Barriers to and facilitators of gestational diabetes mellitus service utilization in Kenya: a qualitative analysis of women’s and healthcare workers’ perspectives

Abstract Background Gestational diabetes mellitus (GDM) is a growing global public health concern, particularly in low- and middle-income countries such as Kenya. Despite rising prevalence and associated maternal and neonatal risks, timely diagnosis and comprehensive GDM care remain limited by systemic, socioeconomic, and cultural barriers. This study identified barriers and facilitators influencing GDM care provision and utilization in Kisumu County, Kenya, from the perspectives of healthcare workers (HCWs) and women affected by GDM. Methods A qualitative content analysis combined semistructured interviews and structured surveys. Participants were purposively sampled from two healthcare facilities in Kisumu County: Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu Specialists Hospital. Interviews involved eight HCWs and two women diagnosed with GDM, and surveys were administered to eleven women with a history of GDM. Data collection instruments, developed from the health needs assessment and knowledge, attitude, and behaviour frameworks, were validated by an expert panel from Kenya and Germany. Thematic analysis identified key barriers to and facilitators of GDM care. Results Stakeholders highlighted systemic gaps and resource constraints affecting GDM care, including high costs, inadequate insurance, supply shortages, and poor infrastructure, which especially affected rural and low-income women. Barriers including financial burden, distance, inconsistent protocols, communication gaps, and negative patient-provider relationships hindered access and adherence. Facilitators included family and social support, health worker education and follow-up, and self-management through dietary counseling, monitoring, and lifestyle changes. All groups advocated universal screening, expanded insurance, community outreach, and better education to strengthen GDM care and improve outcomes. Conclusions GDM care provision and utilization in Kenya are shaped by multilevel barriers spanning individual, systemic, and cultural domains. Addressing them requires targeted interventions, including enhanced HCW training, greater community awareness, and strengthened health system infrastructure. Integrating GDM services into existing maternal health programmes is essential to improving outcomes for women and their infants in resource-constrained settings.