Perceptions and Concerns Regarding Diabetes Mellitus During Pregnancy Among American Indian Women

Abstract

Diabetes among American Indian (AI) people is a. condition that creates excessive morbidity and mortality and is a significant health disparity. This research delineated culturally constructed models of diabetes mellitus (DM) among 97 pregnant women in 2 large AI Nations to Oklahoma. Analysis of data revealed intense anxiety, fear, and dread related to DM during pregnancy. The sample was stratified by DM status: (a) absence of DM (n = 66), (b) DM prior to pregnancy (n = 4), and (c) gestational (n = 27). Structured and semistructured interviews elicited patient culturally based explanatory models (EMs) of etiology, course, and treatment. The research incorporated an integrated phenomenologic and ethnographic approach and yielded both quantitative and qualitative data. General findings comprised the following main categories of patients’ concerns regarding DM as an illness: (a) care-seeking behaviors, (b) medical management, (c) adherence and self-management, (d) complications, and (e) the conceptual sense of DM as a “severe” and feared condition. Many findings varied according to acculturation status, but all included significant fear and anxiety surrounding (a) the health and well-being of the unborn child, (b) the use of insulin injections, (c) blindness, (d) amputation, and (e) death, but with (f) a paradoxically lowered anxiety level about diabetes severity overall, while at the same time expressing extreme dread of specific outcomes. The latter finding is considered consistent with the presence of chronic conditions that can usually be managed, yet still having risk if severe.

A systematic review and meta-analysis of gestational diabetes mellitus and mental health among BAME populations

“…An initial search identified 20,040 studies, of which, those with limited discussions in relation to MH outcomes and of poor quality, were excluded, resulting in a final dataset of 69 studies ( Table 1a ) of which 46 studies were systematically included and thematically analysed ( Table 2 ). These 46 studies included 26 qualitative [ 12 , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ], 17 cohort [ 7 , 18 , 21 , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] ], 6 controlled [61] , [62] , [63] , [64] , [65] , [66] , 2 randomised controlled trials [ 19 , 67 ] and 2 mixed methods [ 68 , 69 ] studies. Based on the eligibility criteria, and the quality assessment, 21 studies were selected for the meta-analysis.…”

“…Of the 26 studies that reported psychological experiences of women with GDM [ 12 , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ], there appears to be psychological distress associated with concerns related to the baby [23] , blood glucose monitoring [45] and administering insulin injections [39] . Whilst these studies highlighted the emotional burden of GDM, the self-reported, subjective descriptions of the psychological distress experienced by these women, a clinical diagnosis remained absent.…”

“…Migrant women experiencing language barriers reported frustration accessing healthcare [32] and some BAME women did not feel satisfied with care [28] . Some women deemed dietary and lifestyle advice unacceptable and resorted to traditional herbal remedies [26] or spiritual measures [27] to manage the condition. Due to the small sample sizes demonstrated within these studies, the generalisability of the findings were challenging to quantify.…”

“…Although translations were cross-checked, this introduced a possible risk of bias. In contrast, several other studies excluded women who could not speak English [ 12 , 23 , 26 , 34 , 53 , 69 ], which could be perceived as possible discrimination. Lack of cultural paradigm-based methodology and incremental procedures to reflect these during the study design process, further purports concern around the translation of research outcomes to clinical practices, where BAME populations are involved.…”

The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions

“…The paucity of qualitative research exploring Indigenous women’s experiences and perceptions of GDM [ 11 , 36 – 38 ] was highlighted for us when conducting research on T2DM. While undertaking a qualitative study in a rural Māori community about the complexities of living with diabetes, we noted that a common, often emotional, discourse about the experience of diabetic pregnancies was emerging from the data.…”