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The Experiences of Diabetes in Pregnancy among First Nations Women in Alberta; and the Contributors to a Healthy Pregnancy
 

The Experiences of Diabetes in Pregnancy among First Nations Women in Alberta; and the Contributors to a Healthy Pregnancy

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16th Annual Canadian Diabetes Association / CSEM Professional Conference & Annual Meetings

16th Annual Canadian Diabetes Association / CSEM Professional Conference & Annual Meetings
Montreal, Quebec
October 17-19, 2013

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    The Experiences of Diabetes in Pregnancy among First Nations Women in Alberta; and the Contributors to a Healthy Pregnancy The Experiences of Diabetes in Pregnancy among First Nations Women in Alberta; and the Contributors to a Healthy Pregnancy Presentation Transcript

    • The Experiences of Diabetes in Pregnancy among First Nations Women in Alberta; and the Contributors to a Healthy Pregnancy Richard T. Oster, Maria J. Mayan and Ellen L. Toth INTRODUCTION University of Alberta RESULTS Table 1. Participant characteristics In the current study we aimed at gaining insight into the dramatic differences in rates of diabetes in pregnancy, and outcomes of such pregnancies, between Canadian women of First Nations descent and women of the general population (1-3). Our purpose was to acquire a deeper understanding in this area from the perspective of First Nations women with real life experience or diabetes in pregnancy. Qualitative findings among non-Aboriginal women with gestational diabetes (GDM) (4,5), including a recent review (6), have been published, and suggest areas in need of improvement for the health care systems to benefit pregnant women and their families. However, little is known of the experiences of First Nations women. This study was part of a larger mixed methods plan aimed at examining diabetes in pregnancy among Aboriginal women, with the ultimate goal of developing interventions that can effectively improve care for diabetes in pregnancy. A multiphase mixed methods research approach is being utilized (7), whereby this study encompassed the initial qualitative phase. OBJECTIVE To use a focused ethnography to understand the experience of diabetes in pregnancy and what factors contribute to achieving a healthy pregnancy in First Nations women. METHODS Sample Women were recruited via the practices of two physicians, and the allied health professional members of their diabetes care team, as well as through word of mouth and a recruitment poster. First Nations (self-reported) adult women (18 years or older) that had previously had GDM or pregestational diabetes in pregnancy (within five years) were recruited. All of the participants received care for diabetes in pregnancy within the same major metropolitan city. Convenience sampling methodology was utilized. A total of 12 First Nations participants were needed to reach data saturation. Data Generation Data were generated over a period of approximately 10 months from May 2012 to March 2013. Unstructured interviews with participants were carried out at a mutually selected location. During the interviews, open-ended questions were asked to prompt unstructured discussion. Interviews were audio recorded and transcribed (verbatim). Data Analysis Data were subject to qualitative content analysis using ATLAS.ti for data management and organization. Data analysis took place concurrently with data collection. Data collection and analysis ceased on data saturation, when no new information or insight emerged, and when the categories were well refined and defined. The participants were invited to a group meeting to hear the results share their views. Each participant that attended the meeting was provided their transcript for review and the findings were verified as an accurate portrayal of their collective experiences. Rigor Rigor in our study was achieved by adhering to the principles of validity, generalizability, and reliability (8). Also, throughout the entire research process, a reflective approach was strived for by keeping a personal journal of thoughts, emotions, reactions, expectations, assumptions, ‘why’ questions, and so forth. Ethics We obtained ethical approval from the Human Research Ethics Board of the University of Alberta. Participants remained unidentifiable and written informed consent was obtained. Numerous meetings with interested Aboriginal persons were undertaken prior to, during, and after data collection. These meetings served to lend advice and guide the research in a culturally appropriate manner. Participant number Age during pregnancy Diabetes