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PURPOSE: The purpose of this article is to present the results of the process evaluation and patient experience in completing the Diabetes Self-management Assessment Report Tool (D-SMART(R)), an instrument within the AADE Outcome System to assist diabetes educators to assess, facilitate, and track behavior change in the provision of diabetes self-management education (DSME). METHODS: The D-SMART was integrated into computer and telephonic systems at 5 sites within the Pittsburgh Regional Initiative for Diabetes Education (PRIDE) network. Data were obtained from 290 patients with diabetes using the system at these programs via paper-and-pencil questionnaires following baseline D-SMART assessments and electronic system measurement of system performance. Process evaluation included time of completion, understanding content, usability of technology, and satisfaction with the system. Patients were 58% female and 85% Caucasian and had a mean age of 58 years. Fifty-six percent of patients had no more than a high school education, and 78% had Internet access at home. RESULTS: Most patients reported completing the D-SMART at home (78%), in 1 attempt (86%) via the Internet (55%), and in less than 30 minutes. Seventy-six percent believed the questions were easy to understand, and 80% did not need assistance. Age was negatively associated with ease of use. Moreover, 76% of patients believed the D-SMART helped them think about their diabetes, with 67% indicating that it gave the diabetes educator good information about themselves and their diabetes. Most (94%) were satisfied with the D-SMART. Level of satisfaction was independent of the system being used. CONCLUSIONS: The D-SMART was easily completed at home in 1 attempt, content was understandable, and patients were generally satisfied with the wording of questions and selection of answers. The D-SMART is easy to use and enhanced communication between the patient and clinician; however, elderly patients may need more assistance. Computer-based and telephonic D-SMARTs appear to be feasible and useful assessment methods for diabetes educators. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine psychometric properties of scales within the theoretically based Reproductive Health Attitudes and Behavior (RHAB) instrument for examining preconception planning of young women with diabetes. Scales represented constructs from 3 social cognition models that can influence reproductive health behavior. METHODS: Psychometrics were examined on data from a telephone interview on this 48-item instrument using a sample of 87 female adolescents with diabetes from 4 medical centers. RESULTS: Overall, the major factors (scales) clustered according to theoretical underpinning. Most Cronbach alphas were moderate (.60-.83). CONCLUSIONS: RHAB appears to have acceptable levels of validity/reliability for use with female adolescents with diabetes. [ABSTRACT FROM AUTHOR]

PURPOSE: This study explored the awareness of issues related to diabetes and pregnancy, preconception counseling (PC), and contraception in adolescent women with type 1 diabetes (T1D). METHODS: A descriptive-qualitative method was used to collect open-ended data during a telephone interview on reproductive health by same-gender research assistants. Eighty subjects were recruited from multiple sites (mean age = 17.6 +/- 1.0 year; range, 16-20). Questions focused on 2 themes, awareness of diabetes and reproductive health (pregnancy, PC, birth control) and where to seek information about these issues. Responses were written verbatim. Pattern recognition detected common themes. Results were cross-checked for interrater reliability. RESULTS: Overall, the response 'don't know' or 'never heard about it' was most frequently given. Most teens in this sample were unaware of the term preconception counseling; 65% (n = 52) indicated they knew nothing about PC. Many were not aware of the risks of pregnancy-related complications in women with diabetes. One fourth of the teens were aware of preplanning a pregnancy and the importance of good metabolic control. Many knew where to seek information about diabetes and pregnancy, and birth control. CONCLUSIONS: This sample of teens lacked awareness of pregnancy-related complications with diabetes, the term and role of PC in preventing these complications, and the importance for women with diabetes to use a highly effective birth control method for preventing an unplanned pregnancy. Because of its implications for future reproductive health behavior and preventing unplanned pregnancies and complications, during their routine clinic visits, it is imperative for health professionals to raise these issues with their adolescent female patients. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to examine the diabetes nurse educator's role, practice, and training in preconception counseling (PC) when caring for adolescents with diabetes. METHODS: A descriptive, correlational research design, using a cross-sectional survey technique, was used. Subjects were 2003 registered nurse members of the American Association of Diabetes Educators. A survey instrument was developed by the investigator and placed on the World Wide Web. RESULTS: Although most of the diabetes nurse educators were aware of PC, most reported not having received any training in PC and would benefit from this education. Thirty percent of the respondents did not routinely provide PC to their adult female clients, and 40% did not provide this to adolescents. CONCLUSIONS: Results of this study suggest that the diabetes nurse educators in this sample would benefit from receiving instruction about PC. The diabetes nurse educators should be trained to provide PC to all female clients with diabetes of childbearing age starting at puberty. [ABSTRACT FROM AUTHOR]

