Publications by authors named "Denise Charron-Prochownik"

49 Publications

Trait Mindfulness and Mindfulness Practices in Adolescents with Type 1 Diabetes: Descriptive and Comparative Study.

J Pediatr Health Care 2021 Sep 4. Epub 2021 Sep 4.

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 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.
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http://dx.doi.org/10.1016/j.pedhc.2021.07.012DOI Listing
September 2021

Reducing risk for gestational diabetes among American Indian and Alaska Native teenagers: Tribal leaders' recommendations.

Int J Gynaecol Obstet 2021 Jul 31. Epub 2021 Jul 31.

Department of Health Promotion and Development, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.

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.
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http://dx.doi.org/10.1002/ijgo.13849DOI Listing
July 2021

Risky sexual behaviors in adolescents and young adult women with type 1 diabetes: An overlooked problem.

Pediatr Diabetes 2021 Jun 30. Epub 2021 Jun 30.

Institute Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.

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.
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http://dx.doi.org/10.1111/pedi.13245DOI Listing
June 2021

Adolescent Latinas' with Diabetes and Their Mothers' Understanding of Diabetes and Reproductive Health: Converging Themes to Inform a Culturally Sensitive Preconception Counseling Program.

J Pediatr Health Care 2021 Mar-Apr;35(2):205-215. Epub 2020 Dec 25.

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.
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http://dx.doi.org/10.1016/j.pedhc.2020.10.004DOI Listing
December 2020

"Together We Can Return to Balance"-Eastern Woodlands Native Perspectives and Type 2 Diabetes: A Qualitative Study.

Diabetes Educ 2020 12 30;46(6):597-606. Epub 2020 Oct 30.

University of Massachusetts Medical School, Graduate School of Nursing, Worcester, Massachusetts.

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.
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http://dx.doi.org/10.1177/0145721720967631DOI Listing
December 2020

Beta Testing of a Gestational Diabetes Risk Reduction Intervention for American Indian and Alaska Native Teens.

J Pediatr Health Care 2020 Sep - Oct;34(5):418-423. Epub 2020 Jun 9.

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.
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http://dx.doi.org/10.1016/j.pedhc.2020.04.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7608544PMC
September 2021

Stopping Gestational Diabetes in American Indian and Alaska Native Girls: Nutrition as a Key Component to Gestational Diabetes Risk Reduction.

Curr Dev Nutr 2021 Jun 6;5(Suppl 4):13-21. Epub 2020 May 6.

University of Colorado Anschutz Medical Campus; Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA.

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 (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 ( = 5); AI/AN girls at risk of GDM ( = 14), and their mothers ( = 11), health care providers, and health administrators who care for AI/AN girls ( = 16); AI/AN elected leaders; and Indian health system administrators ( = 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: ) 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; ) participants expressed the need for education on the role of nutrition and weight management in GDM risk reduction; ) 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.
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http://dx.doi.org/10.1093/cdn/nzaa081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242493PMC
June 2021

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens.

Pediatr Diabetes 2020 05 21;21(3):415-421. Epub 2020 Feb 21.

Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

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.
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http://dx.doi.org/10.1111/pedi.12990DOI Listing
May 2020

Pregnancy and Gestational Diabetes Mellitus (GDM) in North American Indian Adolescents and Young Adults (AYA): Implications for Girls and Stopping GDM.

Curr Diab Rep 2019 11 4;19(11):113. Epub 2019 Nov 4.

University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street, Pittsburgh, PA, 15261, USA.

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.
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http://dx.doi.org/10.1007/s11892-019-1241-3DOI Listing
November 2019

Sleep in Parental Caregivers and Children With Type 1 Diabetes.

J Sch Nurs 2021 Aug 31;37(4):259-269. Epub 2019 Jul 31.

UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.

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 ( = 18, mean age: 39.3 ± 5.4 years, 100% Caucasian, 83% mothers) and children ( = 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; = .638, = .004), mean sleep efficiency ( = .823, < .001), and mean daily wake after sleep onset (minutes; = .530, = .024).
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http://dx.doi.org/10.1177/1059840519865942DOI Listing
August 2021

Reducing Risk for Gestational Diabetes Mellitus (GDM) Through a Preconception Counseling Program for American Indian/Alaska Native Girls: Perceptions From Women With Type 2 Diabetes or a History of GDM.

