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Ghose B. Household Wealth Gradient in Low Birthweight in India: A Cross-Sectional Analysis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1271. [PMID: 37508768 PMCID: PMC10378485 DOI: 10.3390/children10071271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
A low birthweight is a common complication that can result from numerous physiological, environmental, and socioeconomic factors, and can put babies at an increased risk for health issues such as breathing difficulties, developmental delays, and even death in severe cases. In this analysis, I aim to assess the differences in the burden of low birthweight based on household wealth status in India using data from the latest National Family Health Survey (NFHS 2019-21). The sample population includes 161,596 mother-child dyads. A low birthweight is defined as a weight that is <2500 g at birth. I used descriptive and multivariate regression analyses in R studio to analyse the data. The findings show that 16.86% of the babies had a low birthweight. At the state level, the percentage of low birthweights ranges from 3.85% in Nagaland to 21.81% in Punjab. The mean birthweights range from 2759.68 g in the poorest, 2808.01 g in the poorer, 2838.17 g in the middle, 2855.06 g in the richer, and 2871.30 g in the richest wealth quintile households. The regression analysis indicates that higher wealth index quintiles have progressively lower risks of low birthweight, with the association being stronger in the rural areas. Compared with the poorest wealth quintile households, the risk ratio of low birthweight was 0.90 times lower for the poorer households and 0.74 times lower for the richest households. These findings indicate that household wealth condition is an important predictor of low birthweight by which low-income households are disproportionately affected. As wealth inequality continues to rise in India, health policymakers must take the necessary measures to support the vulnerable populations in order to improve maternal and infant health outcomes.
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Affiliation(s)
- Bishwajit Ghose
- Center for Social Capital and Environmental Research, Ottawa, ON K1M OZ2, Canada
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2
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Sinha DD, Williams RC, Hollar LN, Lucas HR, Johnson-Javois B, Miller HB, Stoermer A, Colditz GA, James AS, Herrick CJ. Barriers and facilitators to diabetes screening and prevention after a pregnancy complicated by gestational diabetes. PLoS One 2022; 17:e0277330. [PMID: 36399472 PMCID: PMC9674174 DOI: 10.1371/journal.pone.0277330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is increasing in the United States, with higher rates among minoritized racial and ethnic populations and lower income populations. GDM increases risk for type 2 diabetes (T2DM), and postpartum diabetes screening and prevention are imperative. This qualitative study examines barriers and facilitators to postpartum T2DM screening and prevention among non-privately insured individuals with a history of GDM in a state prior to Medicaid expansion. METHODS Thirty-six non-privately insured women with a history of GDM completed semi-structured interviews. Four focus groups and seven interviews were conducted with 30 nurse practitioners, physicians, physician assistants, nurses and registered dietitians from Federally Qualified Health Centers in St. Louis, MO. Interviews and focus groups were audio-recorded and transcribed. Data were analyzed using an integrative thematic analysis informed by the socio-ecological model. RESULTS Barriers and facilitators to T2DM screening and prevention occur across multiple environments (society, healthcare system, interpersonal, and individual). Societal barriers include insurance issues, unemployment, and lack of transportation, childcare, safe housing, and healthy food access, while facilitators include government sponsored programs and community organizations. Healthcare system barriers include care fragmentation, scheduling policies and time constraints while facilitators include care coordination, pregnancy support groups, and education materials. Interpersonal barriers include negative care experiences, cultural differences, communication challenges, competing priorities, and lack of a social support network, while facilitators include family and friend support and positive care experiences. Individual barriers include health complications and unhealthy food and exercise patterns, while facilitators include child wellbeing, empowered attitudes and healthy food and exercise patterns. CONCLUSIONS The socioecological model highlights the societal and systemic determinants that encompass individual and interpersonal factors affecting postpartum T2DM screening and prevention. This framework can inform multi-level interventions to increase postpartum T2DM screening and prevention in this high-risk population, including policy changes to alleviate higher-level barriers.
