Procrastination as a Key Factor in Postpartum Screening for Diabetes: A Qualitative Study of Iranian Women with Recent Gestational Diabetes

Background: Women with previous gestational diabetes mellitus (GDM) are at elevated risk for developing Type 2 diabetes. Despite the recommendation for postpartum diabetes screening for these women, the rate of screening is low. Objectives: The present study aimed at conducting an in-depth exploration of the experiences of Iranian women with recent GDM in the process of diabetes screening. Methods: This grounded theory qualitative study was conducted in Tehran, Iran, from 2013 to 2016. In this study, 22 women with recent GDM, who gave birth at least 6 months before the interview, were selected by purposeful sampling method; then, to achieve saturation, the participants were followed using theoretical sampling method. The participants were asked about their postpartum experiences, specially about the process of attendance/not attendance in diabetes screening at 6weeks to 6 months after child birth, using semi-structured interviews. Data were analyzed using Corbin and Strauss method (2008). Results: Three main categories were extracted as postpartum diabetes screening process in women with a recent GDM: to be aware, to be sensitive, and to perceive severity of the threat. Also, the outcomes have been classified into 4 levels: selective screening, accidental screening, primary lack of screening, and secondary lack of screening. In our study, the participants had a range of procrastination in screening, from no procrastination in selective screening to high procrastination in secondary lack of screening. Sometimes, the participants had the intention to be screened but they took no action, did not do the screening due to self-deception, or perceived screening as lacking immediate reward (3 main features of procrastination). Thus, due to procrastination, they did not do the screening. Screening in the range of procrastination, as the core category, was the most obvious concept that implicitly existed in all the data. Conclusions: Even when sensitivity and perceiving a threat about diabetes were activated in women with recent GDM, they did not undertake screening due to procrastination. Procrastination is an important and missed factor in screening. Conducting further studies is recommended to develop evidence-based strategies to decrease women's procrastination in screening.