PURPOSE: Genetic education Internet sites and peer-reviewed medical literature were reviewed and critiqued to develop tables summarizing online resources for diabetes health professionals. METHODS: Using Internet search engines, each Web site identified for this project met the following criteria: (1) accurate and valid site content based on widely accepted genetic texts, (2) credibility of the organization that maintained the Web site, (3) ease of navigation, and (4) provision of continuing education credits. PubMed was used to find journal articles using similar criteria. RESULTS: There were 33 Web sites on genetic education for diabetes health professionals that met the inclusion criteria. The literature search identified 36 articles regarding the importance of genetic education for nurses and other health professionals, as well as information regarding genetics and diabetes. CONCLUSIONS: Valid and credible information on genetics and type 1 diabetes is available for diabetes health professionals on the Internet and in the medical literature. [ABSTRACT FROM AUTHOR]

PURPOSE: This Web-based review was undertaken to compile online resources for diabetes educators on genetics--specifically, the genetics of type 1 diabetes--and to provide helpful and accurate information for the public. METHODS: Keyword searches were performed to identify Web sites for genetics education for the lay public and for sites specifically geared toward children/young adults. Web sites were critiqued based on credibility (source, currency, relevance/utility), content (accuracy), and design (accessibility, logical organization). Additional keyword searches were conducted to find sites describing the genetics of type 1 diabetes, which were evaluated for content validity. RESULTS: The Web sites selected for general genetics education contain accessible, credible, and accurate information about basic genetics in an easy-to-follow format with both text and visual aides. Although these sites adequately educate the public about genetics, only diabetes-specific Web sites discussed the relationship between genetics and risk for type 1 diabetes associated with high-risk HLA alleles. CONCLUSIONS: In this genomic age, it is important for healthcare professionals to provide genetics information. Educational tools that specifically address the genetics of type 1 diabetes are urgently needed to fill the current information gaps on the Internet. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this secondary analysis was to describe and compare adolescent females with and without diabetes in terms of use of condoms, pregnancy outcomes, and sexually transmitted disease (STD) outcomes. METHODS: Data from a multisite, case-controlled, telephone survey study were used in a secondary analysis to evaluate the parameters stated in the purpose. RESULTS: The 87 females with type 1 diabetes and 45 nondiabetic females who participated were 16 to 22 years old. Most were Caucasian, in high school, and lived with their parents. No demographic differences were noted between the groups. Of those sexually active, for both groups, the most common contraceptive method was male condoms. Four females with diabetes and 2 without diabetes reported an unplanned pregnancy. Three females with diabetes reported an STD infection (chlamydia or trichomonas). Five females with diabetes and 4 nondiabetic females had abnormal pap tests. CONCLUSIONS: Adolescent females with and without diabetes engaged in less than optimally protected sexual activity, which increased their risk for unplanned pregnancies and STD infections. Further research is needed of the incidence, treatment, and short-term and long-term complications of STDs in adolescent females with diabetes. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to compare the efficacy of outpatient vs inpatient programs on medical, cognitive, behavioral, and psychosocial outcomes. METHODS: Using three large, tertiary medical centers in the United States, the sample of 32 children newly diagnosed with diabetes and their parents were recruited. Children and parents who received outpatient education were compared with those who received inpatient education. The following outcome variables were compared: (1) rates of hospital readmissions and/or emergency room visits for either severe hypoglycemia or ketoacidosis, (2) knowledge, (3) sharing of responsibilities, (4) adherence, (5) family functioning, (6) coping, and (7) quality of life. RESULTS: In general, no statistically significant differences were found between the groups. A trend was noted in the outpatient group with regard to improved use of emergency precautions on the adherence measure, roles on the family functioning measure, maintaining family integration on the parental coping measure, and disposition on the children's coping instrument. CONCLUSIONS: Findings support the safety and efficacy of the outpatient program method. [ABSTRACT FROM AUTHOR]

