PRENATAL DIABETES EDUCATION IN PIMA INDIANS

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Compared with whites in the United States, Native Americans suffer from higher prevalence of Diabetes Mellitus (diabetes). Because the etiology of diabetes includes a complex set of genetic and environmental factors, its prevention requires the patient's behavioral commitment in several lifestyle areas. Exacerbating incidence rates is the fact that children born to mothers who had gestational diabetes are at greater risk for developing diabetes themselves. Thus, several biomedical concepts - namely risk, prevention, disease latency, and genetic predisposition or heritibility - are both key in the prevention of diabetes and very difficult to translate cross-culturally. The aim of this research is to develop a culturally informed understanding of diabetes in Native American communities and to translate this understanding into more effective diabetes prevention programming. A focus on women and mothers is used in recognition of the importance of mother's behaviors (e.g., prenatal diabetes control, breastfeeding) as factors in their children's diabetes status. The research focuses on the Pima Indians who, despite their participation in longitudinal diabetes research for over three decades, maintain high rates of diabetes. The unique feature of this project is its rigorous ethnographic method. At least 10 key informants (male and female) will participate in regular, ongoing interviews. An additional 85 women (including 25% of women expected to be pregnant during the research period) will complete lengthy, open- ended interviews in home and other non-hospital settings. Other research methods are: daylong observations of behavioral data (e.g., diet, exercise/activity), participant observation in several settings, and interviews with hospital employees. Expected results include an ethnographic database which examines how/to what degree indigenous and popular systems of healing are blended with biomedical concepts; narratives, key terms, and explanatory models for diabetes, pregnancy, disease latency, vulnerability, heritibility, and risk; and a determination of the information and service needs of this risk group, including educational materials and methods. Results will be used for innovative hospital employee trainings, client care programming, prevention message development, and community education programs. This medical ethnography will also pave new ground in anthropological and biomedical research by contributing a model for ethnography-based quality monitoring and improvement.