Elsevier

Journal of Nutrition Education and Behavior

Volume 43, Issue 6, November–December 2011, Pages 482-491
Journal of Nutrition Education and Behavior

Research Article
Food Perceptions and Concerns of Aboriginal Women Coping with Gestational Diabetes in Winnipeg, Manitoba

https://doi.org/10.1016/j.jneb.2011.05.017Get rights and content

Abstract

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.

Introduction

An estimated 150 million people worldwide received a diagnosis of diabetes in 2000. By 2025, this figure is predicted to increase to 380 million.1 For Aboriginal groups, type 2 diabetes is of particular concern and widely considered to have reached epidemic proportions.2, 3, 4 Rates of gestational diabetes mellitus (GDM) appear to reflect the increasing incidence and prevalence of type 2 diabetes among Aboriginal populations around the world.2, 5 GDM has been defined as glucose intolerance of variable severity, with onset or first recognition during pregnancy.6 Reported prevalence rates for GDM range from 11.5% to 12.8% among groups of Aboriginal women in Canada compared with 3.7% in the overall Canadian population.7, 8, 9 A recent Quebec study revealed prevalence rates as high as 14.9% and 27.4% among Cree women who were classified at the onset of pregnancy as overweight with a body mass index (BMI) between 25 and 30, respectively, or obese with a BMI of greater than 30.10

Excessive weight gain before and during pregnancy, among other risk factors such as family history, has been found to increase a woman's risk of developing GDM.1, 10, 11 Few studies, however, exist that examine Aboriginal women's eating patterns in a Canadian context or otherwise. For Canadian Aboriginal women in their childbearing years, higher rates of overweight/obesity have been published, with 64% of Aboriginal women being classified as overweight compared with 47% of non-Aboriginal women. These young Aboriginal women (aged 19 to 30 years) also reported daily caloric intakes that significantly exceeded those of their non-Aboriginal counterparts, with items other than those included in the main food groups making up 32% of their average daily intake. Soft drink consumption for Aboriginal women was 3 times that of non-Aboriginal women in the same age category.12

These findings are supported by other recent dietary studies with smaller groups of Aboriginal women in the United States and Canada that point to poor-quality diets and lack of physical activity as contributing to weight issues.13, 14 Many knowledge and research gaps continue to exist in this area. Food consumption patterns and behaviors for pregnant Aboriginal women have been significantly over-looked in the published literature.15 Those studies that exist use almost exclusively self-reported dietary recall measures.16, 17 Although these studies are helpful in documenting dietary patterns, they are not able to address the complexities and meanings behind food choices and behaviors. Use of qualitative methodology is far less common, especially among Abori-ginal women experiencing diabetes and pregnancy.18, 19 There are no other studies that have examined the food perceptions of Aboriginal women with GDM in an urban environment.

Given the lack of research in this area, a qualitative research design was chosen for this study, incorporating an Explanatory Model Framework20 to provide Aboriginal women the opportunity to discuss their experiences with GDM. In Canada, the term Aboriginal refers to status and nonstatus First Nation, Inuit, and Métis people21 and will be used throughout this article to refer to the women of self-declared First Nation and Métis backgrounds who participated in this study. The primary objective in conducting the overall research project was to describe how Aboriginal women receiving prenatal care in the urban center of Winnipeg, Manitoba, perceive and cope with GDM according to their own explanations of the condition. In this article, a thematic discussion of participants' perceptions of food and challenges faced will be presented, integrating dietary treatment recommendations into their daily lives while experiencing a pregnancy complicated by GDM.

Section snippets

Methods

One of the strengths of qualitative research is the rich and detailed information it can generate. It provides a means of accessing information and issues about which relatively little is known.22 Participants are free to express themselves in their own terms.23 Findings are also descriptive or holistic, which is more consistent with an Aboriginal worldview or epistemology.24, 25

Interviewing was the primary method of data collection. Participants’ understandings and experiences with GDM were

Participant Characteristics

Women ranged in age from 18 to 43 years. On average, they had 3 children. As indicated in Table 1, 16 women were pregnant and 9 had GDM when they were interviewed. Thirteen were not pregnant during their interview but had experienced GDM during the previous 5 years. While receiving treatment for GDM, 18 of the 29, or 62% of participants, were prescribed insulin to manage their blood glucose (BG) levels. The remaining women were able to control their BG through lifestyle measures, including

Discussion

For this group of Aboriginal women with gestational diabetes, factors influencing food choice and eating behaviors were multifaceted. Participants in this study were attempting to gain control of their challenging life situations, as well as their BG levels in managing GDM. Many discussed dysfunctional or even abusive environments, with a myriad of stresses such as economic or social pressures that affected their ability to react confidently to treatment advice and effectively control their

Implications for Research and Practice

There is a need for detailed counseling and support for individuals with diabetes, as well as an increased focus on emotional outcomes, especially around eating.41 GDM represents the “burden of a potentially chronic, life-threatening illness” combined with the psychosocial stress of pregnancy.34 Further attention should therefore be directed toward the psychosocial management of GDM, with emphasis on flexibility, balance, and personal preferences when it comes to food choice. Avoiding an

Acknowledgments

I acknowledge the women who shared their experiences, the advisors and other community members for their insight and assistance, and members of my advisory committee: Gail Marchessault, Sharon Bruce, David Gregory, and Sora Ludwig. This research was made possible by the Manitoba Aboriginal Capacity and Developmental Research Environments (ACADRE)/Network Environments for Aboriginal Health Research (NEAHR), the Canadian Institutes of Health Research–Institute of Aboriginal People's Health, the

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