Previous studies of chronic illness management in children have focused mainly on parents' health beliefs. However, children's health beliefs also can be an important factor in predicting adherence. Indeed, children 6 to 10 years old spend most waking hours away from home, are under less parental supervision, and are becoming more responsible for their own care. The purpose of this study was to develop a pictorial, multi-item instrument to measure dimensions of the Health Belief Model (HBM) and self-efficacy (SE), designed specifically for children with diabetes, thus making it possible to examine both the parent's and child's health beliefs; to explore the relationship between their beliefs; and to examine the extent to which these beliefs are predictors of adherence and metabolic control. [ABSTRACT FROM AUTHOR]

Objective: To understand the perspectives of key informant experts regarding the relationship between food insecurity and gestational diabetes mellitus risk reduction behaviors among young American Indian and Alaska Native females., Methods: Participants were adult key informants with expertise in food/nutrition and health within Tribal communities (N = 58) across the US. Data were collected through 1:1 interviews using a semistructured moderator guide and analyzed using thematic content analysis methods., Results: Three themes included (1) diet and nutrition habits are formed through intergenerational food preferences and are driven by lasting implications of colonization; (2) young people are influenced by what their peers eat and the food environment, including outside of the home; and (3) the methods used to understand household food insecurity and nutrition habits in the parent study were likely limited., Conclusions and Implications: Findings provide guidance as to where nutrition education and interventions may best support young Native females., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs)., Methods: Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members., Results: Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05)., Discussion: As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention., (© 2024 by the American College of Nurse‐Midwives.)

American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Background: American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented., Methods: We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews., Results: Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals., Conclusion: Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies., (© 2023. The Author(s).)

Purpose: The purpose of the study was to describe, compare, and examine associations at baseline of reproductive health awareness, knowledge, health beliefs, communication and behaviors related to gestational diabetes (GDM) and GDM risk reduction in a vulnerable population of both American Indian/Alaska Native (AIAN) adolescent girls and their mothers., Methods: Descriptive/comparative/correlational analyses examined multitribal baseline data on 149 mother-daughter (M-D) dyads (N = 298; daughter age = 12-24 years) enrolled in a longitudinal study to adapt and evaluate a culturally relevant diabetes preconception counseling (PC) program (Stopping-GDM). The associations between GDM risk reduction awareness, knowledge, health beliefs, and behaviors (eg, daughters' eating, physical activity, reproductive-health [RH] choices/planning, M-D communication, daughters' discussions on PC) were examined. Data collected online from 5 national sites., Results: Many M-D lacked awareness/knowledge of GDM and risk reduction. Both M-D were unaware of the girl's risk for GDM. Mothers' knowledge and beliefs on GDM prevention/RH were significantly higher than daughters. Younger daughters had greater self-efficacy healthy living. Overall sample reported low to moderate scores for both M-D communication and daughters' GDM and RH risk-reduction behaviors., Conclusions: Knowledge, communication, and behaviors to prevent GDM were low in AIAN M-D, especially daughters. More than daughters, mothers perceive greater risk of GDM for daughters. Early culturally responsive dyadic PC programs could help decrease risk of developing GDM. Implications for M-D communication is compelling.