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Affiliation(s)
- Drishti D. Sinha
- Division of Endocrinology, Department of Medicine, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Roxann C. Williams
- Division of Endocrinology, Department of Medicine, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Laura N. Hollar
- Heritage Medical Associates, Nashville, Tennessee, United States of America
| | - Hannah R. Lucas
- Division of Endocrinology, Department of Medicine, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | | | - Heidi B. Miller
- St. Louis Integrated Health Network, St. Louis, Missouri, United States of America
| | - Amanda Stoermer
- St. Louis Integrated Health Network, St. Louis, Missouri, United States of America
| | - Graham A. Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Aimee S. James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Cynthia J. Herrick
- Division of Endocrinology, Department of Medicine, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, United States of America
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3
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Neven ACH, Lake AJ, Williams A, O'Reilly SL, Hendrieckx C, Morrison M, Dunbar JA, Speight J, Teede H, Boyle JA. Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework. Diabet Med 2022; 39:e14945. [PMID: 36004677 PMCID: PMC9826483 DOI: 10.1111/dme.14945] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/08/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023]
Abstract
AIMS Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from diverse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability, Opportunity, Motivation-Behaviour (COM-B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior GDM and identify relevant intervention components. METHODS Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive-deductive model, themes were mapped to the TDF and COM-B model. RESULTS After screening 5148 citations and 139 full texts, we included 35 studies (N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence-based recommendations for communications to support behaviour change. CONCLUSIONS We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from diverse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.
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Affiliation(s)
- Adriana C. H. Neven
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
| | - Amelia J. Lake
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Amelia Williams
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Sharleen L. O'Reilly
- Centre for Physical Activity and Nutrition ResearchDeakin UniversityBurwoodVictoriaAustralia
- UCD Institute of Food and Health, School of Agriculture and Food Science, University CollegeDublin 4Ireland
| | - Christel Hendrieckx
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | | | - James A. Dunbar
- Deakin Rural Health, School of MedicineDeakin UniversityWarrnamboolVictoriaAustralia
| | - Jane Speight
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes VictoriaMelbourneVictoriaAustralia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, Monash Public Health and Preventive MedicineMonash UniversityClaytonVictoriaAustralia
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4
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Ikemoto Sato AK, Zerbinatti Pereira R, Moreira Dos Santos PH, Mazzo A, Zajdenverg L, Negrato CA. Barriers and interventions for postpartum reclassification of glycemic status in women with gestational diabetes mellitus: A scoping review. Diabetes Metab Syndr 2022; 16:102552. [PMID: 35921764 DOI: 10.1016/j.dsx.2022.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Our aim was to summarize, analyze and disseminate the current state of knowledge about the barriers and facilitators in postpartum reclassification that women who have had gestational diabetes face. METHODS Data collection was carried out from January to March 2021 in PubMed, Scopus, Web of Science (WoS), Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS Of the 361 studies initially retrieved in the search, 32 articles published between 2010 and 2020 were selected because they were within our objective. CONCLUSION Multiple barriers and interventions were found regarding the reclassification of the glycemic status of women who had Gestational Diabetes during pregnancy. Therefore, further studies are needed to achieve a better intervention for this condition.
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Brown JA, Leonard M, Clinton T, Bower JK, Gillespie SL, Fareed N, Thomas N, Prater L, Lorenz A, May S, Voisin C, Thung S, Oza-Frank R, Bose Brill S. Mothers' Perspectives on a Mother/Infant Dyad Postpartum Primary Care Program Following Gestational Diabetes Mellitus: A Qualitative Pilot Study. Sci Diabetes Self Manag Care 2022; 48:247-257. [PMID: 35658777 DOI: 10.1177/26350106221100539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study is to characterize mothers' experiences within a mother/infant dyad postpartum primary care program (Dyad) following gestational diabetes mellitus (GDM) to inform improvements in the delivery of care. METHODS A qualitative pilot study of women (n = 10) enrolled in a mother/infant Dyad program was conducted in a primary care practice at a large, urban academic medical center. Respondents were asked a series of open-ended questions about their experience with GDM, the Dyad program, and health behaviors. Interviews were audio-recorded, transcribed verbatim, and analyzed using ground theory with NVivo 12 Plus software. RESULTS Three key themes emerged: (1) Dyad program experience, (2) implementation of health behavior changes, and (3) acknowledgment of future GDM and type 2 diabetes mellitus (T2DM) health risks. Respondents found the Dyad program respondents felt that the program conveniently served mother and infant health care needs in a single appointment. Respondents also valued support from primary care providers when implementing health behavior changes. The Dyad program provided an opportunity for respondents to understand their current and future risk for developing GDM and T2DM. CONCLUSIONS Postpartum women enrolled in the Dyad program received highly personalized primary care services. The results of our study will help integrate patient-centered strategies into models for GDM care to maintain patient engagement in postpartum clinical services.