Diabetes Educ 2019 04 2;45(2):137-145. Epub 2019 Jan 2.

Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.

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http://dx.doi.org/10.1177/0145721718821663DOI Listing
April 2019

Sleep in Caregivers of Children With Type 1 Diabetes.

Diabetes Educ 2019 02 22;45(1):80-86. Epub 2018 Nov 22.

University of Pittsburgh School of Nursing, Pittsburgh, PA, USA.

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http://dx.doi.org/10.1177/0145721718812484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391169PMC
February 2019

Exploring the Experiences, Challenges, and Approaches of Parish Nurses in Their Community Practice.

J Holist Nurs 2019 Jun 29;37(2):121-129. Epub 2018 Sep 29.

University of Pittsburgh.

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.
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http://dx.doi.org/10.1177/0898010118801414DOI Listing
June 2019

Preconception Counseling for Adolescents and Young Adults with Diabetes: a Literature Review of the Past 10 Years.

Curr Diab Rep 2018 02 15;18(3):11. Epub 2018 Feb 15.

University of Pittsburgh School of Nursing, 440 Victoria Building, Pittsburgh, PA, 15261, USA.

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.
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http://dx.doi.org/10.1007/s11892-018-0983-7DOI Listing
February 2018

Cultural understanding, experiences, barriers, and facilitators of healthcare providers when providing preconception counseling to adolescent Latinas with diabetes.

Res J Womens Health 2018 ;5

University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street Pittsburgh, USA.

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.
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http://dx.doi.org/10.7243/2054-9865-5-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6768083PMC
January 2018

A Mindful Approach to Diabetes Self-Management Education and Support for Veterans.

Diabetes Educ 2017 12 27;43(6):608-620. Epub 2017 Oct 27.

School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Chasens, Dr Charron-Prochownik, Dr Cohen).

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.
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http://dx.doi.org/10.1177/0145721717738019DOI Listing
December 2017

Experiences of Parish Nurses in Providing Diabetes Education and Preconception Counseling to Women With Diabetes.

J Obstet Gynecol Neonatal Nurs 2017 Mar - Apr;46(2):248-257. Epub 2017 Jan 17.

Objective: To explore the role and experiences of the parish nurse in providing diabetes education and preconception counseling to women with diabetes.

Design: Mixed-methods concurrent embedded design.

Setting: Focus groups of community-based parish nurses accessed from a regional database (Pennsylvania, Florida, Ohio, New York, Arizona, and Minnesota).

Participants: Forty-eight parish nurses recruited from the Parish Nurse and Health Ministry Program database in Western Pennsylvania.

Methods: The primary method was focus groups using face-to-face, teleconference, and videoconferencing formats. A secondary method used a quantitative descriptive design with three self-report measures (demographic, preconception counseling self-efficacy, and preconception counseling knowledge). Qualitative content analysis techniques were conducted and combined with descriptive analysis.

Results: Forty-eight parish nurses participated in 1 of 11 focus groups. Eight qualitative themes emerged: Awareness, Experience, Formal Training, Usefulness, Willingness, Confidence, "Wise Women," and Preconception Counseling Tool for Patients. Participants provided recommendations for training and resources to increase their knowledge and skills. Parish nurses' knowledge scores were low (mean = 66%, range = 40%-100%) with only moderate levels of self-efficacy (mean = 99, range = 27-164). Self-efficacy had a significantly positive association with knowledge (r = .29, p = .05).

Conclusion: Quantitative results were consistent with participants' qualitative statements. Parish nurses were unaware of preconception counseling and lacked knowledge and teaching self-efficacy as it related to preconception counseling and diabetes education. Understanding parish nurses' experiences with women with diabetes and identifying their needs to provide education and preconception counseling will help tailor training interventions that could affect maternal and fetal outcomes.
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http://dx.doi.org/10.1016/j.jogn.2016.10.010DOI Listing
February 2018

Operationalizing and Examining Family Planning Vigilance in Adult Women With Type 1 Diabetes.

