Menzies School of Health Research, Charles Darwin University, NT, Darwin, Australia.
Department of Endocrinology, Royal Darwin Hospital, NT, 0810, Darwin, Australia.
BMC Pregnancy Childbirth. 2021 Sep 16;21(1):624. doi: 10.1186/s12884-021-04055-2.
There is a high burden of gestational diabetes (GDM) and type 2 diabetes in pregnancy for Aboriginal and Torres Strait Islander women. Postpartum diabetes programs have the potential to prevent recurrent GDM and improve management of type 2 diabetes. However, data on such programs are limited, particularly in the Indigenous context. We aimed to explore Aboriginal Australian women's and health providers' preferences for a program to prevent and improve diabetes after pregnancy.
A phenomenological methodology underpinned semi-structured in-depth interviews with eleven Aboriginal women and seven health professionals across the Northern Territory from October 2019- February 2020. Interviews were analysed using an inductive analysis framework to address the barriers and enablers of proposed diabetes prevention programs identified by participants.
Identified structural barriers to lifestyle change included: food insecurity, persuasive marketing of unhealthy food options, lack of facilities and cultural inappropriateness of previous programs. Enablers to lifestyle change included: a strong link between a healthy lifestyle and connection with Country, family and community. Suggested strategies to improve lifestyle included: co-designed cooking classes or a community kitchen, team sports and structural change (targeting the social determinants of health). Lifestyle change was preferred over metformin to prevent and manage diabetes after pregnancy by participants and health care providers.
We recommend individual level programs be designed alongside policies that address systemic inequalities. A postpartum lifestyle program should be co-designed with community members and grounded in Aboriginal conceptions of health to adequality address the health disparities experienced by Aboriginal people in remote communities.
原住民和托雷斯海峡岛民妇女的妊娠糖尿病（GDM）和妊娠 2 型糖尿病负担很高。产后糖尿病项目有可能预防 GDM 复发并改善 2 型糖尿病的管理。然而，关于此类项目的数据有限，特别是在土著背景下。我们旨在探讨澳大利亚原住民妇女和卫生保健提供者对预防和改善产后糖尿病的项目的偏好。
2019 年 10 月至 2020 年 2 月，在北领地对 11 名原住民妇女和 7 名卫生专业人员进行了半结构式深入访谈，该研究采用现象学方法为基础。使用归纳分析框架对访谈进行分析，以解决参与者提出的拟议糖尿病预防项目的障碍和促成因素。
确定生活方式改变的结构性障碍包括：粮食不安全、不健康食品选择的有力推销、缺乏设施和以前项目的文化不适当性。生活方式改变的促成因素包括：健康生活方式与与国家、家庭和社区的联系之间的紧密联系。建议改善生活方式的策略包括：共同设计烹饪课程或社区厨房、团队运动和结构性变革（针对健康的社会决定因素）。参与者和医疗保健提供者都倾向于选择生活方式改变而非二甲双胍来预防和管理妊娠后糖尿病。
我们建议在制定针对系统性不平等的政策的同时设计个人层面的项目。产后生活方式项目应由社区成员共同设计，并以原住民对健康的概念为基础，以充分解决偏远社区中土著人民面临的健康差距。