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Affiliation(s)
- Jordyn A Brown
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio.,Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Melissa Leonard
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Tiffany Clinton
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan
| | - Julie K Bower
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Shannon L Gillespie
- The Martha S. Pitzer Center for Women, Children and Youth, The Ohio State College of Nursing, Columbus, Ohio
| | - Naleef Fareed
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Nikki Thomas
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura Prater
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio.,Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, Washington.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Allison Lorenz
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Sara May
- Ohio Colleges of Medicine Government Resource Center, Columbus, Ohio
| | - Christiane Voisin
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Stephen Thung
- Division of General Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Reena Oza-Frank
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, Columbus, Ohio
| | - Seuli Bose Brill
- Division of General Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio
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Wishart D, Cruz Alvarez C, Ward C, Danner S, O'Brian CA, Simon M. Racial and Ethnic Minority Pregnant Patients with Low-Income Experiences of Perinatal Care: A Scoping Review. Health Equity 2021; 5:554-568. [PMID: 34909522 PMCID: PMC8665802 DOI: 10.1089/heq.2021.0017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: The maternal mortality ratio for the United States (US) has consistently risen over recent decades. This mortality is especially pronounced within minority populations who experience a maternal mortality and morbidity rate that are much higher than their non-Hispanic white counterparts. Qualitative data are critical in gaining true insight from minority pregnant and postpartum persons. Such data should serve as the basis for building interventions and programs that seek to eradicate perinatal inequities. This review examines the qualitative literature on racial and ethnic minority pregnant patients with low income and their experiences during perinatal care (PNC) to identify recurrent themes that can be addressed through targeted interventions. Methods: PubMed, CINAHL, and Web of Science databases were searched for qualitative studies on racial and ethnic minority pregnant patients with low income and their experiences during PNC. Twenty-two articles were included for analysis. Thematic synthesis was performed to identify categories and recurring themes in each article. Results: Five major categories were identified as consistent experiences of pregnant patients with PNC clinicians: support, education, connection, communication, and trust. Of these, clinician support was the most consistently coded category. Eighteen of the 23 articles discussed tangible support patients had received from their clinicians, such as care coordination and referrals to support services. The second most coded category was education, which was represented in 16 articles. Education was mostly represented negatively as lack of adequate perinatal care education given during the perinatal period. Finally, the categories of connection, communication, and trust were represented by 18, 17, and 17 articles, respectively. Conclusions: These qualitative studies provided specific examples of what racial and ethnic minority pregnant patients with low income deemed positive and negative during the perinatal period and outline ways that these experiences can be improved. Future studies can take the experiences reported in this review to help inform interventions to improve patient experiences and health outcomes that minority persons face in the perinatal period.
