Summary
CARE GDM is a cross-hospital, cross-country initiative addressing health inequalities in gestational diabetes mellitus (GDM). One in four women in the GDM clinic is from a non-white background, often facing language and cultural barriers. CARE GDM developed culturally adapted, multilingual educational resources co-produced with bilingual clinicians and cultural advisors. Materials included written guides, diet sheets, and short videos in Bengali, Urdu, Arabic and Polish. The project improves understanding, streamlines consultations, and empowers women to engage in care. Aligned with NHS CORE20PLUS5 priorities, CARE GDM offers a scalable model for inclusive care with potential NHS cost savings.
Innovation/Novel approach to an existing problem
At Cambridge University Hospitals, approximately 400–550 women are seen annually in the GDM clinic. Around a quarter come from a non-white ethnic background, often facing language, cultural, or health literacy barriers. Patient education materials, usually only in English and designed for a White British population, did not meet the needs of many patients. Women were frequently overwhelmed, unclear on dietary advice, and disengaged from postnatal follow-up. Audit data, patient feedback, and clinician experience confirmed a consistent gap in the cultural and linguistic accessibility of care information. This contributed to avoidable disparities in patient experience and outcomes. National resources often relied on direct translation, which lacked cultural nuance and failed to reflect real-life food practices, health beliefs, or communication styles. CARE GDM paired linguistically accurate translation with cultural adaptation, co-producing resources with bilingual clinicians, dietitians, and cultural advisors. Materials were developed from the ground up, embedding cultural food habits, beliefs and lived experiences. Barts Health NHS Trust advised on the Bengali diet charts. A dietitian in Pakistan was consulted on South Asian dietary patterns and a dietitian in Jordan advised on the Arabic diet sheets. Multilingual team members brought clinical expertise and linguistic and cultural insights, allowing much of the translation work to be done internally. The resources included written guides, culturally specific diet sheets, and educational videos in Bengali, Urdu, and Arabic, with Polish materials available in written form. They were tested in clinic and refined based on feedback from clinicians and patients. All content underwent clinical review to ensure alignment with NICE guidance and trust policies, with particular regard to advice during pregnancy. The objectives were to: improve patient understanding and engagement across diverse backgrounds; reduce consultation time spent re-explaining key advice; and increase uptake of postnatal follow-up and diabetes prevention messaging.
Equality, Diversity and Variation
The team focused on creating meaningful, practical solutions that improved not only how information was provided but how it was understood, received, and acted upon. The gap between existing materials and lived experience was identified through listening to informal and formal feedback from patients, conversations in clinic, missed postnatal appointments, and clinician frustration with repeatedly explaining inapplicable dietary advice. Access was expanded by making materials available in Bengali, Urdu, Arabic, and Polish. QR codes linking to videos helped women share the information with family members. CARE GDM focused on culturally relevant examples, familiar foods, and content created with input from those who understood their cultural context. Clinicians said patients came better prepared, understood dietary guidance more clearly, and required less time spent on basic explanations. Patients described feeling more confident, less anxious, and more able to take ownership of their care. CARE GDM addressed equality and diversity not as an extra layer but as a fundamental redesign.
Impact to Patient Care
CARE GDM significantly improved patient care, particularly for those from ethnically diverse backgrounds. Before CARE GDM, many of these women struggled to engage with the dietary and self-management advice provided in the clinic. The multilingual, culturally adapted resources reduced anxiety and made dietary management feel achievable. Women reported feeling more confident and empowered. They said the materials helped them explain GDM management to family members, reducing misunderstandings and improving support at home. Healthcare professionals reported a clear improvement in the quality of consultations, with more time to address individual concerns. CARE GDM improved clinic flow and reduced avoidable follow-ups. Clinical teams were able to focus on more complex cases, using healthcare resources more effectively. Women described feeling respected, included, and valued, reducing emotional distress during pregnancy. The culturally aligned materials helped clinicians feel better equipped to serve diverse populations, boosting team confidence, morale, and satisfaction.
Results
CARE GDM has been running for six months and is already demonstrating meaningful improvements. While formal outcome data will be evaluated at the end of the year, early observations show clear progress. Feedback was collected from 16 women attending the GDM clinic who used CARE GDM resources in Bengali, Urdu, Arabic, or Polish. Input was gathered through informal conversations, structured follow-up calls, patient feedback forms, and observation of clinic activity. Patients arrive better prepared and understand advice more clearly, reducing time spent on basic information during appointments. Appointments now focus more on individualised care and problem-solving, improving both quality and efficiency. Consultations are about 10–15 minutes shorter when CARE GDM materials are used. There are also fewer repeat contacts or follow-ups caused by misunderstanding, supporting smoother clinic flow. The new materials have helped women better understand their condition, reduce anxiety, and apply clinical advice more confidently. Many women are now able to explain dietary needs to family members, improving support at home and making adherence to clinical advice more achievable. This shift has reduced feelings of isolation and strengthened shared responsibility for managing GDM during pregnancy. Day-to-day blood glucose management has improved and women are engaging better with care plans. Observations suggest that CARE GDM is helping patients achieve better short-term management and supporting healthier pregnancy behaviours.
User Feedback
Feedback was collected from women attending the GDM clinic, midwives, dietitians, and diabetes specialists. Patient feedback was gathered through informal conversations, structured phone calls, and forms in clinic. Clinician feedback was gathered through team meetings, direct observations, and informal debriefs. Feedback was encouraged from women of different cultural, linguistic, and educational backgrounds, making sure positive and critical comments were recorded. Feedback was invited in patients’ preferred languages, where possible, and suggestions for improvement encouraged. Clinicians described how the materials helped improve the flow of consultations, reduced repeated explanations, and allowed more time for personalised care.
