COMADRE DISCUSSIONS: A CULTURALLY SENSITIVE INTERVENTION TO IMPROVE GESTATIONAL DIABETES OUTCOMES IN HISPANIC WOMEN

Gestational Diabetes Mellitus (GDM) affects more than 25 % of Hispanic women in the United States (Sacks et al., 2012). Hyperglycemia in pregnancy contributes to poor maternal-fetal outcomes. Adherence to GDM management is an ongoing problem for healthcare providers and patients. Once the diagnosis is confirmed, standard management includes non-pharmacological and pharmacological regimens. Management focuses on diet modification, and exercise. In addition to the standard Sweet Success curriculum, adherence to GDM management may improve by using culturally sensitive discussion sessions. The purpose of this quality improvement project was to add Comadre discussions to the standardized educational program in the primary setting for Hispanic GDM’s women to improve perinatal outcomes for both mother and baby. The Culturally Competent Change Theory (CCCT) model was used to pilot this quality improvement project. Two supporting frameworks guided the model: Campinha-Bacote’s cultural competence model (Campinha-Bacote, 2002) and Kurt Lewin’s Model of Change (Lewin, 1951). Preliminary findings compared two groups one the Comadres (n = 10) and the retrospective group non-participants (n = 10). Descriptive statistics indicated participants ages ranged from 18-35 (mean 27.2 [SD 6.2]) for the Comadres group. Non-participant group ages ranged from 24-35 (mean 30.2 [SD 3.8] years. Monitoring of weight gain iv from start of prenatal care to current gestational weeks revealed range weight of 6 to 36 pounds with a mean weight gain of 14 pounds for the Comadres group compared to minus 2 to 75 pounds with a mean weight gain of 24.3 pounds. At this point in time, there is insufficient evidence that the Comadre classes are affecting blood sugar maintenance (mean 106.4 mg/dL [SD 9.42] to mean 107.7 mg/dL [7.08]). Although the impact of blood glucose measures was not statistically significant, there was less weight gain in the Comadres group. Despite the lack of change in blood sugar results, the Comadres revealed behavior change in tracking their blood sugars. Qualitative findings were useful in identifying internal and external factors to change behaviors. Comadre discussions were useful to build rapport and share the women’s experience of their daily struggles to manage their diet, monitor blood sugars and barriers to health care adherence