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Affiliation(s)
- Danielle Wishart
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA.,Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cindy Cruz Alvarez
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Carmenisha Ward
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sankirtana Danner
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Catherine A O'Brian
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Melissa Simon
- Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois, USA
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7
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Bounds FL, Rojjanasrirat W, Martin MA. Team-Based Approach to Managing Postpartum Screening of Women with Gestational Diabetes for Type 2 Diabetes. J Midwifery Womens Health 2021; 66:101-107. [PMID: 33599099 DOI: 10.1111/jmwh.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Approximately 6% of pregnant women develop gestational diabetes mellitus (GDM), which is a strong risk factor for developing type 2 diabetes mellitus. It is recommended that women with GDM complete a 75-g oral glucose tolerance test (OGTT) 4 to 12 weeks postpartum to screen for type 2 diabetes. A 3-month retrospective chart review in 2 patient-centered medical homes found that postpartum screening for type 2 diabetes was performed in only 39% of eligible women, despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) and the American Diabetes Association. Thus, a quality improvement project was initiated to improve the postpartum type 2 diabetes screening rate. PROCESS This quality improvement project involved an education session that described current ACOG recommendations for diabetes screening. The education session included a pretest and posttest that evaluated participants' understanding about development of type 2 diabetes after GDM. A team-based postpartum guideline designed to enable women to complete a 75-g OGTT at the 4-to-12-week postpartum appointment was implemented. A postintervention chart review was conducted to determine the postintervention rate of type 2 diabetes screening. OUTCOME The mean pretest score for the clinical team was 57%, and the mean posttest score was 99%. Postpartum screening for women with GDM was improved from 39% of women for whom screening was indicated to 77% with the implementation of the team-based guideline. DISCUSSION The quality improvement project results demonstrated that improved understanding of ACOG recommendations combined with the implementation of a team-based guideline significantly improved postpartum screening for type 2 diabetes. Team-based management of care, including education of team members about the rationale for change, may also improve outcomes in other quality improvement projects.
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Affiliation(s)
- Faye L Bounds
- Department of Obstetrics and Gynecology, The Texas Children's Health Plan (TCHP) Center for Children and Women, Houston, Texas
| | | | - Mary A Martin
- Graceland University School of Nursing, Independence, Missouri
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8
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Roberts SP, Brown SJ, Roberts SH. Women's engagement, views and experiences of postnatal follow-up after gestational diabetes mellitus in pregnancy. Midwifery 2021; 101:103043. [PMID: 34126338 DOI: 10.1016/j.midw.2021.103043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The evidence base relating to women's engagement and experiences of postnatal care following Gestational Diabetes Mellitus in the United Kingdom is limited. Additionally, the uptake of a postnatal fasting blood glucose testing following Gestational Diabetes Mellitus appears to be poor. OBJECTIVE This study aimed to explore women's engagement, views and experiences of postnatal care following Gestational Diabetes Mellitus in the United Kingdom. DESIGN AND PARTICIPANTS An online survey of participants that had Gestational Diabetes Mellitus was undertaken to gather mixed-methods data regarding women's engagement, views and experiences of postnatal care. Demographic data were also collected. FINDINGS A total of 31 participants completed the online survey; respondents were from two countries in the United Kingdom only (England and Wales). Some respondents indicated positive postnatal experiences following Gestational Diabetes Mellitus (such as good family support) with effective communication by some healthcare teams and screening coinciding with engagement with the routine six week follow-up appointment. Overall, findings indicated a general dissatisfaction with the care provided, mostly due to the inconsistency of information and advice in relation to the type of screening test and the timing, location and organisation of blood glucose screening and follow up care. CONCLUSION This study provides an insight into ways that may improve women's engagement, views and experiences of postnatal care following Gestational Diabetes Mellitus in England and Wales. IMPLICATIONS FOR PRACTICE Findings indicate a lack of consistent adherence to national guidance. A clear care pathway facilitating continuity of care for women in the postnatal period following Gestational Diabetes Mellitus, along with further education and support for health professionals, may improve the provision of postnatal care. The authors recognise the limitations of this small standalone study however, findings highlight the need for further exploration of postnatal follow up following Gestational Diabetes Mellitus in the UK.
