title: Understanding why some women with a history of gestational diabetes do not get tested for diabetes.
abstract: BACKGROUND
  The proportion of women with previous gestational diabetes mellitus (GDM) receiving postpartum diabetes testing is far less than desired. Even in health care systems with high testing rates, some women remain untested. We explored what helps and what hinders women to obtain recommended testing.
  
  
  METHODS
  In this mixed methods study, we recruited 139 patients with a history of GDM in their most recent pregnancy (6 months to 4.5 years before study enrollment) from a delivery system that had instituted a quality improvement program to increase postpartum diabetes testing rates. We determined whether they had received a postpartum diabetes test according to American Diabetes Association guidelines. Using survey data, we ran logistic regression models to assess correlates of testing status, and we conducted in-depth interviews with 22 women to provide greater context to their survey responses.
  
  
  RESULTS
  Of the 139 women, 21 women (15%) did not complete recommended diabetes testing. From the survey data, women who visited a primary care provider had 72% (95% CI, 0.09-0.83) lesser odds of not having been tested. From the qualitative interviews, difficulty fitting testing around work and caregiver demands were the most common reasons for not testing. Untested women interpreted providers' reassurances that diabetes would resolve after delivery and lack of reminders to reschedule missed appointments and to complete diabetes testing as indicators that their physicians were not concerned about their diabetes risk.
  
  
  CONCLUSIONS
  Among hard-to-reach women, multiple demands on their time were common explanations for not receiving a postpartum diabetes test. Consistent messages regarding long-term diabetes risk during pregnancy, access to postpartum primary care and convenient lab appointments, and systematic reminders to providers and patients are approaches that, in combination, may influence more resistant women to test.
authors: Health Policy and Research, Health and Social Development, American Institutes for Research, Silver Spring, Maryland. Electronic address: kpaez@air.org.
authors: Kathryn A
authors: KA
authors: Paez
authors: Obesity Prevention Program, Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors: Emma M
authors: EM
authors: Eggleston
authors: Social & Scientific Systems, Inc., Silver Spring, Maryland.
authors: Susan J
authors: SJ
authors: Griffey
authors: Health Policy and Research, Health and Social Development, American Institutes for Research, Silver Spring, Maryland.
authors: Brandy
authors: B
authors: Farrar
authors: Social & Scientific Systems, Inc., Silver Spring, Maryland.
authors: Jacquelyn
authors: J
authors: Smith
authors: Obesity Prevention Program, Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors: Jennifer
authors: J
authors: Thompson
authors: Obesity Prevention Program, Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
authors: Matthew W
authors: MW
authors: Gillman
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis; D016640:Diabetes, Gestational / Q000175:diagnosis; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D049590:Postpartum Period; D011247:Pregnancy; D011320:Primary Health Care; D012307:Risk Factors; D014930:Women