PRENATAL DIABETES EDUCATION IN PIMA INDIANS

与美国白人相比，美国原住民患糖尿病的患病率更高。由于糖尿病的病因包括一系列复杂的遗传和环境因素，因此其预防需要患者在几个生活方式领域的行为承诺。加剧发病率的事实是，患有妊娠期糖尿病的母亲所生的孩子本身患糖尿病的风险更大。因此，几个生物医学概念-即风险，预防，疾病潜伏期和遗传易感性或遗传性-都是预防糖尿病的关键，并且很难跨文化翻译。这项研究的目的是在美洲原住民社区发展对糖尿病的文化了解，并将这种理解转化为更有效的糖尿病预防规划。对妇女和母亲的关注是为了认识到母亲行为的重要性（例如，产前糖尿病控制，母乳喂养）作为影响其子女糖尿病状况的因素。这项研究的重点是皮马印第安人，尽管他们参与了30多年的纵向糖尿病研究，但糖尿病的发病率仍然很高。该项目的独特之处在于其严格的民族志方法。至少有10名关键举报人（男性和女性）将参加定期、持续的访谈。另外85名妇女（包括25%预计在研究期间怀孕的妇女）将在家中和其他非医院环境中完成冗长的开放式访谈。其他的研究方法有：对行为数据的全天观察（例如，饮食、锻炼/活动）、在几种环境中的参与者观察以及与医院员工的访谈。预期成果包括：建立一个人种学数据库，研究土著和大众的治疗方法如何/在何种程度上与生物医学概念相结合;糖尿病、怀孕、疾病潜伏期、脆弱性、遗传性和风险的叙述、关键术语和解释模型;确定这一风险群体的信息和服务需求，包括教育材料和方法。研究结果将用于创新的医院员工培训，客户护理方案，预防信息开发和社区教育计划。这一医学人种学也将为人类学和生物医学研究铺平新的道路，为基于人种学的质量监测和改进提供一个模式。

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.