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Affiliation(s)
- Siân Pierce Roberts
- Midwifery Department, School of Healthcare Sciences, Bangor University, Fron Heulog, Ffriddoedd Road, Bangor, Gwynedd, Wales, LL57 2DG.
| | - Sheila Js Brown
- School of Healthcare Sciences Bangor University, Fron Heulog, Ffriddoedd Road, Bangor, Gwynedd, Wales, LL57 2DG
| | - Seren Haf Roberts
- School of Health Care Sciences, Bangor University, Archimedes Centre, Wrexham Technology Park, Croesnewydd Road, Wrexham, Wales, LL13 7YP
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Thompson JR, Risser LR, Dunfee MN, Schoenberg NE, Burke JG. Place, Power, and Premature Mortality: A Rapid Scoping Review on the Health of Women in Appalachia. Am J Health Promot 2021; 35:1015-1027. [PMID: 33906415 DOI: 10.1177/08901171211011388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Appalachian women continue to die younger than in other US regions. We performed a rapid scoping review to summarize women's health research in Appalachia from 2000 to 2019, including health topics, study populations, theoretical frameworks, methods, and findings. DATA SOURCE We searched bibliographic databases (eg, PubMed, PsycINFO, Google Scholar) for literature focusing on women's health in Appalachia. STUDY INCLUSION AND EXCLUSION CRITERIA Included articles were: (1) on women's health in Appalachia; (2) published January 2000 to June 2019; (3) peer-reviewed; and (4) written in English. We excluded studies without reported data findings. DATA EXTRACTION Two coders reviewed articles for descriptive information to create summary tables comparing variables of interest. DATA SYNTHESIS Two coders co-reviewed a sub-sample to ensure consensus and refine data charting categories. We categorized major findings across the social-ecological framework. RESULTS A search of nearly 2 decades of literature revealed 81 articles, which primarily focused on cancer disparities (49.4%) and prenatal/pregnancy outcomes (23.5%). Many of these research studies took place in Central Appalachia (eg, 42.0% in Kentucky) with reproductive or middle-aged women (82.7%). Half of the studies employed quantitative methods, and half used qualitative methods, with few mixed method or community-engaged approaches (3.7%). Nearly half (40.7%) did not specify a theoretical framework. Findings included complex multi-level factors with few articles exploring the co-occurrence of factors across multiple levels. CONCLUSIONS Future studies should: 1) systematically include Appalachian women at various life stages from under-represented sub-regions; 2) expand the use of rigorous methods and specified theoretical frameworks to account for complex interactions of social-ecological factors; and 3) build upon existing community assets to improve health in this vulnerable population.
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Affiliation(s)
- Jessica R Thompson
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | - Lauren R Risser
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
| | | | | | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, 51303University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA
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Moore AP, Flynn AC, Adegboye ARA, Goff LM, Rivas CA. Factors Influencing Pregnancy and Postpartum Weight Management in Women of African and Caribbean Ancestry Living in High Income Countries: Systematic Review and Evidence Synthesis Using a Behavioral Change Theoretical Model. Front Public Health 2021; 9:637800. [PMID: 33681136 PMCID: PMC7925838 DOI: 10.3389/fpubh.2021.637800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Women of black African heritage living in high income countries (HIC) are at risk of obesity and weight-related complications in pregnancy. This review aimed to synthesize evidence concerning attitudes to weight management-related health behaviors in pregnancy and postpartum, in women of black African ancestry, living in high-income countries. Methods: A systematic review of the literature and thematic evidence synthesis using the Capability-Opportunity-Motivation Behavioral change theoretical model (COM-B). Databases searched included MEDLINE, EMBASE, Web of Science, and Scopus. The CASP tool was used to assess quality. Results: Twenty-four papers met the selection criteria, most of which were from the US. Motivational factors were most commonly described as influencers on behavior. Normative beliefs about "eating for two," weight gain being good for the baby, the baby itself driving food choice, as well as safety concerns about exercising in pregnancy, were evident and were perpetuated by significant others. These and other social norms, including a cultural acceptance of larger body shapes, and daily fast food, created a challenge for healthy behavior change. Women also had low confidence in their ability to lose weight in the postpartum period. Behavior change techniques, such as provision of social support, use of credible sources, and demonstration may be useful to support change. Conclusions: The women face a range of barriers to engagement in weight-related health behaviors at this life-stage. Using a theoretical behavior change framework can help identify contextual factors that may limit or support behavior change.
