Cultural understanding, experiences, barriers, and facilitators of healthcare providers when providing preconception counseling to adolescent Latinas with diabetes

Abstract

Background:Latinas are at a higher risk than Caucasians for both type 1 and type 2 diabetes (DM), as well as DM-associated reproductive health (RH) complications. Healthcare providers (HCPs) should deliver culturally-sensitive care to enhance the care relationship between Latinos and HCPs and to improve patient outcomes. This study explored an expert panel’s cultural understanding, experiences, barriers, and facilitators regarding RH and preconception counseling (PC) for adolescent Latinas with DM and their families.Methods:This study used open-ended questions with a focus group of 8 HCPs from the mid-Atlantic, Southwest, and Northwest regions of the United States in a teleconference format. Two researchers transcribed and reviewed the transcript for accuracy. Using content analysis, four members of the team identified themes. All researchers discussed themes and a 100% consensus was reached. For confirmation, a coding protocol was created based on the emerging themes.Results:Five themes related to cultural understanding and experiences were identified: 1) issues of identity; 2) acculturation; 3) stigma; 4) ambivalence toward birth control, RH education, and PC; and 5) cultural sensitivity vs. best practice. Four barriers were identified: 1) language; 2) religion; 3) access to healthcare, and 4) discomfort with discussion. Ten facilitators were identified: 1) the importance of support and support networks; 2) promoting trust among HCPs, daughters, and families; 3) assessing emotional development; 4) empowerment; 5) emphasizing safety; 6) communicating in patients’ preferred language; 7) discussing RH-related topics and PC using cultural sensitivity; 8) importance of being ready/temporality/planning for the future; 9) the importance of family-centered care; and 10) variation in educational tailoring and dissemination/ care delivery.Conclusions:Findings support the need for culturally sensitive and developmentally appropriate PC programs to empower adolescent Latinas with DM.

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens

“…Particiapnts also discussed the organization of information and encourage use of third person construction when talking about diseases or conditions such as pregnancy as some communities' view discussing the risk for diseases as potentially bringing about that condition. In contrast, literature on HCP perceptions on culturally tailoring health programs for Spanish speaking audiences suggest communication is important but emphasized the importance of bilingual HCPs …”

“…By using familiar imagery, patients and families may see reflections of themselves in the materials and feel they are more applicable to them . When culturally adapting health programs, the use of familiar imagery is supported by the literature from other distinct cultural audiences …”

Preconception Counseling: Identifying Ways to Improve Services

“… 21 Since providing adequate preconception care allows for health intervention and management offering improved pregnancy outcomes, it is a vital aspect of health care that should be available to all women of childbearing age. 22 23 It is crucial for preconception counseling to be widely available to all women, not just those actively contemplating conception, to optimize maternal and fetal health. 15 The discrepancy of women from minority groups receiving prenatal care represents a serious health care system flaw that needs to be remedied with improved patient outreach and provider referrals.…”

Reducing risk for gestational diabetes among American Indian and Alaska Native teenagers: Tribal leaders' recommendations

“…Latina adolescents with diabetes. 19,20 In these cultural adaptations, we have considered the perspectives of mothers, daughters, and clinicians to increase the acceptance and effectiveness of the program among different racial and ethnic groups. We gathered perspectives from these same key stakeholders for AI/ANs, 7,21 as well as AI/AN women with a history of GDM 6 in culturally tailoring the materials for AI/AN teenagers.…”

“…READY‐Girls has also been culturally adapted for Black and Latina adolescents with diabetes 19,20 . In these cultural adaptations, we have considered the perspectives of mothers, daughters, and clinicians to increase the acceptance and effectiveness of the program among different racial and ethnic groups.…”