Gestational diabetes mellitus is the most common complication of pregnancy and contributes to increased risk for type 2 diabetes in both the mother and offspring. We developed and evaluated a gestational diabetes risk reduction and preconception counseling program, Stopping GDM (SGDM), for American Indian females. The purpose of this study is to examine the experiences of American Indian mother-daughter dyad participants and the site coordinators who facilitated the SGDM randomized controlled trial to inform program revisions. We engaged mother-daughter dyads ( n  = 22 dyads) and site coordinators ( n  = 6) in focus group interviews. Four themes emerged: (1) SGDM sparked valuable quality conversation for dyads; (2) gestational diabetes risk factors and risk reduction was new information for most dyads; (3) all trial sites experienced challenges to recruitment and engagement; and (4) study-improvement recommendations. These findings will be used to enhance SGDM to decrease adverse intergenerational health impacts of gestational diabetes in American Indian communities., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Kelly Moore was a consultant with Novo Nordisk in 2021. None of the other listed authors have any conflicts of interest to disclose., (© The Author(s) 2023.)

The authors examined perspectives of health care providers (HCPs) who serve Native Hawaiian and Pacific Islander (NH/PI) adolescents to inform the adaption of an existing American Indian and Alaska Native-specific gestational diabetes mellitus (GDM) risk reduction and preconception counseling program entitled Stopping GDM, for NH/PI adolescents. Hawai'i-based HCPs (n=14) who care for NH/PI adolescent females volunteered for this expert panel focus group study. These HCP participants served as an expert panel specific to their experiences in providing primary care and reproductive health care/family planning, and their perspectives regarding GDM risk reduction for NH adolescents. Several key themes emerged from these expert panel focus groups: (1) importance of multi-generational family involvement and support; (2) need to address the social determinants of health; (3) strengths-based strategies and recommendations to engage adolescents in a preconception counseling and GDM risk-reduction education program. Findings will inform the adaptation of Stopping GDM into a more holistic, multi-level, strengths-based, culturally tailored GDM risk reduction intervention that fosters empowerment and builds on the resilience of NH/PI communities., (©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Editor's note: This article is adapted from the virtual address Dr. Charron-Prochownik delivered as the recipient of the American Diabetes Association's Outstanding Educator in Diabetes Award for 2021. She delivered the address in June 2021 during the Association's 81st Scientific Sessions, which was held online as a result of the coronavirus disease 2019 pandemic. A webcast of this speech is available for viewing on the DiabetesPro website (https://bit.ly/3Lry4B9)., (© 2022 by the American Diabetes Association.)