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Affiliation(s)
- Amanda P. Moore
- Department of Nutrition, Kings College London, London, United Kingdom
| | - Angela C. Flynn
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | | | - Louise M. Goff
- Department of Nutrition, Kings College London, London, United Kingdom
| | - Carol A. Rivas
- UCL Social Research Institute, University College London (UCL), London, United Kingdom
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11
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Gunn C, Bernstein J, Bokhour B, McCloskey L. Narratives of Gestational Diabetes Provide a Lens to Tailor Postpartum Prevention and Monitoring Counseling. J Midwifery Womens Health 2020; 65:681-687. [PMID: 32568461 DOI: 10.1111/jmwh.13122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 03/02/2020] [Accepted: 03/10/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Women with gestational diabetes mellitus (GDM) have a marked increased risk of early onset type 2 diabetes, but less than half initiate postpartum glucose testing or connect with a primary care provider for continued follow-up after giving birth. This study analyzed women's narratives about their GDM-affected pregnancies to (1) identify different patterns (narrative archetypes) that capture the GDM experience; (2) explore how these patterns relate to awareness of ongoing risk after pregnancy and affect participation in self-care, monitoring, and preventive health care going forward; and (3) explore the use of identified patterns to tailor conversations with patients during prenatal and postpartum care to their actual perceptions and concerns about future risk. METHODS Open-ended interviews elicited women's experiences and perspectives about GDM and its management. A narrative analysis first identified segments of text related to risk and behaviors and then applied Frank's narrative archetypes (restitution, chaos, quest) as an interpretive lens. RESULTS Interviews were completed in English (n = 15), Spanish (n = 7), and Haitian Creole (n = 7). We found distinct patterns: stories of restitution (n = 13), quest (n = 4), chaos (n = 4), and mixed narratives (n = 7). Using these archetypes, we found differences in how women respond to challenges related to disease complexity, treatment, and future risks. These patterns led to marked differences in the steps women took to prevent early onset type 2 diabetes. DISCUSSION Frank's narrative types provided insight into women's responses to clinical protocols, health care advice, and subsequent prevention actions. A restitution pattern may result in premature closure and lack of awareness of risk. Similarly, a chaos pattern may contribute to a sense of helplessness to implement follow-up recommendations, despite risk awareness. Understanding these patterns can help clinicians tailor individualized support as women transition from GDM with its focus on a healthy fetus and newborn to preventive self-care to protect their health.
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Affiliation(s)
- Christine Gunn
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, Boston, Massachusetts.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Judith Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.,Department of Emergency Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Barbara Bokhour
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts.,Center for Health Quality, Outcomes and Economic Research at the Bedford Veterans Affairs, Boston, Massachusetts
| | - Lois McCloskey
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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12
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Ingol TT, Kue J, Conrey EJ, Oza-Frank R, Weber MB, Bower JK. Perceived Barriers to Type 2 Diabetes Prevention for Low-Income Women With a History of Gestational Diabetes: A Qualitative Secondary Data Analysis. DIABETES EDUCATOR 2020; 46:271-278. [PMID: 32597385 DOI: 10.1177/0145721720920255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this qualitative study was to examine perceived barriers to adoption of lifestyle changes for type 2 diabetes prevention among a diverse group of low-income women with a history of gestational diabetes mellitus (GDM). METHODS A secondary data analysis of 10 semistructured focus group discussions was conducted. Participants were low-income African American, Hispanic, and Appalachian women ages 18 to 45 years who were diagnosed with GDM in the past 10 years. A qualitative content analysis was conducted to identify key themes that emerged within and between groups. RESULTS Four key themes emerged on the role of knowledge, affordability, accessibility, and social support in type 2 diabetes prevention. Women discussed a lack of awareness of the benefits of breastfeeding and type 2 diabetes prevention, inaccessibility of resources in their local communities to help them engage in lifestyle change, and the desire for more culturally relevant education on healthful food options and proper portion sizes. DISCUSSION Study findings suggests that to improve effectiveness of type 2 diabetes prevention efforts among low-income women with GDM history, health care providers and public health practitioners should avoid using "one-size-fits-all" approaches to lifestyle change and instead use tailored interventions that address the cultural and environmental factors that impact women's ability to engage in recommended behavior change.