Diabetes Care 2016 Dec 11;39(12):2197-2203. Epub 2016 Oct 11.

School of Nursing, University of Pittsburgh, Pittsburgh, PA.

Objective: Because unplanned pregnancies could cause maternal-fetal complications for women with diabetes, family planning vigilance (FPV) is imperative. The aims of this article are to operationalize and describe FPV and examine the associations among FPV behaviors and diabetes self-care management (DSM) and health outcomes of women with type 1 diabetes (T1D).

Research Design And Methods: Retrospective data were used from a follow-up study of adult women with T1D who participated as adolescents in a preconception counseling (PC) intervention trial and matched comparison women with T1D who did not receive the adolescent PC intervention. Participants completed online questionnaires regarding family planning behaviors, DSM, and clinical and reproductive health outcomes.

Results: Participants (N = 102) were, on average, 23.7 years old (range 18-38) and 98.0% were white, 82.2% had some college, 25.8% were married, and 11.8% had biological children. Of those sexually active (n = 80, 78.4%), 50% were contraceptive vigilant and 11% were FPV (i.e., being contraceptive vigilant, receiving PC, and initiating discussions with health care professionals). Among FPV behaviors, only receiving PC and initiating discussion with health care professionals were correlated (r = 0.29, P = 0.010). Compared with nonvigilant women, contraceptive vigilant and FPV women used more effective contraceptive methods (P = 0.025) and experienced less diabetic ketoacidosis (P = 0.040) and hospitalizations (P = 0.064), whereas FPV women were aware of PC (P = 0.046) and younger when they received PC (P < 0.001). FPV components were associated with DSM and health outcomes (P < 0.05).

Conclusions: Women with diabetes should be FPV, but few were. FPV women were more likely to have PC earlier and better health outcomes, supporting early PC intervention.
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http://dx.doi.org/10.2337/dc16-1648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127226PMC
December 2016

Race and Religious Beliefs Are Associated With Communication Regarding Reproductive Health and Preconception Counseling in Young Women With Diabetes.

Diabetes Educ 2016 12 28;42(6):721-727. Epub 2016 Sep 28.

University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Sereika, Dr Cohen, Dr Charron-Prochownik)

Purpose: The purpose of this study was to examine the relationship between selected internal and external characteristics and communication (intended and actual) with health care providers (HCPs) about reproductive health and preconception counseling among adolescent females with diabetes.

Methods: A descriptive, correlational design was employed to conduct a secondary analysis of baseline data from a multisite, randomized controlled trial. Participants were 110 female adolescents (92% type 1 diabetes). Analysis included multiple linear regression and multivariate binary logistic regression analyses to examine the association of internal characteristics (age, race, religion, and religious beliefs) and external characteristics (ever sexually active, social support, and type of routine HCP).

Results: Participants were from 13.3 to 20.0 years of age, 82% were Caucasian, 80% had never been sexually active, and 58% perceived low to moderate amounts of social support. For both internal and external characteristics, no significant main effects were found for actual or intended communication. For internal characteristics, there was an interaction between race and religious beliefs for the probability of actual communication. African American women who reported that their religious beliefs did not influence their sexual behavior had the lowest probability of actual communication compared to all other participants.

Conclusion: Race and religious beliefs should be considered when providing reproductive health information to young women with diabetes. Further research with a larger, more diverse sample is warranted. These results may be considered for future development of novel interventions with targeted messages based on these personal characteristics to empower young women to initiate conversations with HCPs about reproductive health and preconception counseling.
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http://dx.doi.org/10.1177/0145721716671008DOI Listing
December 2016

Efficacy of the READY-Girls Program on General Risk-Taking Behaviors, Condom Use, and Sexually Transmitted Infections Among Young Adolescent Females With Type 1 Diabetes.

Diabetes Educ 2016 12 14;42(6):712-720. Epub 2016 Sep 14.

