Title: Pre-conception care for women with type 1 or type 2 diabetes: What are the facilitators and barriers to uptake?
Funder: Department of Health (England)

Abstract: Design: This study will adopt a mixed-methods qualitative approach to gain a better understanding of the views of women staff and stakeholders on the facilitators and barriers to the uptake of pre-conception care. This design will ensure that the views of service users are at the centre of the research and will allow meaningful data to emerge that can be used to understand how pre-conception care could be provided to optimise uptake and outcomes.Settings: Sandwell and West Birmingham CCG and Heartlands Hospital in Birmingham (including the diabetes care team diabetes midwifery services and pre-conception clinics) will be used to access service users staff and stakeholders. Both sites will reflect the diversity of service users in terms of age ethnicity socio-economic status and diabetes type. Literature review strategy: A systematic review of the descriptive literature will be undertaken using the method of meta-summary (Thorne at al 2004). Using constant comparison (Lincoln and Guba 1985) emerging codes and themes will be explored to identify what is already known on the facilitators and barriers to the uptake of pre-conception care. This method will also identify gaps in knowledge.Target population: Women with pre-existing diabetes of childbearing age.Inclusion/Exclusion criteria:Inclusion:•Nulli- primi- and multiparous women with pre-existing diabetes of childbearing age who have accessed pre-conception care in the past 3 years and those that have not.•Staff who provide pre-conception care and other stakeholders (GPs nurses midwives specialist nurses diabetes consultants community pharmacists and obstetricians).Exclusion:•women with diagnosed mental health issues •women <16 and >45.Health technologies: This project focuses on pre-conception care for women with pre-existing diabetesTimetable: The project will consist of five phases (with phase overlap as necessary): I – literature review (4 months); II – guided one-to-one interviews with women (7 months); III – focus groups with women (3 months); IV – guided one-to-one interviews with staff/stakeholders (5 months); V – dissemination and output preparation (3 months).Sample size:Phase II: 10 women who have accessed pre-conception in primary care and 10 that have accessed the service in secondary care (5 in each group with type 1 diabetes and 5 with type 2); 20 women who have not accessed pre-conception care drawn from the primary care setting (total n40).Phase III: 4 focus groups with 10 women each – sampling to be determined following phase II (total c. 40 women)Phase IV: 20 individuals from across professional roles (between 2 and 3 of each role will be selected)The team: The multidisciplinary team will include up to 4 service users. Academic and methodological expertise is provided by PI and Co-A Earle and Lloyd who bring expertise of qualitative methodologies descriptive review and experience of conducting research in reproduction and diabetes. Clinical and research expertise from primary and secondary care settings is provided by Co-A’s Gill Karamat and Webb. Gill is a GP and experienced primary care researcher. Karamat is a Consultant Physician with research experience and specialist expertise in the provision of diabetes services in secondary care. Webb is Lead Diabetes Specialist Nurse in the Diabetes Endocrinology Centre at Heartlands Hospital Birmingham and has practice experience of pre-conception care.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.3 MANAGEMENT AND DECISION MAKING
Health categories: METABOLIC AND ENDOCRINE