Abstract:
Background: Gestational Diabetes Mellitus (GDM) contributes to maternal and neonatal complications
and is a growing concern in Kenya. The 2-hour oral glucose tolerance test (OGTT) is recommended to
diagnose GDM between 24 and 28 weeks of pregnancy, but uptake remains low in settings experiencing
financial and structural barriers to health care access. The Stratification Risk of Diabetes in Early
pregnancy (STRiDE) tool is a risk-prediction model designed to identify women at elevated risk for GDM.
The STRiDE-GDM screening approach integrates this tool within community-based peer groups to guide
targeted, risk-stratified GDM screening and referrals to local health care facilities. However, little is
known about implementation of STRiDE-GDM in Kenya. This study explored determinants (facilitators
and barriers) of STRiDE-GDM implementation among pregnant and postpartum women in western
Kenya.
Methods: Community Health Promoters (CHPs) recruited 18 women from Chamas, a community-based
women’s peer group program to complete in-depth interviews exploring beliefs, perceptions, and experiences
related to the STRiDE-GDM screening approach. Transcribed audio-recordings were translated from Swahili to
English. We conducted thematic analysis using a hybrid inductive-deductive coding approach to identify and
explore facilitators and barriers to STRiDE-GDM implementation. The resulting themes were then
systematically mapped to the Theoretical Domains Framework (TDF) domains.
Results: Participants had a mean age of 26.6 years (SD=7.2); 39% were pregnant, with most experiencing their
first pregnancy and one-half were enrolled in the national health insurance. Key implementation determinants
were mapped to relevant domains within the TDF. Facilitators to engage in the STRiDE-GDM screening
included motivations to maintain maternal health in order to fulfill caregiving responsibilities, perceived
benefits of early GDM diagnosis, support from Chamas peer groups and guidance from trusted CHPs. Barriers
included limited awareness about GDM screening, transportation and cost constraints, competing household
responsibilities, stigma, disclosure concerns within the Chamas peer groups, limited spousal support, and fear
of adverse outcomes.
Conclusion: Findings highlight that individual, social and structural factors influence engagement in STRiDE-
GDM screening. Community-based peer groups, such as Chamas emerged as an ideal setting to support
screening. Addressing modifiable barriers including low GDM screening awareness, transportation, cost, and
scheduling constraints prior to implementation may improve feasibility and uptake