Skills shortages
DIABETIC KETOACIDOSIS, TYPE 1 DIABETES, EMERGENCY
As several interviewees observed, after setting up and linking components, training and supporting women to use the HCL app/algorithm was “pretty straightforward” (HP-003) because “there aren't an enormous number of things to change… it seems a fairly intuitive interface” (HP-012). Given this, interviewees suggested that the greatest challenge to rolling out HCL technology to pregnant women would reside with upskilling centers and colleagues with limited experience interpreting CGM data and/or supporting insulin pump users (Additional Participant QuotationsT1D, type 1 diabetes.Several noted that it would be particularly challenging to upskill healthcare professionals in smaller sites with a fluid workforce, because of staff shortages and difficulties in appointing new members who are able to support technology use. It was also noted that, in some smaller and less experienced sites in particular, existing staff lacked time or motivation to take on new training, an issue heightened by the Covid-19 pandemic (Moreover, interviewees indicated the importance of upskilling a wider corpus of hospital staff (e.g., in Accident and Emergency, Maternity Assessment and Delivery units) who provide support to women presenting acutely (e.g., with diabetic ketoacidosis): “so when patients are admitted… wider healthcare professionals aren't doing things they shouldn't be doing” (HP-015).Several expressed additional concerns that, without widespread upskilling, existing regional disparities in healthcare professionals' skills and expertise might result in women in certain locations, especially those living far away from centers with HCL technology experience, having inequitable access (