University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Dr Thurheimer, Dr Founds, Dr Charron-Prochownik)

Purpose: The purpose of this study is to examine the short-term efficacy (3 months) of early diabetes-specific READY-Girls preconception counseling (RGPC) on more general risk-taking behaviors, condom use, and sexually transmitted infections (STIs) among adolescent females with type 1 diabetes.

Methods: Secondary analysis was performed with data pooled from 2 independent randomized controlled trials to evaluate the short-term impact of RGPC. The pooled sample had 136 participants (mean age, 16.9 years; range, 13-19 years) and compared those who received the RGPC (n = 76) with a control group who received standard care (n = 60). Both groups self-reported on demographic characteristics, risk-taking behaviors (eg, substance use and unsafe sex), birth control, and STIs.

Results: No effect of RGPC emerged on risk-taking behaviors, condom use, and STIs. Only 25% (n = 36) of the adolescents were sexually active at baseline, and 29% (n = 39) were sexually active at 3 months. Their overall mean age of sexual debut was 15.4 years, with more than half reporting an episode of unprotected sex. Condoms were the most frequent type of birth control used by both groups at both time points. By 3 months, only 4 participants had been diagnosed with an STI. Over time, subjects in both groups became more sexually active and used more condoms.

Conclusion: RGPC did not appear to directly affect general risk-taking behaviors or STIs, since it focuses on diabetes and reproductive health issues. Condom use did increase over time in both groups. More information on risk-taking behaviors and STIs should be included in diabetes-specific preconception counseling programs, including RGPC.
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http://dx.doi.org/10.1177/0145721716668651DOI Listing
December 2016

Mother-daughter dyadic approach for starting preconception counseling at puberty in girls with diabetes.

Res J Womens Health 2014 Dec;1

Center for Research and Evaluation, School of Nursing, University of Pittsburgh, USA.

Background: Preconception counseling (PC) significantly and inexpensively reduces risks of reproductive-health complications for women with diabetes. Our validated technology-based preconception counseling intervention, , is tailored for female teens with type 1 (T1D) and type 2 (T2D) diabetes and targets decision-making regarding effective family planning and seeking PC. Our teen-focused research was instrumental in changing the American Diabetes Association's Practice Recommendations to specify that preconception counseling should "Start at puberty…". This directive requires support from well-informed mothers of teens. Our goal is to provide both teen girls and their mothers with preconception counseling knowledge, and provide mothers with sex-communication training. Evaluation should focus on mother-daughter dyads.

Purpose: This feasibility study explored mother's and daughter's awareness and knowledge of diabetes and pregnancy, and preconception counseling; and compared mother-daughter responses using dyadic analyses.

Methods: A mixed-method design was conducted with 10 mothers of daughters with T1D. Mothers were given intervention and completed knowledge and support questionnaires. Their responses were compared to those of their daughter's who were participating in a large randomized, control intervention trial with .

Results: The major theme from one-on-one interviews was, "I know nothing about diabetes/pregnancy risks and PC". Mother's and daughter's perceptions of having limited knowledge were confirmed by low knowledge scores. Mothers perceived giving higher levels of support compared to their daughter's perceptions of receiving support.

Conclusion: Mothers can play a vital role in initiating discussions regarding reproductive-health with their daughters and reinforcing preconception counseling. Mother-daughter team approach for starting preconception counseling at puberty in girls with diabetes is feasible. Mother-daughter dyadic analyses can be important to explore possible mediating and moderating roles of mother-daughter communication and support about reproductive health on the relationship between intervention and sustainable outcomes.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316737PMC
http://dx.doi.org/10.7243/2054-9865-1-2DOI Listing
December 2014

Long-term effects of the booster-enhanced READY-Girls preconception counseling program on intentions and behaviors for family planning in teens with diabetes.

Diabetes Care 2013 Dec 15;36(12):3870-4. Epub 2013 Oct 15.

Corresponding author: Denise Charron-Prochownik,

Objective: To examine 12-month effects of a booster-enhanced preconception counseling (PC) program (READY-Girls) on family planning for teen girls with type 1 and type 2 diabetes.

