Perceptions of 2 Generations of Aboriginal Women on Causes of Diabetes During Pregnancy

Aboriginal Women's Experiences With Gestational Diabetes Mellitus: A Participatory Study With Mi'kmaq Women in Canada

In Canada, diabetes is 3 to 5 times more common among Aboriginal people than in the general population. Women with a diagnosis of gestational diabetes mellitus have an increased risk of developing glucose intolerance later in life, with almost half developing type II diabetes within 15 years. A participatory action research study using a Two-Eyed Seeing approach was conducted. Conversational interviews with 9 Mi'kmaq women who experienced gestational diabetes mellitus and talking circles were held. Hermeneutic phenomenology was used for data analysis. Themes included life-altering experience; barriers limiting access to health care; social support during pregnancy; and feeling compelled to take action.

Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States

Recently proposed international guidelines for screening for gestational diabetes mellitus (GDM) recommend additional screening in early pregnancy for sub-populations at a high risk of type 2 diabetes mellitus (T2DM), such as indigenous women. However, there are criteria that should be met to ensure the benefits outweigh the risks of population-based screening. This review examines the published evidence for early screening for indigenous women as related to these criteria. Any publications were included that referred to diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States (n = 145). The risk of bias was appraised. There is sufficient evidence describing the epidemiology of diabetes in pregnancy, demonstrating that it imposes a significant disease burden on indigenous women and their infants at birth and across the lifecourse (n = 120 studies). Women with pre-existing T2DM have a higher risk than women who develop GDM during pregnancy. However, there was insufficient evidence to address the remaining five criteria, including the following: understanding current screening practice and rates (n = 7); acceptability of GDM screening (n = 0); efficacy and cost of screening for GDM (n = 3); availability of effective treatment after diagnosis (n = 6); and effective systems for follow-up after pregnancy (n = 5). Given the impact of diabetes in pregnancy, particularly undiagnosed T2DM, GDM screening in early pregnancy offers potential benefits for indigenous women. However, researchers, policy makers and clinicians must work together with communities to develop effective strategies for implementation and minimizing the potential risks. Evidence of effective strategies for primary prevention, GDM treatment and follow-up after pregnancy are urgently needed.

Meaning of Health: The Perspectives of Aboriginal Adults and Youth in a Northern Manitoba First Nations Community

OBJECTIVE

To explore perspectives on the meaning of health to Aboriginal adults and youth living in a northern Manitoba First Nations community.

METHODS

Six focus groups with 29 youth and individual interviews with 10 adults were audio-recorded, transcribed verbatim and thematically analyzed.

RESULTS

Adults and older youth used aspects of health depicted in the Medicine Wheel to describe being healthy, but younger youth were not as specific. Both generations spoke about the importance of positive adult role models (emotional health), incorporation of traditional First Nations practices into everyday life (spiritual health), changes in diet and activity (physical health) and the significance of making good choices (mental health).

CONCLUSIONS

Participants incorporated aspects of current and traditional lifestyles into their discussion of health. Use of the Medicine Wheel to conceptualize health holistically on the part of both adults and older youth suggest that it may be an effective way to frame health promotion strategies for younger youth. Because it is in harmony with cultural values, such an approach may influence other members of this community to adopt healthful lifestyle practices.

Food perceptions and concerns of aboriginal women coping with gestational diabetes in Winnipeg, Manitoba

OBJECTIVE

To describe how Aboriginal women in an urban setting perceive dietary treatment recommendations associated with gestational diabetes mellitus (GDM).

DESIGN

Semi-structured explanatory model interviews explored Aboriginal women's illness experiences with GDM.

SETTING AND PARTICIPANTS

Twenty-nine self-declared Aboriginal women who had received a diagnosis of GDM within the last 5 years in Winnipeg, Manitoba.

MAIN OUTCOME MEASURES

Factors influencing Aboriginal women's prenatal food perceptions with GDM.

ANALYSIS

Thematic analysis was used through coding linkages and matrix queries to assist in identifying and categorizing patterns or relationships.

RESULTS

Participants associated fear, anxiety, and frustration with GDM. Emotional reactions appeared alongside negative relationships with food and other prescribed lifestyle treatments. Collectively, these results suggested that the experience of living with GDM can be overwhelming, as suggested by some of the complex factors influencing women's perceptions and reported behaviors. Discussions indicated many felt socially isolated and had a poor self-image and sense of failure resulting from ineffective GDM management practices.

CONCLUSIONS AND IMPLICATIONS

Future efforts should focus on self-efficacy and security in Aboriginal women's own interpretation of GDM, providing them with the understanding that there is potential for prevention and change.