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Affiliation(s)
| | - Jennifer Kue
- College of Nursing, The Ohio State University, Columbus, Ohio (Dr Kue)
| | - Elizabeth J Conrey
- Ohio Department of Health, Columbus, Ohio (Dr Conrey, Dr Oza-Frank).,Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Conrey)
| | - Reena Oza-Frank
- Ohio Department of Health, Columbus, Ohio (Dr Conrey, Dr Oza-Frank)
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Weber)
| | - Julie K Bower
- College of Public Health, The Ohio State University, Columbus, Ohio (Dr Bower)
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13
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Barriers and facilitating factors in the prevention of diabetes type 2 and gestational diabetes in vulnerable groups: A scoping review. PLoS One 2020; 15:e0232250. [PMID: 32401778 PMCID: PMC7219729 DOI: 10.1371/journal.pone.0232250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/12/2020] [Indexed: 11/27/2022] Open
Abstract
Aims Type 2 diabetes mellitus (T2DM) and gestational diabetes (GDM) are globally on the rise, accompanied by comorbidities and associated health costs. Increased physical activity, healthy nutrition, and weight loss have shown the potential to prevent T2DM/GDM. Despite this, reaching vulnerable groups remains a key challenge. The aim of this scoping review was to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Methods We conducted a systematic literature search in May 2018, updated in September 2019, in several databases (e.g. PubMed, Embase) to identify barriers and facilitating factors in the prevention of T2DM/GDM in vulnerable groups. Two reviewers independently screened the results. Extracted data was charted, categorized, and summarized. Results We included 125 articles. Ninety-eight studies were extracted, and eight categories of barriers and facilitating factors were formed. The most common categories of barriers were limited knowledge, family/friends, and economic factors, and the most common categories of facilitating factors were family/friends, social support, and knowledge. Conclusion This scoping review identified various barriers and facilitating factors in vulnerable groups. Preventive interventions should consider these barriers and facilitating factors in developing preventive interventions or in adapting existing ones.
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14
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Linn BK, Ely GE, Staton M. Latent Profiles of Health and Reproductive Risk and Protective Factors among Women in Appalachia. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2020; 20:155-167. [PMID: 33209100 PMCID: PMC7668409 DOI: 10.1080/1533256x.2020.1748976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Women who use opiates and are involved in the criminal justice system in Appalachia may be prone to adverse health outcomes. In this study, we performed a latent class analysis of risk and protective factors on 400 drug-using women recruited from rural, Appalachian jails. A two-profile solution best fit the data. Both profiles evinced low levels of condom use, reproductive and physical health screens, and STD history. However, the primary substantive difference between the profiles was partner risk behavior: the higher risk class had main male partners with histories of injection drug use and incarceration. Results suggest that interventions need to be tailored to unique profiles of risk and protective factors, which should include taking partner risk into consideration.
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Affiliation(s)
- Braden K Linn
- Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, Buffalo, NY
| | - Gretchen E Ely
- School of Social Work, University at Buffalo, The State University of New York, Buffalo, NY
| | - Michele Staton
- University of Kentucky, College of Medicine, Medical Behavioral Science Building, Lexington, KY
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15
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Daneshmand SS, Stortz S, Morrisey R, Faksh A. Bridging Gaps and Understanding Disparities in Gestational Diabetes Mellitus to Improve Perinatal Outcomes. Diabetes Spectr 2019; 32:317-323. [PMID: 31798289 PMCID: PMC6858080 DOI: 10.2337/ds19-0013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IN BRIEF For a woman who is facing financial, cultural, psychological, or social challenges, discovering that she has gestational diabetes mellitus (GDM) represents a significant burden. By better understanding challenges underserved women with GDM face, multidisciplinary clinical teams can make essential changes in health care delivery to optimize outcomes not just during pregnancy, but also, equally importantly, beyond pregnancy to prevent long-term disease.
