Barriers and facilitators to oral healthcare support in gestational diabetes mellitus: An interview study with healthcare professionals

Abstract

Aim: Periodontitis is a chronic inflammatory oral disease characterised by the persistent activation of immune cells, which contributes to insulin resistance and, consequently, an increased risk of systemic diseases, including gestational diabetes mellitus (GDM). At the same time, the risk of periodontitis is higher in individuals with diabetes, with higher glycaemic levels being the primary contributing factor. Oral health review is also advised in diabetes care by the NICE guidelines, because of its impact on blood glucose management. However, oral health may be overlooked in GDM due to the volume of other interventions required. Furthermore, little is known about the barriers and facilitators to oral healthcare support among healthcare professionals (HCPs) working in GDM care. To examine the barriers and facilitators to oral healthcare support among HCPs in GDM care. Methods: The interview guide was based on the Theoretical Domains Framework (TDF), and semi-structured interviews were used for data collection. The sample consisted of UK-based HCPs with different professional backgrounds. Results: Four barriers and three facilitators were identified. These are related to the following TDF domains: professional role and identity; beliefs about consequences; knowledge; skills; memory, attention, and decision processes; and environmental context and resources. Conclusions: Oral health was not prioritised in GDM care. Furthermore, limited knowledge, increasing demands and time constraints, and fear of health-related information overload were barriers to oral healthcare support. Training and education to increase knowledge, perceived importance of oral health and the HCPs' role and responsibilities facilitated oral healthcare support.