Research Design And Methods: Participants 13-19 years of age (n = 109) were randomized to a standard care control group (CG) or intervention group (IG) that received PC over three consecutive clinic visits. Prepost data were collected at baseline, 3- and 6-month booster sessions, and a 12-month follow-up visit.

Results: Mean age was 15.8 years; 9 (8%) subjects had type 2 diabetes; and 18 (17%) subjects were African American. At baseline, 20% (n = 22 of 109) had been sexually active, and of these, 50% (n = 11) had at least one episode of unprotected sex. Over time, IG participants retained greater PC knowledge (F[6, 541] = 4.05, P = 0.0005) and stronger intentions regarding PC (significant group-by-time effects) especially after boosters. IG participants had greater intentions to discuss PC (F[6, 82.4] = 2.56, P = 0.0254) and BC (F[6, 534] = 3.40, P = 0.0027) with health care providers (HCPs) and seek PC when planning a pregnancy (F[6, 534] = 2.58, P = 0.0180). Although not significant, IG participants, compared with CG, showed a consistent trend toward lower rates of overall sexual activity over time: less sexual debut (35 vs. 41%) and higher rates of abstinence (44 vs. 32%). No pregnancies were reported in either group throughout the study.

Conclusions: READY-Girls appeared to have long-term sustaining effects on PC knowledge, beliefs, and intentions to initiate discussion with HCPs that could improve reproductive health behaviors and outcomes. Strong boosters and providing PC at each clinic visit could play important roles in sustaining long-term effects.
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http://dx.doi.org/10.2337/dc13-0355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3836127PMC
December 2013

A quality improvement initiative to increase HPV vaccine rates using an educational and reminder strategy with parents of preteen girls.

J Pediatr Health Care 2014 Mar-Apr;28(2):155-64. Epub 2013 Mar 20.

Introduction: A quality improvement project was undertaken to determine if an evidence-based educational brochure and reminder system can increase human papillomavirus (HPV) vaccine uptake and dose completion rates.

Method: Development of a brochure to promote HPV vaccine uptake was based on predictors of parental acceptance and Health Belief Model concepts. Electronic alerts prompted telephone reminders for dose completion. This quality improvement project utilized a quasi-experimental design with 24 parents of preteen girls from a private pediatric practice and a historical control group of 29 parents. HPV vaccine rates were compared between the groups.

Results: A significant difference in HPV vaccine uptake (χ(2) = 11.668, P = .001; odds ratio [OR] = 9.429, 95% confidence interval [CI] = 2.686-33.101) and dose completion (χ(2) = 16.171, P < .001; OR = 22.500, 95% CI = 4.291-117.990) rates were found between the historical control and intervention groups. Parents who received the clinical protocol were 9.4 times and 22.5 times more likely to have HPV vaccine uptake and dose completion, respectively.

Discussion: Low national HPV vaccine rates demonstrate the need for theory-based vaccine delivery programs. These results show that an evidence-based educational brochure and reminder system appeared to improve HPV vaccine uptake and dose completion rates at this private pediatric practice.
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http://dx.doi.org/10.1016/j.pedhc.2013.01.002DOI Listing
April 2015

Condom use among sexually active rural high school adolescents personal, environmental, and behavioral predictors.

J Sch Nurs 2013 Jun 24;29(3):212-24. Epub 2012 Sep 24.

University of Pittsburgh at Bradford, Bradford, PA 16701, USA.

Adolescents who engage in unprotected intercourse are at risk of pregnancy and sexually transmitted infection (STI). Although adolescents in rural areas participate in levels of sexual risk taking similar to that of nonrural youth, few data are available identifying factors that influence condom use among rural adolescents. The purpose of this study is to determine the predictive value of selected personal, environmental, and behavioral factors for condom use among rural adolescents in grades 9-12. A cross-sectional survey was conducted among sexually active youth (N = 613), ages 14-19, in three rural school districts in the Northeast. Using logistic regression, identified predictors for condom use include personal standards (odds ratio [OR] = 2.45; confidence interval [CI]: [2.39, 6.47]), condom use goals (OR = 1.32; CI [1.21, 1.45]), condom use at first intercourse (OR = 3.93; CI [2.39, 6.47]) and male gender. School nurses are encouraged to incorporate identified predictors of condom use when considering interventions promoting safer sexual behaviors among rural youth.
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http://dx.doi.org/10.1177/1059840512461282DOI Listing
June 2013

Self-monitoring of blood glucose is associated with problem-solving skills in hyperglycemia and hypoglycemia.

