ABSTRACT
Global prevalence of hyperglycaemia in pregnancy in
women of 20 - 49 years was estimated to be 16.9% and affecting 21.4 million live
births, in 2013, 90% of which occurred in developing countries. The cornerstone
of anti-diabetic therapy is diet, physical activity and medications. The study
utilized a qualitative descriptive design using key informant interviews from
August 2016 to November 2016 to explore challenges of adherence to
anti-diabetic therapy in pregnant women with diabetes at a central hospital in
Harare, Zimbabwe. Permission to conduct the study was obtained from the
respective local and national ethical review boards. All participants gave
verbal and written informed consent. A sample of eight key informants directly
involved in the care of pregnant women with diabetes was purposively selected
for key informant interviews. Key informants should have worked with diabetic
pregnant women for at least one year. Sample size was determined by data saturation.
Interviews followed a semi structured questionnaire that had sections on the
burden of diabetes in pregnancy, challenges of adherence, challenges in
management and possible solutions to challenges faced. All interviews were
conducted in a private room. Detailed notes were taken during the interviews
which were also being audiotaped. Trustworthiness was achieved by observing
credibility, dependability, transferability and confirmability. Thematic analysis
was done. Thematic analysis was done manually. The stages of data analysis
followed were data organization, familiarization, transcription, coding, developing a thematic framework, indexing,
displaying and reporting. Major themes identified were barriers and
facilitators of adherence to anti-diabetic therapy. Categories under barriers
were financial barriers, lack of health education, lack of trained personnel,
shortage of staff and lack of collaboration among practitioners. Categories
under facilitators of adherence were subsidization
of care, formal training of professionals, promoting collaboration and
establishment of a unit dedicated to the care of pregnant women with diabetes.
Barriers and solutions identified should be utilized to
develop frameworks to promote adherence to anti-diabetic therapy incidence of
adverse perinatal outcomes.