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Affiliation(s)
- Sean S. Daneshmand
- Division of Perinatology, Department of Obstetrics and Gynecology, Scripps Memorial Hospital La Jolla, San Diego, CA
| | - Sharon Stortz
- Department of Obstetrics and Gynecology, Naval Medical Center, San Diego, CA
| | | | - Arij Faksh
- Division of Perinatology, Department of Obstetrics and Gynecology, Scripps Memorial Hospital La Jolla, San Diego, CA
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16
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Abstract
PURPOSE OF REVIEW Gestational diabetes (GDM) is associated with adverse pregnancy and neonatal outcomes and increased maternal risk for subsequent type 2 diabetes. The best diagnostic strategy for GDM is debated and the role of oral antidiabetic medications (OAD) for treatment is unclear. In this paper, we review methods of GDM diagnosis, updates in GDM therapy, and interventions to reduce future type 2 diabetes in women with a history of GDM. RECENT FINDINGS A "one-step" screening protocol for GDM using 75-g, 2-h oral glucose tolerance testing at 24-28 weeks gestation is recommended by the International Association of the Diabetes and Pregnancy Study Groups, the American Diabetes Association, and the Endocrine Society. This strategy identifies a milder degree of hyperglycemia and thus increases GDM prevalence. Studies indicate that in these cases of mild hyperglycemia, treatment decreases pregnancy and neonatal complications. Insulin analogues including detemir, aspart, and lispro have been shown to be safe in pregnancy with a pregnancy category B classification. Growing literature suggests that sulfonylureas cross the placenta and are associated with increased incidence of macrosomia and neonatal hypoglycemia. Telephone or online diabetes prevention program (DPP)-based interventions for women with GDM have shown encouraging results in pilot studies. Insurance coverage remains a barrier. Additional studies are needed to determine the safety of OAD in pregnancy. Public policy supporting DPP could help improve patient access to these proven interventions.
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Affiliation(s)
- Laura T Dickens
- Department of Medicine, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S. Maryland Ave., MC 1027, Chicago, IL, 60637, USA.
| | - Celeste C Thomas
- Department of Medicine, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S. Maryland Ave., MC 1027, Chicago, IL, 60637, USA
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Continued Disparities in Postpartum Follow-Up and Screening Among Women With Gestational Diabetes and Hypertensive Disorders of Pregnancy: A Systematic Review. J Perinat Neonatal Nurs 2019; 33:136-148. [PMID: 31021939 PMCID: PMC6485948 DOI: 10.1097/jpn.0000000000000399] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The postpartum period represents a critical window to initiate targeted interventions to improve cardiometabolic health following pregnancies complicated by gestational diabetes mellitus and/or a hypertensive disorder of pregnancy. The purpose of this systematic review was to examine studies published since 2011 that report rates of postpartum follow-up and risk screening for women who had gestational diabetes and/or a hypertensive disorder of pregnancy and to identify disparities in care. Nine observational studies in which postpartum follow-up visits and/or screening rates were measured among US women following pregnancies complicated by gestational diabetes and/or a hypertensive disorder of pregnancy were reviewed. Rates of postpartum follow-up ranged from 5.7% to 95.4% with disparities linked to black race and Hispanic ethnicity, low level of education, and coexisting morbidities such as mental health disorders. Follow-up rates were increased if the provider was an obstetrician/endocrinologist versus primary care. Payer source was not associated with follow-up rates. The screening rate for diabetes in women who had gestational diabetes did not exceed 58% by 4 months across the studies analyzed, suggesting little improvement in the last 10 years. While women who had a hypertensive disorder appear to have had a postpartum blood pressure measured, it is unclear whether follow-up intervention occurred. Overall, postpartum screening rates for at-risk women remain suboptimal and vary substantially. Further research is warranted including reliable population-level data to inform equitable progress to meeting the evidence-informed guidelines.
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