Feasibility and acceptability of a co-created family-centred self-management program for Aboriginal women with diabetes in pregnancy: a pilot study

Women with any form of hyperglycaemia in pregnancy inclusive of type 1 diabetes, type 2 diabetes and gestational diabetes during pregnancy and up to 6-months post-pregnancy. Observation of standard care. Co-creation process: The framework for the ORCHID program was co-designed in 2023-2025. The ORCHID working group, including four Aboriginal researchers, conducted research yarns and semi-structured interviews with 49 Aboriginal women with gestational diabetes, their family members and healthcare providers from the Kimberley, South West and Great Southern regions of Western Australia. Key themes within ten topics were identified by the ORCHID working group. Findings from the research yarns and interviews were shared with 28 co-investigators during eight workshops in Broome and Bunbury. Co-investigators included: 21 Aboriginal community members including women and their partners who recently had a baby, six healthcare providers and one ACCHO board member. Each workshop ran for two to three days. Co-investigators discussed the findings and developed a set of recommendations that informed a program framework. The framework has informed the co-design of an implementation manual for the pilot program at each site: South West Aboriginal Medical Service (SWAMS) and Broome Regional Aboriginal Medical Service (BRAMS). The pilot program will be delivered as part of standard care, throughout antenatal care and postpartum up to 6 months. It will be conducted at both sites for 24 months and there will be no limit to the number of times a family can engage in the program. The manual for each site will include: - Each of the program components: *Professional development and training for staff for community mentors. o Offering early HbA1c testing (at first antenatal visit <20 weeks gestation) o Offering HbA1c testing between 4 and 6 months postpartum to coincide with child health checks (for all postpartum women and support people) o Assigning Aboriginal Health Navigator at each site to assist in continuity of care and perform barrier reducing tasks (identified during the pilot period) during antenatal and post-partum periods. o Offering Continuous Glucose Monitors to monitor blood glucose levels o Offering peer mentor support to families o Offering digital and hardcopy resources to families, identified during the co-design process o Offering components one on one and in groups; online and face-to-face, depending upon participant preferences. - Roles and responsibilities: Program delivery at each site will be championed by; o The lead midwife during the antenatal period. o The lead child health nurse in the Maternal Child Health team and the Chronic Conditions team lead for the postpartum period. o The Aboriginal Health Navigator will oversee day to day activities and ensure continuity of care throughout the patient journey. - The evaluation plan: o Acceptability and feasibility will be assessed using measures co-designed with each site, through surveys, semi-structured interviews and research yarns with consenting healthcare providers and family members. o The program will evolve over time based on acceptability and feasibility at each of the pilot sites and all changes will be documented in each of the manuals. *Training for the Aboriginal Health Navigator has been co-designed with each site and includes standard on-boarding procedures. External training delivered by DiabetesWA (Diabetes Education Self-management Yarning DESY, 37.5 hours training prior to engagement with families). Other training identified by the Navigator and the services will be integrated as required.