Incorporating Aboriginal Women’s Voices in Improving Care and Reducing Risk for Women With Diabetes in Pregnancy - A Phenomenological Study.

Abstract

Background: There is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Indigenous women globally. Postpartum diabetes programmes have the potential to prevent recurrent GDM and improve management of type 2 diabetes. However, data on such programmes, particularly in the Indigenous context are limited. We aimed to explore Indigenous Australian women’s and health providers’ preferences for a program to prevent and improve diabetes after pregnancy. Methods: A phenomenological methodology underpinned semi-structured in-depth interviews with 11 Indigenous women and seven health professionals across the Northern Territory. Interviews were analysed using an inductive and descriptive approach to address the barriers and enablers of proposed diabetes prevention programs identified by participants.Results: Identified structural barriers to lifestyle change included: food insecurity, persuasive marketing of unhealthy food options, lack of facilities and cultural inappropriateness of previous programs. Enablers to lifestyle change included: a strong link between a healthy lifestyle and connection with the land, family and community. Suggested strategies to improve lifestyle included: co-designed cooking classes or a community kitchen, team sports and structural change (targeting the social determinants of health). Lifestyle change was preferred over metformin to prevent and manage diabetes after pregnancy by participants and health care providers. Conclusions: We recommend individual level programs be designed alongside policies that address systemic inequalities. A postpartum lifestyle program should be co-designed with community members and grounded in Indigenous conceptions of health to adequality address the health disparities experienced by Indigenous people in remote communities.