American Indian Diabetes Beliefs and Practices: Anxiety, Fear, and Dread in Pregnant Women With Diabetes

Abstract

Diabetes among American Indian (AI) people is a health disparities condition that creates excessive morbidity and mortality. This research delineated culturally constructed models of type 2 diabetes among 97 pregnant women in two large AI nations in Oklahoma. The data analysis of explanatory models of type 2 diabetes revealed the participants’ intense anxiety, fear, and dread related to the condition. The sample was further stratified by combinations of diabetes status: 1) absence of type 2 diabetes (n = 66), 2) type 2 diabetes prior to pregnancy (n = 4), and 3) gestational diabetes (n = 27). Patients were interviewed regarding perceptions of the etiology, course, and treatment of diabetes. The research incorporated an integrated phenomenologic and ethnographic approach using structured and semi-structured interviews to yield both quantitative and qualitative data.General findings comprised three main categories of patients’ concerns regarding type 2 diabetes as an illness: 1) mechanical acts (i.e., injections), 2) medical complications, and 3) the conceptual sense of diabetes as a “severe” condition. Specific findings included significant fear and anxiety surrounding 1) the health and well-being of the unborn child, 2) the use of insulin injections, 3) blindness, 4) amputation, and 5) death. Paradoxically, although there was only a slight sense of disease severity overall, responses were punctuated with dread of specific outcomes. The latter finding is considered consistent with the presence of chronic diseases that can usually be managed but present risk of severe complications if not well controlled.

‘Is gestational diabetes a severe illness?’ exploring beliefs and self‐care behaviour among women with gestational diabetes living in a rural area of the south east of China

“…The result was similar to other studies, for example, north American indigenous women with GDM had significant fear and anxiety surrounding the health and well-being of the unborn child and the use of insulin injections. 20 The women in the present study attributed illness and health to the individual factors such as wrong dietary habits, which demonstrated a belief in their own responsibility for their illness and health. 4 This implied that it was possible for these women to take the responsibility for controlling their GDM.…”

Low rates of predominant breastfeeding in hospital after gestational diabetes, particularly among Indigenous women in Australia

“…There are complex psychosocial, physiological and practical challenges for breastfeeding among women with GDM. A study among Indigenous women with GDM in the United States reported a high ‘perception of risk’ coupled with low levels of self‐efficacy for preventing cardio‐metabolic disease, 27,28 a combination associated with avoidance behaviour 29 . This suggests recommendations to include confidence‐building (‘strengths‐based’) strategies in breastfeeding support 30 may be particularly important for Indigenous women with GDM.…”

Knowledge regarding diabetes among expectant mothers attending ante natal clinic of a tertiary care institution of Kolkata: a cross sectional study

“…Giving incentives for attendance or having the classes become social events with community support were reccommended. 29 The present study was a preliminary study and it does indicate aspects of the disease where antenatal mothers lack adequate knowledge. However, a future study on the at risk population such pregnant women with high Body Mass Index, previous history of GDM, currently suffering from the same is required for better interpretation of the study results.…”