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. 2023 Aug 1;23(1):552.
doi: 10.1186/s12884-023-05850-9.

Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study

Kelly R Moore  1 , Sarah A Stotz  1 , Martha Ann Terry  2 , Ellen W Seely  3 , Kelly Gonzales  4 , Gale Marshall  5 , Kristen J Nadeau  6 , Aletha Akers  7 , Yesenia Garcia-Reyes  6 , Denise Charron-Prochownik  8   9 ; Stopping GDM Study Group
Collaborators, Affiliations

Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study

Kelly R Moore et al. BMC Pregnancy Childbirth. .

Abstract

Background: American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented.

Methods: We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews.

Results: Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals.

Conclusion: Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.

Keywords: Adolescents; American Indians; Gestational diabetes; Reproductive health.

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Conflict of interest statement

Dr. Moore was a paid consultant for Novo Nordisk, Inc. No other authors have any conflicts to declare.

Figures

Fig. 1
Fig. 1
Images of mothers and daughters adapted to include grandmother for intergenerational focus as recommended by tribal voices for Stopping GDM
Fig. 2
Fig. 2
Image depicting physical activity adapted to include traditional game group physical activity as recommended by tribal voices for Stopping GDM
See this image and copyright information in PMC

References

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