The presence of unprotected sex activity in women living with type 1 diabetes (T1D) who have insufficient glycemic control should be considered as a specific risky behavior. To evaluate risky behaviors, including unprotected sexual activity, sources of information and knowledge related to reproductive health in adolescents and young adult women with T1D (PwT1D) compared to a group of adolescents and young adult women without diabetes (Comparison group). PwT1D and the Comparison group completed a questionnaire with validated measures that assessed reproductive health. PwT1D (n = 115, age = 17.7 ± 3.2 years) and Comparison group (n = 386, age = 18.3 ± 2.9) were recruited. The proportion of women reporting having sex without any contraceptive was similar in both groups (57.1% and 50%, in PwT1D and Comparison group, respectively). The use of non-effective contraceptive was reported in 63.2% and 63.6% of the PwT1D and Comparison group, respectively. Among PwT1D, parents, formal sex education, and friends were the primary source of information on reproductive health. Low levels of knowledge about diabetes and pregnancy were observed in PwT1D. HbA1c level was associated with having at least one sexual activity without any contraception (OR = 1.63, p = 0.039). PwT1D have similar rates of risky behaviors compared to a Comparison group. Sexual risky behaviors should be especially considered in PwT1D with glycemic control above the optimal level. Parents are an important source of reproductive health information for PwT1D. Use of effective contraception should be reinforced in sexually active PwT1D., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Study describes mindfulness (trait and practices) and compares levels of trait mindfulness (low/high) and practices (yes/no) on demographic, clinical characteristics, and diabetes-related outcomes among adolescents with type 1 diabetes (T1D)., Methods: Adolescents completed a survey on demographics, clinical data, trait mindfulness/practices, diabetes-specific stress, and diabetes self-management (DSM). Glycemic control (A1c) obtained from medical records. T and χ 2 tests were applied for comparative analyses., Results: 129 adolescents (12-18 years) reported moderately high levels of mindfulness (31 ± 8; range, 10-40). One-third (30%) reported having experience with mindfulness practices (formal, informal, and religious). Adolescents who reported higher levels of trait mindfulness had higher insulin pump usage (p =.005), less diabetes-specific stress (p <.001), greater DSM (p =.006), and less A1c (p =.013). Adolescents who reported more types of mindfulness practices had greater DSM scores., Discussion: Adolescents with higher levels of trait mindfulness and with more types of mindfulness practices had better diabetes-related outcomes. Introducing mindfulness training tailored to adolescents with T1D should be examined., (Copyright © 2021 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Objective: To elicit feedback from tribal leaders and American Indian/Alaska Native (AI/AN) health system administrators as a national stakeholder perspective to inform the development of a gestational diabetes mellitus (GDM) risk reduction and preconception counseling intervention for AI/AN teenagers at high risk for GDM., Methods: A semi-structured focus group interview guide was developed by both principal investigators and qualitative methods experts. Using open-ended questions about the Reproductive-health Education and Awareness of Diabetes in Youth for Girls (READY-Girls) booklet and video clips, AI/AN health care system administrators and elected tribal leaders attending the 2015 National Indian Health Board Conference in Washington, DC, made recommendations on adaptation for an AI/AN audience. The focus group was recorded, transcribed verbatim, and analyzed by two researchers using an inductive coding technique with constant comparison method as supported by the grounded theory approach., Results: Recommendations from the 12 participants included: (1) the best ways to communicate with AI/AN teenagers, (2) the importance of parental, family, and community education and engagement to support AI/AN teenagers in GDM risk reduction, and (3) building on traditional AI/AN cultural values and practices, while accommodating differences between tribes and regions., Conclusion: Findings from this focus group were used to inform the iterative development of a GDM risk reduction and preconception counseling intervention for AI/AN teenagers., (© 2021 International Federation of Gynecology and Obstetrics.)

The purpose of this cross-sectional, descriptive, pilot study was to examine the correlations in sleep between caregivers (≥18 years) and young (6-12 years) children with type 1 diabetes. Sleep was measured in both parent and child over 7 days using actigraphy and a sleep diary. Parents completed questionnaires on sleep, stress, depressive symptoms, and demographics. Children completed pediatric anxiety and fatigue questionnaires, and A1C (Hemoglobin A1c) was documented at clinic. Descriptive statistics and Pearson correlations were used to analyze data. Parents ( N = 18, mean age: 39.3 ± 5.4 years, 100% Caucasian, 83% mothers) and children ( N = 18, mean age: 9.6 ± 2.4 years, diagnosed for mean 3.0 ± 2.4 years, 66% female, mean A1C: 7.5 ± 0.8%) were recruited. Strong to moderate correlations were found for several measures including sleep measures based on actigraphy: mean sleep duration (hours; 7.6 ± 0.7 for parents and 8.8 ± 0.8 for children; r = .638, p = .004), mean sleep efficiency ( r = .823, p < .001), and mean daily wake after sleep onset (minutes; r = .530, p = .024).

