Perspectives of health educators and interviewers in a randomized controlled trial of a postpartum diabetes prevention program for Latinas: a qualitative assessment

Abstract

Background Lifestyle interventions regularly rely on study staff to implement the intervention and collect outcomes data directly from study participants. This study describes the experiences of project staff in two randomized controlled trials of a postpartum lifestyle intervention to reduce risk factors for type 2 diabetes in Latinas. Latinas are the fastest growing minority group in the U.S. and have the highest rates of type 2 diabetes after a diagnosis of gestational diabetes mellitus. The challenges of implementing lifestyle interventions for postpartum women have been poorly documented. Methods A qualitative focus group was conducted with eight staff members (five health educators and three health interviewers) involved in Proyecto Mamá and Estudio Parto . The discussion was audio recorded, transcribed, and coded in NVivo. Focus group topics included: 1) participant recruitment, 2) participant retention, 3) implementation of the lifestyle intervention, 4) assessment of behavior change, 5) overall challenges and rewarding aspects of the trial, and 6) recommended changes for future trials. Results Key themes emerged regarding enabling factors and barriers to implementing a lifestyle intervention in postpartum Latinas. Enabling factors included: a) the staff’s belief in the importance of the intervention, b) opportunities associated with the longitudinal nature of the trial, c) belief that the staff could empower participants to make behavior change, d) benefits of flexible intervention sessions, and e) connection with participants due to shared cultural backgrounds. Barriers included: a) participant stressors: home, food, and financial insecurity, b) low health literacy, c) issues related to recent immigration to the continental U.S., d) handling participant resistance to behavior change, e) involvement of family members in assessment visits, f) limitations of the assessment tools, and g) time limitations. Conclusions Findings highlight the challenging contexts that many study participants face, and shed light on the potentially influential role of health educators and interviewers in intervention implementation and data collection. Specific recommendations are made for strategies to improve adherence to diabetes prevention programs in postpartum underserved and minority populations in this challenging, transitional period of life. Trial registration NCT01679210 . Registered 5 September 2012; NCT01868230 . Registered 4 June 2013.

The Impact of a Lifestyle Intervention on Postpartum Weight Retention Among At-Risk Hispanic Women

“…Strengths of the study included the randomized design and its high-reach strategy, which could readily be translated into clinical practice in underserved and minority populations. The use of individualized and culturally tailored intervention components and the onset of the intervention during pregnancy are also strengths, 44 as were blinding of health assessors and a contact time−matched comparison arm. This study was significant because it focused on Hispanic pregnant women, a growing high-risk population who are consistently under-represented in research.…”

“…Future interventions should consider food, home, and financial insecurity and immigration issues; include ways in which family members can be engaged to positively support behavior change and enhance outcomes; and finally provide comprehensive training for those implementing the intervention to deal with issues related to social inequality and sociocultural expectations. 44…”

“…Consistent with prior literature, 45 the pressures of caring for a new baby tend to dominate the early postpartum period, and fatigue, work-related obstacles, and lack of time and motivation were major barriers to engagement. 44 Indeed, women lost to follow-up were more likely to be employed outside the home, which may help to explain lack of time to participate. In one of the few studies to commence during pregnancy, Ferrara et al 8 found that 26.4% of women were missing weights at 6 months postpartum and 32.7% at 12 months postpartum.…”

The impact of a randomized controlled trial of a lifestyle intervention on postpartum physical activity among at-risk hispanic women: Estudio PARTO

“…In addition, lifestyle interventions that start during pregnancy would take advantage of the "teachable moment" of pregnancy by addressing the observation that women with glucose intolerance in pregnancy do not perceive themselves as being at high risk for diabetes. Use of such high-reach, low-cost design strategies would facilitate translation of such interventions into clinical practice in underserved and minority populations [41].…”

Retraction

“…4 Even though several medicines including herbal are available in diabetes care, there are certain limitations. 5 Therefore, searching for appropriate drugs is of great importance for the clinical treatment of T1DM.…”