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

Abstract

Background: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population.Objective: To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes.Design: Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes.Results: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/ motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma.Conclusions: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population. K E Y W O R D S American

Understanding Historical Trauma for the Holistic Care of Indigenous Populations: A Scoping Review

“…There was also evidence of a need to be more comprehensive in the understanding of historical trauma since the overwhelming emphasis has been on mental health effects, with less effort to explore physical health effects. Research on physical health addressed diabetes (Terry et al, 2020), obesity (Kelley & Lowe, 2018;Kulhawy-Wibe et al, 2018), and cancer (Burnette, Roh, et al, 2019;Henderson et al, 2018) in indigenous populations. While these are health problems that have high prevalence in many Indigenous communities, other health challenges of Indigenous with likely connection to the stresses of historical trauma were surprisingly unexplored, including cardiovascular and respiratory diseases.…”

The effects of the instantaneous scanning glucose monitoring system on hypoglycemia, weight gain, and health behaviors in patients with gestational diabetes: a randomised trial

“…At the same time, patients can make adjustments to daily exercise and eating routines in response to the real time results of dynamic blood glucose monitoring. This leads to improved control of blood sugar levels and promotes patients to establish healthy behaviors (20).…”

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

“…Tailoring health education materials to be culturally responsive for AI/ANs is a well-established method to improve the acceptance and effectiveness of health programs created for AI/AN communities. 9,21 Examining perspectives from key stakeholders is essential when tailoring health education programs on sensitive health topics for different ethnic groups. 22 This is perhaps even more important when designing programs that are national in their scope, as in our GDM risk reduction through preconception counseling intervention.…”

“…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. Tailoring health education materials to be culturally responsive for AI/ANs is a well‐established method to improve the acceptance and effectiveness of health programs created for AI/AN communities 9,21 …”

“…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. Tailoring health education materials to be culturally responsive for AI/ANs is a well‐established method to improve the acceptance and effectiveness of health programs created for AI/AN communities 9,21 …”