Diabetes Educ 2012 Mar-Apr;38(2):207-18

University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Dr Matthews, Dr Charron-Prochownik, Dr Sereika, Dr Siminerio)

Purpose: The purpose of this study was to examine the association between self-monitoring of blood glucose (SMBG) and problem-solving skills in response to detected hyperglycemia and hypoglycemia among patients with type 2 diabetes.

Methods: Data were obtained from the American Association of Diabetes Educators Outcome System, implemented in 8 diabetes self-management education programs in western Pennsylvania. SMBG was measured by asking patients how often they checked, missed checking, or checked blood glucose later than planned. Problem-solving skill was measured by asking how often they modified their behaviors after detecting high or low blood glucose.

Results: Most patients checked their blood glucose at least once per day. However, when blood glucose was high or low, many of them reported doing nothing, and only some of them resolved the problem. There were significant associations between self-monitoring of blood glucose and problem-solving skills for hyperglycemia and hypoglycemia, after controlling for age, gender, ethnicity, education, and time since diagnosis.

Conclusions: Patients reported poor problem-solving skills when detecting hyperglycemia and hypoglycemia via SMBG. Patients need to learn problem-solving skills along with SMBG training to achieve glycemic control.
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http://dx.doi.org/10.1177/0145721712440331DOI Listing
June 2012

Effects of depression and antidepressant use on goal setting and barrier identification among patients with type 2 diabetes.

Diabetes Educ 2011 May-Jun;37(3):370-80. Epub 2011 Apr 1.

The Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania (Ms Chen, Dr Ruppert, Mr Noullet, Dr Zgibor)

Purpose: The purpose of this study was to examine the effects of depression and antidepressant use on goal setting and barrier identification in patients with type 2 diabetes.

Methods: In a large diabetes education network, 778 patients with type 2 diabetes were enrolled in the American Association of Diabetes Educators (AADE) Outcomes System as part of their routine diabetes education between 2005 and 2008. Self-reported depression, 7 self-identified behavior change goals, and 13 barriers to diabetes self-care were collected from the Diabetes Self-Management Assessment Report Tool (D-SMART(®)); antidepressant use was documented from the Diabetes Educator Tool (D-ET(®)). Multiple linear regression was used to evaluate the effects of depression or antidepressant use on the number of goals or the number of barriers while controlling for relevant covariates.

Results: Among 778 patients (507 nondepressed, 181 depressed with antidepressant use, 90 depressed without antidepressant use), median age was 58, 60.9% were female, and 85.9% were Caucasian. Patients with and without depression had a similar number of self-identified behavior change goals, whereas patients with depression had 1 additional barrier to diabetes self-care compared with those without depression. In the depressed subgroup, antidepressant use had no association with the number of goals that the subjects set or the number of barriers they identified.

Conclusions: Among patients with type 2 diabetes, depression was associated with a slightly greater number of barriers, which may support the importance of depression screening and depression treatment in patients with diabetes.
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http://dx.doi.org/10.1177/0145721711400662DOI Listing
October 2011

Implications of type 2 diabetes on adolescent reproductive health risk: an expert model.

Diabetes Educ 2010 Nov-Dec;36(6):911-9. Epub 2010 Oct 13.

University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Copeland, Dr Doswell, Dr. Charron-Prochownik)

Purpose: The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D).

Methods: Using a mental model approach, a panel of experts--representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health--was convened to discuss reproductive health issues for female adolescents with T2D.

Results: Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one's lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management.

Conclusions: Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.
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http://dx.doi.org/10.1177/0145721710383586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3462007PMC
April 2011

Perceived access to contraception among adolescents with diabetes: barriers to preventing pregnancy complications.

Diabetes Educ 2010 May-Jun;36(3):489-94. Epub 2010 Mar 23.

