RESEARCH CORE

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This research will elicit Explanatory Models of diabetes during pregnancy from pregnant diabetics (n=40), 60 pregnant non-diabetics (n=60), and their health care providers (n=60 ) regarding etiology, course, and treatment in order to reduce barriers to adherence and improve diabetes outcomes. All pregnant subjects are AI's. "Health Care Providers" are defined as physicians, licensed nurses, Certified Diabetes Educators (CDE's), and tribal Community Health Representatives (CHR's: paraprofessionals trained for home visits, screenings, health education, community resource identification, and transportation to health care sites). Collaboration with the Choctaw and Chicksaw Nations of Oklahoma will be continuous to strengthen all phases of the research process and assure that appropriate research goals will be met. Specific Aim # 1: Collaboration with Choctaw and Chickasaw Nations on decisions regarding questionnaire refinement, research implementation, and application of the research findings. Specific Aim # 2: Recruit 60 health care providers and 100 pregnant patients to serve as subjects for interviews. Specific Aim #3: Delineate the Explanatory Models held by 100 pregnant women of which 10 will have pre-gestational diabetes, 30 will have gestational diabetes, and 60 will not have diabetes. Hypothesis: Explanatory Models will vary by category of disease experience. Specific Aim # 4: Delineate the Explanatory Models held by patients about maternal and infant outcomes relevant to diabetes during pregnancy. Hypothesis: Patient's Explanatory Models of maternal and infant outcomes may predict help-seeking and adherence behaviors. Specific Aim # 5: Delineate the Explanatory Models of diabetes held by providers regarding their patients' diabetes education, care-seeking behaviors, and adherence/non-adherence to treatment plans. Hypothesis: Provider Explanatory Models of diabetes may be discordant with patient models of diabetes, contributing to communication barriers. Perceptions of patient help-seeking and adherence may either facilitate or be a barrier to optimal care. Specific Aim #6: Delineate provider models of care delivery. Hypothesis: Provider models of care delivery may either facilitate or impede patients' help-seeking and adherence behaviors.. Specific Aim #7: Delineate subjects' degree of identification with traditional AI culture or mainstream culture. Hypothesis: Subjects' cultural identification may predict their Explanatory Model of diabetes. Specific Aim # 8: In collaboration with Choctaw and Chickasaw Nations, disseminate the findings of the research to health care providers in both tribes.