Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Nicola L. Hawley

Abstract

Background: Gestational diabetes mellitus (GDM) is associated with significant maternal and neonatal risks, with Samoa facing a disproportionate burden of GDM linked to high obesity (76.7% of women), type 2 diabetes (19.5%), and cultural-systemic barriers to care[1]. Despite GDM accounting for 38% of pregnancy complications at Tupua Tamasese Meaole (TTM) Hospital, qualitative insights into GDM care or provider experiences remain limited. This study applies a socio-ecological framework to explore multi-level influences on GDM care within Samoa’s unique cultural context and healthcare landscape.

Aim: To understand the barriers and facilitators to effective care-team response when treating gestational diabetes patients at TTM hospital, in addition to challenges for providers in delivering quality care and recommendations for management practices.

Methods: Semi-structured interviews with 11 healthcare providers–physicians and midwives–at TTM Hospital were analyzed thematically, guided by grounded theory principles.

Findings: Results highlighted significant barriers with health system and provider resource constraints, poor health literacy, and high costs of healthy foods and transportation, in addition to the facilitators of clear guidelines, team training, and strong patient health literacy. Three central themes emerged: cultural and gendered caregiving burdens limiting women’s engagement in care, tensions between provider responsibility and systemic barriers, and power dynamics in clinical encounters that hinder open communication and honest disclosure.

Conclusions: The current factors influencing GDM care are complex and challenging, shaped by provider attitudes, systemic constraints, and cultural dynamics. Culturally adapted, multi-level interventions that address systemic gaps and align with the Samoan socio-cultural context are essential to empower providers and women to improve health outcomes for mothers with GDM.

Comments

This is an Open Access Thesis.

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