Abstract
Background
Intersectoral coordination of disease prevention is highly complex. The case of women who develop diabetes during pregnancy (GDM) is a case in point: intersectoral coordination mainly concerns diabetes prevention and thus stretches over the life course of women and their families. Our study aims to analyse how health professions through their day-to-day practice contribute to the creation, maintenance and transformation of intersectoral coordination of diabetes prevention over the life course; and how contexts at systems/organisational influences such processes.
Methods
The study draws on organisational studies of professions and focuses on the mechanisms underlying the making of intersectoral coordination. As part of a pilot study, we conducted a review of the international literature on intersectoral coordination of public health, a review of national policy documents, and a secondary analysis of interviews conducted as part of the development of the Face-it intervention.
Results
The organisation of GDM diabetes prevention in Denmark emerges as fragmented. Care pathways are divided between different phases, types of services, sectors and health professions. There are additional variations among municipalities. Formal (intersectoral) coordination is also limited to vulnerable women and their families. GDM diabetes prevention involves a broad range of professions; professional agency in GDM diabetes prevention is dispersed. Clinical specialists in hospitals show the strongest interest, rooted in healthcare knowledge on prevention. General practitioners have a similar knowledge base, but consider prevention less central. The same applies to health visitors and midwives, whose knowledge base also includes social care.
Conclusions
Individual professions have a strong capacity for intersectoral agency. Strengthening this capacity requires alignment across professions and adaptation to specific contexts.
Intersectoral coordination of prevention over the life course:
professionals and the making of diabetes prevention in Denmark