collectively building care strategies staff taking a long-term care of a community perspective rather than episodic service delivery and feedback processes being provided and acted on across the practice. The observable factors from the external perspective were: leadership by identified practice staff, reminder systems in action and practice staff driving the process collectively. Successful engagement in diabetes prevention for women with previous GDM requires proactive building of the critical improvement factors and audit feedback into routine GP.
Location: No location found
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
No related grants have been discovered for James Dunbar.