Introduction: Latinas are at an increased risk for diabetes and reproductive health (RH) complications with sexuality and pregnancy. This study explored the understanding of diabetes related to RH, pregnancy, unplanned pregnancies, preconceptioncounseling, tight-control, and family planning among Latina adolescents with diabetes and their mothers and explored converging themes., Method: The qualitative descriptive study used written open-ended questions (English or Spanish) with Latina mothers (n = 13) and daughters (n = 21). Responses were transcribed. Content analysis was used by four researchers who coded and discussed themes and reached consensus. Converging themes were confirmed using Atlas.ti software., Results: Seven themes emerged from the mother-daughter dyad: communication (awkwardness, ambivalence, styles); control (being controlled vs. controlling); consequences (fertility, complications); planning (pregnancy, being healthy, life plan, RH); support; danger, risk, and safety; and stigma., Discussion: Many mother-daughter dyads were not ready to discuss RH among themselves. Cultural and familial perspectives should be considered when providing care and preconception counseling to this population., (Copyright © 2020. Published by Elsevier Inc.)

Purpose: To explore the perspectives of Eastern Woodlands Native people with type 2 diabetes (T2DM) in the context of health beliefs, T2DM disease self-management, and family and community connections., Methods: A qualitative descriptive method using face-to-face or telephonic semistructured interviews was employed with Native people ages 18 years or older who have a diagnosis of T2DM (N = 12) from an unidentified Eastern Woodlands tribe. The PEN-3 Cultural Model guided the study initially., Results: The overarching theme "together we can return to balance" corresponded to 5 subthemes: coming to know life paths with T2DM, acknowledging the imbalance, negotiating my way forward, making important connections, and sticking closer to Mother Earth. Dimensions within the subthemes suggest why Native people may not be reaching T2DM treatment goals. Reasons include incomplete diabetes knowledge, difficulty accessing resources, and contextual variations in adoption of conventional diabetes treatments., Conclusion: This study identified themes from Native perspectives about T2DM self-management and about prospects that may mitigate incomplete knowledge and support. Integrating indigenous health and wellness knowledge with conventional principles of diabetes care presents several opportunities for nurses to advance diabetes self-management (DSM) education and support. Including Native health concepts when educating patients about DSM should be viewed as desirable for holistic family and community involvement that is central toward preventing disease progression.

Introduction: American Indian and Alaska Native (AIAN) girls have double the risk of obesity, pregnancy, and gestational diabetes mellitus (GDM) than the general U.S., Population: The purpose of this study was to beta test Stopping GDM (SGDM), a GDM risk reduction intervention for at-risk AIAN teens, before beginning a randomized controlled trial., Method: A sample of 11 AIAN mothers and daughters were recruited through an urban Indian health program. Daughters were at risk of GDM as assessed by a BMI ≥ 85th percentile. Pre- and posttest online questionnaires evaluated the online intervention (e-book and video)., Results: Mean pre- to posttest knowledge increased for mothers and daughters on diabetes prevention, reproductive health, and GDM knowledge. Daughters demonstrated an increased self-efficacy for healthy living and pregnancy planning. Satisfaction for the e-book, video, and online survey was moderately high to very high., Discussion: The SGDM intervention is feasible and acceptable in AIAN mother-daughter dyads. These findings informed the SGDM intervention and the randomized controlled trial evaluation protocol., (Copyright © 2020 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Background: American Indian and Alaska Native (AI/AN) women have a higher risk of gestational diabetes mellitus (GDM) and subsequent diagnosis of diabetes than do non-Hispanic White women. Healthy eating is key to weight management both prior to pregnancy and between pregnancies and can reduce the risk of developing GDM. Our research team developed an innovative preconception counseling and diabetes risk-reduction program, which includes nutrition and weight-management principles and is culturally tailored for adolescent AI/AN women. The program is entitled Stopping Gestational Diabetes Mellitus (SGDM)., Objective: The purpose of this article is to examine nutrition-related information collected as a part of the formative qualitative research conducted for the development of a preconception counseling and gestational diabetes risk-reduction program, SGDM., Methods: This in-depth secondary analysis explored the original qualitative data from the needs assessment for SGDM program development. Participants included AI/AN women with a history of GDM ( n  = 5); AI/AN girls at risk of GDM ( n  = 14), and their mothers ( n  = 11), health care providers, and health administrators who care for AI/AN girls ( n  = 16); AI/AN elected leaders; and Indian health system administrators ( n  = 12). All focus groups and interviews were reanalyzed utilizing the following research question: "How do key stakeholders discuss food and/or nutrition in terms of gestational diabetes risk reduction for AI/AN adolescent girls?", Results: Three primary nutrition themes emerged: 1 ) AI/AN women were aware of healthy nutrition, healthy weight gainduring pregnancy, and healthy nutrition for people with type 2 diabetes, but these principles were not linked to reducing the risk of GDM; 2 ) participants expressed the need for education on the role of nutrition and weight management in GDM risk reduction; 3 ) participants shared challenges of healthful eating during and before pregnancy for AI/AN women., Conclusions: These stakeholders' comments informed the development of the nutrition components of SGDM., (© The Author(s) on behalf of the American Society for Nutrition 2020.)