in pregnancy type 1 2 38 33 GDM GDM Number of years between birth and interview 3 2 3 4 5 6 7 8 9 10 11 12 Average 28 27 32 26 38 30 32 39 36 38 33 Pregestational GDM GDM Pregestational GDM GDM Pregestational Pregestational Pregestational Pregestational N/A Total number Home of children community type 2 4 5 1 1 1 4 1 2 1 2 3 5 Urban city Urban city 4 3 6 5 5 2 4 1 3 6 4 Aboriginal Aboriginal Aboriginal Aboriginal Aboriginal Urban city Aboriginal Aboriginal Aboriginal Aboriginal N/A Taken together, the experience of diabetes in pregnancy for First Nations women was “good and bad”, one wrought with struggle but balanced to some degree by positive lifestyle changes. A loss of control, and at the same time striving to control blood sugar levels, permeated living with diabetes in pregnancy. For some women, diabetes in pregnancy offered a chance to take control of their health. The degree to which the women felt they could control their diabetes and their health strongly influenced whether the women felt they had had a positive or a negative pregnancy experience. Having a strong support system including family, healthcare provider, cultural/community, and internal support, was crucial to whether the women felt they had a healthy pregnancy or not. Facing diabetes in pregnancy alone resulted in a daunting and challenging pregnancy. Most women had the necessary resources to manage their diabetes but when awareness and preceding knowledge of diabetes in pregnancy was lacking, many of the women felt overwhelmed with information upon diagnosis. Figure 1. Model of integrated main qualitative findings. “+” denotes increase and ““ denotes decrease. What is it like to have diabetes in pregnancy? Challenges: “It was hard” Positives: “It helped me too” “Extra stress” “Extra work” “Inconvenient” “Problematic” “Fear” “Scared for the baby more than for myself” “Many different emotions” “It was a real eye-opener” “It made me take care of myself better and eat healthier” “Now I know and I can show my kids” “Ever since then me and my kids diet has changed” “I’m more knowledgeable” Control: “A struggle for control” “No getting around it” “No control over my health” “Just do as your doctor says” “I had to take control” “My blood sugars got out of control” What factors might contribute to attaining a healthy pregnancy in women that have diabetes in pregnancy? Support: “I didn’t do it alone” “Family helped” “My husband tried to understand” “Healthcare staff was always there” “Women like to hear like they are doing something good, not just that they are harming themselves” “Health is more holistic” “An open ear” “For my baby” Awareness and Resources: “There was a lot to learn” “I didn’t even know what it was” “A whole lot of information thrown at me” “I had good access” “Sometimes you don’t have money to buy healthy foods” “Its harder when you are on a budget” “I walked a lot” IMPLICATIONS As high-risk pregnancies and poor outcomes are more common among First Nations women regardless of diabetes status, efforts must be made to improve pregnancy care. First Nations women with diabetes in pregnancy are not likely to benefit from ‘broad brush’ healthcare, rather providers should look to boost the support systems of these women, add to their sense of autonomy, and raise awareness of diabetes in pregnancy. Accordingly, providers should strive for a more patient-centered approach. Such an approach should allow for mutual exchanging of information, shared power and decision making, and an even patient-provider partnership where providers actively listen to patients and learn in-depth about their life circumstances. Healthcare providers should also work to strengthen women’s support systems beyond solely that of healthcare provider support. Spouses and other family members should be engaged and involved as much as possible during clinic visits throughout the pregnancy. Other cultural and/or community supports should also be included if possible and if required, such as Elders or close friends. Peer support or cultural support programs are needed, particularly for those that lack family support. Women’s internal drive to protect their fetus should also be stoked by providers through positive encouragement rather than fear inducement. REFERENCES 1. Dyck R et al. Diabetes Care. 2002;25(3):487-93. 2. Liu SL et al. Diabetic Medicine. 2012;29(8):E180-3. 3. Willows N et al. Am J Human Biol. 2011;23(1):126-31. 4. Evans MK & O'Brien B. Qual Health Res. 2005;15(1):66-81. 5. Persson M et al. Scan J Car Sci. 2009;24(3):454-62. 6. Devsam B et al. Women Birth. 2013;26(2):E69-76. 7. Creswell J, Plano Clark VL. SAGE Publications; 2011. 8. 7. Morse JM et al. Int J Qual Meth. 2002;1(2):13-22.