Qualitative study finds clinician protocols outweigh patient preferences in gestational diabetes screening

A qualitative study at urban clinics affiliated with New York-Presbyterian Queens found that major patient-level barriers to one-step gestational diabetes screening were generally less significant than expected, while institutional norms and established protocols shaped which test clinicians selected. Pregnant Asian and Hispanic women who had received either one-step or two-step screening generally considered fasting manageable, accepted the time required for testing and valued the information provided by a diagnosis, even when the process had caused anxiety. Among the 10 obstetric providers interviewed, however, test selection depended more on training, workflow constraints and reluctance to depart from standard practice than on patient preference or a belief that one method was clinically superior.

The study, conducted from June 2023 through January 2026, used purposive sampling and semi-structured interviews with 17 pregnant Asian and Hispanic women without prior diabetes and 10 obstetric providers. Participants had experienced either the one-step oral glucose tolerance test or the two-step approach used in the United States. The interviews examined experiences with screening, perceptions of the different testing modalities and barriers to implementing the one-step method. Researchers transcribed the interviews and analyzed them through thematic analysis with inductive coding, producing two overarching themes from the relatively small qualitative sample.

Although the one-step test is more sensitive and is recommended by several international organizations, the two-step procedure remains the standard in the United States. Concerns that the one-step test would impose an excessive fasting burden, create undue anxiety or require too much time have limited its adoption, particularly in populations described as being at higher risk, including Asian and Hispanic women. The findings suggest that some of those concerns may be overstated at the patient level: most women in the study said fasting was manageable, accepted the time commitment and regarded the possible diagnosis as worthwhile because it could support efforts to protect maternal and infant health.

Providers nevertheless described their own reasons for continuing to use the two-step approach. Their choices were driven primarily by institutional norms, established protocols, training and system constraints, as well as a reluctance to deviate from standard practice. This pattern indicates that improving early detection through a more sensitive screening approach may depend less on persuading patients to accept one-step testing than on changing the clinical systems in which tests are ordered and delivered. The authors identify updated guidelines and infrastructure as necessary system-level changes, with particular relevance for groups in which earlier recognition of gestational diabetes could improve opportunities to reduce longer-term metabolic risk.

The research does not establish that one-step screening improves clinical outcomes, nor does it quantify how many patients would change their preferences or how widely the results apply. As a qualitative evaluation based on 27 participants at a single affiliated clinic network, it is intended to illuminate experiences and decision-making rather than test screening performance or compare rates of gestational diabetes diagnosis. Its strongest supported conclusion is that institutional inertia appeared central to the continuing use of two-step testing in the studied setting, while anticipated patient resistance proved less substantial than providers expected.

Subject of Research: Provider decisions and patient experiences with one-step and two-step gestational diabetes screening

Article Title: A qualitative evaluation of provider decision-making and patient experiences with 1-step and 2-step gestational diabetes (GDM) screening

Article References: Gogineni, S., Sirna, S., Chitnavis, S., Lin, V., Desai, S., Sajjad, R., Dayal, A., S Mathad, J., Sundararajan, R., & Chebrolu, P. (2026). A qualitative evaluation of provider decision-making and patient experiences with 1-step and 2-step gestational diabetes (GDM) screening. BMC Public Health. https://doi.org/10.1186/s12889-026-29819-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29819-3

Keywords: gestational diabetes, pregnancy screening, oral glucose tolerance test, clinical guidelines, healthcare systems, patient experience, provider decision-making, early diagnosis, ethnic health disparities, qualitative research, qualitative, evaluation