Patient-centredness in gestational diabetes mellitus healthcare services in Saudi Arabia—an exploration

Background: Gestational diabetes mellitus (GDM) is one of the most prevalent complications of pregnancy and an important risk factor for type II diabetes mellitus (T2DM) (McIntyre and Moses, 2020). Prevalence of GDM in Kingdom of Saudi Arabia (KSA) is substantially higher than the global average and is increased. Despite this, there is limited information on quality of care for GDM in KSA, in particular women’s experiences of services. Aims: To explore the quality of GDM healthcare services in KSA and suggest evidence-based recommendations for improvement. Methods: A mixed methods approach was used incorporating three studies; i) a systematic review (SR) synthesizing data from seven qualitative research articles; ii) a qualitative study using semi-structured interviews with patients with GDM (16 from an urban setting and 11 from a rural setting); and iii) an electronic Delphi (e-Delphi) study with 17 specialist providers of GDM care. Each phase was undertaken sequentially Findings: The narrative synthesis of the SR identified four key barriers to high-quality GDM care: limited access to healthcare, limited patient-centred care, limited professional and material resources, and poverty of patients. From the qualitative interviews, four themes relating to barriers for GDM patients emerged: access to care, communication, health provider factors and patient factors. Not every participant experienced problems with each factor. From the e-Delphi study, consensus was achieved among experts regarding the most and least important of the issues identified by patients. The five priority issues were: gaps in staff training, lack of doctors’ expertise regarding GDM, short consultation times, long waiting times, and administrative problems when making appointments. Conclusion: This thesis identifed potential ways to improve the quality of GDM healthcare services in Saudi Arabia. Recommendations are suggested to improve the quality of GDM healthcare, ranging from new training programs to greater investment in facility scheduling systems.