Background: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population., Objective: To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes., Design: Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes., Results: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma., Conclusions: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose of Review: To provide an updated synopsis of the research and clinical practice findings on pregnancy and gestational diabetes mellitus (GDM) in American Indian and Alaska Native (AIAN) adolescents and to describe the newly developed "Stopping GDM," an early intervention, culturally tailored risk reduction program for AIAN girls and their mothers., Recent Findings: Five research articles met our inclusion criteria. Three retrospective quantitative studies published in the past 10 years corroborated a 1.5 to 2 times higher prevalence for GDM for all age groups in the AIAN population as compared to other ethnic groups, and that the percentage of GDM cases attributable to overweight and obesity was highest for AIs (52.8%). Moreover, First Nations women across all age groups had more adverse pregnancy risk factors than non-First Nations women. Out of the five selected articles, two were qualitative research articles: one examined AIAN women's experiences of having GDM or type 2 diabetes (T2D) during pregnancy and the other appraised the understanding of GDM and reproductive health of at-risk AIAN girls. There is a paucity of research published on this topic. AIAN females are at high risk for developing GDM. Early, culturally responsive interventions and cohort follow-up studies are needed among adolescents and young adults, using technology that appeals to this age group.

Purpose: To explore the personal experiences, challenges, and practices of parish nurses in their communities., Method/design: The overall study used a mixed methods concurrent embedded design to describe parish nurses' experiences with diabetes education and preconception counseling in their practice. Also included were descriptions of generalized practices. Therefore, this current report will focus on these broader experiences. Focus group data were collected using face-to-face, teleconference, and video conferencing formats with 48 nurses who consider themselves to be parish nurses and analyzed with content analysis., Findings: Four qualitative themes were identified in the data: (1) Gaining Entry Through Trust, (2) Enhanced Focus on Spiritual Caring, (3) Accomplishing Much Despite Challenges, and (4) Practice Making a Difference. Parish nurses are uniquely situated to provide holistic care for the mind, body, and spirit of their patients. Despite the many positive aspects, parish nurses experience unique challenges, such as funding their practice and working independently., Conclusions: The parish nurses can play a vital role in providing holistic care to patients in a faith-based community. Future work is needed to address the challenges of parish nurses such as access to continuing education programs related to health topics of concern to their community members.

