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Perspectives on Prevention of Type 2 Diabetes After Gestational Diabetes: A Qualitative Study of Hispanic, African-American and White Women

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Abstract

Women with gestational diabetes (GDM) have a fivefold higher risk of developing type 2 diabetes (T2DM). Furthermore, Hispanic and African-American women are disproportionately affected by GDM, but their views on prevention of T2DM after gestational diabetes are largely unknown. We conducted semi-structured interviews with 23 women (8 Hispanic, 8 African-American, 7 non-Hispanic White) from two academic clinics in Chicago, IL. Interview questions elicited perspectives on prevention of T2DM; the interview protocol was developed based on the Health Belief Model. Two investigators applied template analysis to identify emergent themes. Women conceptualized risk for T2DM based on family history, health behaviors, and personal history of GDM. A subgroup of women expressed uncertainty about how GDM influences risk for T2DM. Women who described a strong link between GDM and T2DM often viewed the diagnosis as a cue to action for behavior change. T2DM was widely viewed as a severe condition, and desire to avoid T2DM was an important motivator for behavior change. Children represented both a key motivator and critical barrier to behavior change. Women viewed preventive care as important to alert them to potential health concerns. Identified themes were congruent across racial/ethnic groups. Diagnosis with GDM presents a potent opportunity for engaging women in behavior change. To fully harness the potential influence of this diagnosis, healthcare providers should more clearly link the diagnosis of GDM with risk for future T2DM, leverage women’s focus on their children to motivate behavior change, and provide support with behavior change during healthcare visits in the postpartum period and beyond.

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Acknowledgments

We would like to thank the patients and staff of the Prentice Ambulatory Clinic, the Northwestern Medical Faculty Foundation Obstetrics and Gynecology Clinic, and the Northwestern Memorial Physician’s Group Obstetrics and Gynecology clinic. Dr. Tang was supported by a pilot grant through the Feinberg School of Medicine Center for Equity in Clinical Preventive Services (a Center of Excellence funded by the Agency of Healthcare Research and Quality P01 HS021141, David W. Baker, PI). The funding agency had no involvement in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. A portion of these results were previously presented at the 2013 SGIM National Meeting in Denver, CO.

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Authors and Affiliations

  1. Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, 10th floor, Chicago, IL, 60611, USA

    Joyce W. Tang, Javiera Pumarino, Ronald T. Ackermann & Kenzie A. Cameron

  2. Department of Family Medicine, Jefferson Medical College, Philadelphia, PA, USA

    Krys E. Foster

  3. School of Population and Public Health, University of British Columbia, Vancouver, Canada

    Alan M. Peaceman

  4. Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Alan M. Peaceman

Authors
  1. Joyce W. Tang
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  2. Krys E. Foster
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  3. Javiera Pumarino
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  4. Ronald T. Ackermann
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  6. Kenzie A. Cameron
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Corresponding author

Correspondence to Joyce W. Tang.

Appendix: Health Beliefs and Lifestyle Behaviors of Women Diagnosed with Gestational Diabetes

Appendix: Health Beliefs and Lifestyle Behaviors of Women Diagnosed with Gestational Diabetes

Patient Qualitative Interview Protocol

  1. 1.

    As you know, we are particularly interested in hearing more about your experience with having gestational diabetes during your recent pregnancy. Take me back to when you first heard that you had gestational diabetes (during your recent pregnancy). Can you describe how you found out that you had GDM?

  2. 2.

    Can you tell me about what that experience was like for you?

  3. 3.

    How did you go about learning more about gestational diabetes? Who are the main people you talked with to find out more about gestational diabetes?

  4. 4.

    Can you tell me what questions you still have about gestational diabetes?

  5. 5.

    How did having gestational diabetes affect your pregnancy?

  6. 6.

    How does having had gestational diabetes affect your health now, if at all, after having your baby?

  7. 7.

    Did you get any testing for diabetes after delivering your baby?

    1. a.

      If no or unsure, were you given any information about needing a test for diabetes?

      1. i.

        If yes, can you tell me more about what may have prevented you from getting testing?

    2. b.

      If yes, what did it show?

  8. 8.

    How would you describe your chance of getting gestational diabetes with a future pregnancy? Tell me more, if you will, about your thinking on that.

    1. a.

      Is there anything you can do to lower your chances of getting gestational diabetes?

  9. 9.

    How would you describe your chance of getting diabetes in the future? Tell me more, if you will, about your thinking on that.

    1. a.

      Is there anything you can do to lower your chances of getting diabetes?

We’ve been talking about your experiences with having had gestational diabetes. Next I’d like to ask you some general questions about your current health.

  1. 10.

    Tell me about your most important health concerns right now. Can you tell me more about that?

  2. 11.

    How important, if it all, is it for you to see a doctor regularly for your health? Can you tell me more about your thinking on that? Do you plan to see a doctor for your health in the next year? Who do you consider your primary doctor (e.g., obstetrician/gynecologist, family medicine doctor, internist)?

  3. 12.

    How do you feel about your current level of exercise? What would you like to be doing?

  4. 13.

    How do you feel about your diet?

  5. 14.

    How do you feel about your weight?

  6. 15.

    What are the biggest challenges you face to exercising more? To improving your diet?

  7. 16.

    Who could help make it easier for you to exercise/eat more healthily?

That covers the things I wanted to ask. Can you think of anything else that I should have asked you, but didn’t think to ask?

  • Before we finish, do you mind if I ask you…

  • How would you describe your race or ethnicity?

  • How much schooling have you completed?

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Tang, J.W., Foster, K.E., Pumarino, J. et al. Perspectives on Prevention of Type 2 Diabetes After Gestational Diabetes: A Qualitative Study of Hispanic, African-American and White Women. Matern Child Health J 19, 1526–1534 (2015). https://doi.org/10.1007/s10995-014-1657-y

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  • DOI: https://doi.org/10.1007/s10995-014-1657-y

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