Incorporating Aboriginal women\u2019s voices in improving care and reducing risk for women with diabetes in pregnancy - A phenomenological study

Anna J Wood,Sian Graham,Jacqueline A Boyle,Louise Maple-Brown,Harold D Mcintyre,Christine Connors,Beverley Marcusson-Rababi,Renae Kirkham,Shonada Anderson

doi:10.1186/s12884-021-04055-2

Abstract

BackgroundThere is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Aboriginal and Torres Strait Islander women. Postpartum diabetes programs have the potential to prevent recurrent GDM and improve management of type 2 diabetes. However, data on such programs are limited, particularly in the Indigenous context. We aimed to explore Aboriginal Australian women’s and health providers’ preferences for a program to prevent and improve diabetes after pregnancy.MethodsA phenomenological methodology underpinned semi-structured in-depth interviews with eleven Aboriginal women and seven health professionals across the Northern Territory from October 2019- February 2020. Interviews were analysed using an inductive analysis framework to address the barriers and enablers of proposed diabetes prevention programs identified by participants.ResultsIdentified 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 Country, 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.ConclusionsWe 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 Aboriginal conceptions of health to adequality address the health disparities experienced by Aboriginal people in remote communities.

Highlights

There is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Aboriginal and Torres Strait Islander women
Recurrence of Gestational Diabetes (GDM) is reported to occur in 30–84 % of subsequent pregnancies [4] and women with GDM have a sevenfold higher risk of developing type 2 diabetes compared to women without GDM [5]
Whilst community A and B are unique in terms of traditional owners and language groups, themes were consistent across the communities

Summary

Introduction

There is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Aboriginal and Torres Strait Islander women. Trials showing type 2 diabetes can be prevented with lifestyle change, such as the Diabetes Prevention Program, generally involve expensive and time-consuming interventions [10] This presents a challenge for mothers with young families, who commonly cite tiredness, and competing work and carer duties as barriers to lifestyle change in the postpartum period [11, 12]. To date, this evidence is primarily based on research of non-Indigenous women in urban centres and may not be applicable in other contexts. Whilst there are several lifestyle programs targeted at Indigenous populations [13, 14], there is currently no literature on specific postpartum programs in Indigenous populations worldwide

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