Women who've had gestational diabetes are at increased risk for developing type 2 diabetes, but efforts to prevent the latter condition have had limited success, primarily due to challenges with the implementation and sustainability of diabetes prevention programs. Researchers conducted a mixed-methods study to identify factors in the general practice setting associated with the success or failure of the implementation of a diabetes prevention intervention for women with previous gestational diabetes.

Fifteen general practices participated in a 12-month quality improvement collaborative intervention. The authors used quantitative and qualitative methods with normalization process theory as the study's theoretical framework. They used clinical audit data to identify general practice engagement with guideline-led postpartum diabetes prevention activities and conducted semistructured interviews with health service staff and focus groups with stakeholders.

Screening for diabetes more than doubled from 26% at baseline to 61% at 12 months. Increases were also seen in diabetes prevention planning consultations (from 1% to 10%), postpartum screening (from 43% to 60%), and weight monitoring (from 51% to 69%). Normalization process theory constructs were more visible in practices that were actively participating in the intervention. Levels of change in diabetes screening rates, diabetes prevention planning, and weight monitoring were higher in these practices than in moderately participating practices.

The main themes identified within the practice normalization factors from the interviews and focus group data were mothers being seen as participants in their care, staff collectively creating the care process, practice staff identifying a long-term community care perspective, and feedback being provided and acted on throughout the practice. External changes were noted by regional program officers. The themes for actively participating practices were leadership by champions, collective staff action, and reminder systems in action.

The authors note that the study was conducted in a limited number of practices within a single state, the intervention lasted only 12 months, and there was no control group.