Purpose of Review: Women with diabetes who have unplanned pregnancies and uncontrolled blood sugars are at a higher risk for maternal and fetal morbidities and mortalities. Preconception counseling (PC) has been shown to decrease the risks and improve health outcomes. From 2009 to 2017, the American Diabetes Association has recommended that preconception counseling be given at each clinic visit for all women with diabetes of childbearing age starting at puberty (prior to sexual debut)., Recent Findings: This article reports both national and international progress in PC efforts for adolescents and young adults (12-34 years) with diabetes over the past decade. Twenty-eight publications were identified and included in this article (11 were research, 12 clinical guidelines, and 5 reviews). Despite recommendations to start PC at puberty, only four studies had interventions that targeted the adolescent and young adult age group. Three of them were associated with the same PC awareness program. Positive outcomes were reported in all of these studies. Greater family vigilance was observed in a long-term follow-up of a cohort of women who received PC as teens. Adolescents should receive awareness PC. More early PC interventions and cohort follow-up studies are needed among adolescents and young adults, using technology that appeals to this age group. Programs should be expanded to include other populations like males with diabetes and females from other cultures and religions that would require program modification.

Background: Latinas are at a higher risk than Caucasians for both type 1 and type 2 diabetes (DM), as well as DM-associated reproductive health (RH) complications. Healthcare providers (HCPs) should deliver culturally-sensitive care to enhance the care relationship between Latinos and HCPs and to improve patient outcomes. This study explored an expert panel's cultural understanding, experiences, barriers, and facilitators regarding RH and preconception counseling (PC) for adolescent Latinas with DM and their families., Methods: This study used open-ended questions with a focus group of 8 HCPs from the mid-Atlantic, Southwest, and Northwest regions of the United States in a teleconference format. Two researchers transcribed and reviewed the transcript for accuracy. Using content analysis, four members of the team identified themes. All researchers discussed themes and a 100% consensus was reached. For confirmation, a coding protocol was created based on the emerging themes., Results: Five themes related to cultural understanding and experiences were identified: 1) issues of identity; 2) acculturation; 3) stigma; 4) ambivalence toward birth control, RH education, and PC; and 5) cultural sensitivity vs. best practice. Four barriers were identified: 1) language; 2) religion; 3) access to healthcare, and 4) discomfort with discussion. Ten facilitators were identified: 1) the importance of support and support networks; 2) promoting trust among HCPs, daughters, and families; 3) assessing emotional development; 4) empowerment; 5) emphasizing safety; 6) communicating in patients' preferred language; 7) discussing RH-related topics and PC using cultural sensitivity; 8) importance of being ready/temporality/planning for the future; 9) the importance of family-centered care; and 10) variation in educational tailoring and dissemination/ care delivery., Conclusions: Findings support the need for culturally sensitive and developmentally appropriate PC programs to empower adolescent Latinas with DM.

Purpose The purpose of this study is to determine feasibility, satisfaction, and preliminary effects of Mindful Stress Reduction in Diabetes Education (Mind-STRIDE), a mindfulness-based intervention for veterans. Methods The study used a single-group pretest-posttest repeated-measures design. The 90-minute Mind-STRIDE training, adapted from Mindfulness Based Stress Reduction (MBSR), was provided as the final component of a half-day diabetes self-management education class at a Veterans Affairs (VA) outpatient diabetes clinic. Following initial training, participants were asked to practice mindfulness at home for 10 minutes each day during the 3-month study. Study recruitment and retention were calculated as rates. Veteran and diabetes educator satisfaction were assessed by rating scales and open-ended comments. Psychosocial-behavioral and metabolic outcomes were assessed at baseline and 3 months after initial training. Bivariate correlations were performed to describe relationships between mindfulness and other outcome variables. Gain scores and Wilcoxon matched-pair signed rank tests were used to assess pre to post changes; Cohen's d was applied to estimate the magnitude of effects. Results Twenty-eight of 49 eligible veterans (57%) enrolled in the study. Of those, 11 veterans (39%) demonstrated participation in home practice, and 20 veterans (71%) completed the study. Overall, participants and diabetes educators were highly satisfied with the Mind-STRIDE intervention. Significant improvements were found in diabetes distress, diabetes self-efficacy, diabetes self-management behaviors, mindful-describing, and A1C. Conclusion Results suggest feasibility, satisfaction, and positive preliminary effects. Efficacy testing by randomized controlled trial with analysis of covariance structures is warranted.