ORCID Profile
0000-0003-1906-2431
Current Organisations
King's College London
,
King's College London - Waterloo Campus
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Publisher: Wiley
Date: 08-05-2023
DOI: 10.1111/DME.15105
Abstract: The aim of the study was to examine the content and impact of interventions that have been used to increase the uptake of pre‐pregnancy care for women with type 2 diabetes, and their impact on maternal and fetal outcomes. A systematic search of multiple databases was conducted in November 2021, and updated July 2022, to identify studies assessing interventions to enhance pre‐pregnancy care for women with type 2 diabetes. Over 10% of articles were screened by two reviewers at title and abstract phase, after which all selected full‐text articles were screened by two reviewers. Quality assessment was conducted using the Critical Appraisal Skills Programme checklist for cohort studies. Meta‐analysis was not possible due to study heterogeneity therefore, narrative synthesis was conducted. Four eligible cohort studies were identified. The conclusions able to be drawn by this review were limited as women with type 2 diabetes ( n = 800) were in the minority in all four studies (35%–40%) and none of the interventions were exclusively tailored for them. The uptake of pre‐pregnancy care was lower in women with type 2 diabetes (8%–10%) compared with other participant groups in the studies. Pregnancy preparation indicators generally improved among all groups exposed to pre‐pregnancy care, with varying impact on pregnancy outcomes. This review demonstrates that previous interventions have had a limited impact on pre‐pregnancy care uptake in women with type 2 diabetes. Future studies should focus on tailored interventions for improving pre‐pregnancy care for women with type 2 diabetes, particularly those from ethnic minorities and living in poorer communities.
Publisher: Springer Science and Business Media LLC
Date: 13-04-2022
DOI: 10.1186/S12875-022-01683-1
Abstract: The number of women of childbearing age with Type 2 diabetes(T2DM) is increasing, and they now account for 50% of pregnancies in women with pre-existing diabetes. Diabetes pregnancies without adequate pre-pregnancy care have higher risk for poor outcomes (miscarriages, birth-defects, stillbirths) and are associated with increased complications (caesarean deliveries, macrosomic babies, neonatal intensive-care admissions). The risks and costs of these pregnancies can be reduced with pregnancy preparation (HbA1c, ≤ 6.5%, 5 mg folic acid and stopping potentially harmful medicines). However, 90% of women with T2DM, most of whom are based in primary care, are not adequately prepared for pregnancy. This study will evaluate a programme of primary care-based interventions (decision-support systems pre-pregnancy care-pathways pregnancy-awareness resources professional training and performance monitoring) to improve pregnancy preparation in women with T2DM. The study aims to optimise the programme interventions and estimate their impact on pregnancy preparation, pre-pregnancy care uptake and pregnancy outcomes. To evaluate this multimodal intervention, we will use a multi-method research design following Complex Adaptive Systems (CAS) theory, refining the interventions iteratively during the study. Thirty GP practices with ≥ 25 women with T2DM of reproductive age (18–45 years) from two South London boroughs will be exposed to the intervention. This will provide 750 women with an estimated pregnancy incidence of 80–100 to study. The research involves: a clinical audit of processes and outcomes a process evaluation informing intervention feasibility, implementation, and behaviour change and a cost-consequences analysis informing future economic evaluation. Performance data will be collected via audits of GP systems, hospital antenatal clinics and pregnancy outcomes. Following CAS theory, we will use repeated measurements to monitor intervention impact on pregnancy preparation markers at 4-monthly intervals over 18-months. We will use performance and feasibility data to optimise intervention effects iteratively. The target performance for the intervention is a 30% increase in the proportion of women meeting pre-pregnancy care criteria. The primary output will be development of an integrated programme of interventions to improve pregnancy preparation, pre-pregnancy care uptake, and reduce adverse pregnancy outcomes in women with T2DM. We will also develop an implementation plan to support the introduction of the interventions across the NHS. ISRCTN47576591 February 8, 2022.
Publisher: Wiley
Date: 25-10-2022
DOI: 10.1111/JNU.12835
Abstract: A diagnosis of chronic illness posed a serious threat to people during the recent COVID‐19 pandemic. People with chronic illnesses were faced with increased mortality and reduced access to healthcare. Self‐care is the process of maintaining health and managing a chronic illness. Nurses working in specialist services provide healthcare education to people with chronic illnesses. Access to these nurses was decreased during periods of the COVID‐19 virus escalation due to the reconfiguration of services and redeployment of nurses. The purpose of the research was to learn from the experiences of people with a chronic illnesses in self‐care behaviors and accessing altered healthcare services to inform future practices. A population survey design. A mixed methods survey was designed, combining validated questionnaires and scales with open‐ended questions. A convenience s le was utilized via using social media platforms. Data analysis included descriptive and inferential statistics. Content analysis was used to analyze open‐ended responses. There were 147 responses, with approximately half reporting no changes in face‐to‐face healthcare contact, 41% reporting decreased contacts and 12% increased contacts. Non‐face‐to‐face contacts were reduced by almost 9%, did not change by almost 60%, while 33% indicated an increase. Participants reported mixed perceptions in contact with healthcare providers during restrictions. In the Patient Assessment of Chronic Illness Care and the Self‐Care of Chronic Illness scales, participants scored statistically lower scores than in previous studies. Participants indicated that public health restrictions negatively impacted their confidence, created challenges with re‐engaging and that access to care was more difficult. This research highlights the importance of providing continued support to people with chronic illness irrespective of other challenges to healthcare services. A structured approach to virtual self‐care education is required. This research concluded that the experience of access to one healthcare professional as opposed to erse multidisciplinary input was similar for a number of chronic illnesses groups of people during the COVID‐19 pandemic. There was an altered dynamic of virtual contacts with healthcare providers and a lack of confidence interpreting what monitoring was required by people with a chronic illnesses due to a lack of preparedness for virtual healthcare delivery.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: Ireland
No related grants have been discovered for Rita Forde.