The University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Schwarz, Dr Charron-Prochownik)

Purpose: The purpose of this study was to assess beliefs, perceived access to, and practices regarding contraception among adolescent women with type 1 diabetes.

Methods: Eighty-nine females with type 1 diabetes between the ages of 13 and 19 years, who were recruited from 2 endocrinology practices as part of a larger study, completed a battery of questionnaires designed to assess variables relevant to discussions of sexuality, preconception counseling, contraception, and pregnancy. In addition, items were designed to explore adolescents' relationship with their health care provider and comfort requesting birth control. Baseline data were analyzed using descriptive statistics.

Results: Half of the sexually active adolescents in this sample reported having had sex without birth control at a time they were trying to avoid pregnancy. A third (36%) of subjects felt that women with diabetes have very limited choices of birth control, and 43% incorrectly believe that all birth control methods are less effective when used by women with diabetes. Less than half (47%) reported that they had discussed birth control with a health care professional, and 29% of subjects reported they had not received formal instruction on birth control in any setting. Perhaps of greatest concern, only 69% stated they would feel comfortable asking a professional for birth control.

Conclusion: Many adolescent women with diabetes are at risk of unintended pregnancy and do not feel comfortable asking a health professional for birth control. Diabetes educators who initiate preconception counseling at puberty and discuss contraceptive options with adolescent women with diabetes may improve pregnancy outcomes.
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http://dx.doi.org/10.1177/0145721710365171DOI Listing
September 2010

Impact of a preconception counseling program for teens with type 1 diabetes (READY-Girls) on patient-provider interaction, resource utilization, and cost.

Diabetes Care 2010 Apr 12;33(4):701-5. Epub 2010 Jan 12.

University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA.

Objective: To evaluate the impact of a preconception counseling program tailored for teens with type 1 diabetes on cognitive, psychosocial, and behavioral outcomes and to assess its cost-effectiveness.

Research Design And Methods: A total of 88 teens with type 1 diabetes from two sites were randomized into the READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) intervention (IG) (n = 43) or standard care (SC) (n = 45) groups. During three diabetes clinic visits, IG subjects viewed a two-part CD-ROM, read a book, and met with a nurse. Program effectiveness was measured by knowledge, attitudes, intentions, and behaviors regarding diabetes, pregnancy, sexuality, and preconception counseling. Assessments occurred at baseline, before and after viewing program materials, and at 9 months. Economic analyses included an assessment of resource utilization, direct medical costs, and a break-even cost analysis.

Results: Age range was 13.2-19.7 years (mean +/- SD 16.7 +/- 1.7 years); 6% (n = 5) were African American, and 24% (n = 21) were sexually active. Compared with baseline and SC subjects, IG subjects demonstrated a significant group-by-time interaction for benefit and knowledge of preconception counseling and reproductive health: increasing immediately after the first visit (P < 0.001) and being sustained for 9 months (P < 0.05 benefits; P < 0.001 knowledge). For IG subjects, preconception counseling barriers decreased over time (P < 0.001), and intention and initiation of preconception counseling and reproductive health discussions increased (P < 0.001). Costs of adverse reproductive outcomes are high. Direct medical costs of READY-Girls were low.

Conclusions: READY-Girls was beneficial and effects were sustained for at least 9 months. This low-cost self-instructional program can potentially empower young women with type 1 diabetes to make well-informed reproductive health choices, adding little time burden or cost to their diabetes management.
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http://dx.doi.org/10.2337/dc09-1821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2845009PMC
April 2010

A self-instructional program for diabetes educators on preconception counseling for women with diabetes.

Diabetes Educ 2009 Jul-Aug;35(4):652-6. Epub 2009 May 15.

University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania (Dr Sereika, Ms Fischl, Ms Schmitt, Dr Charron-Prochownik).

Purpose: The purpose of this study was to develop, implement, and evaluate the effectiveness of a self-instructional preconception counseling (PC) training program for Certified Diabetes Educators (CDEs) to enhance PC knowledge and self-efficacy.

Methods: A 1-group, pre-post test study was conducted with 31 CDEs from a large medical center in western Pennsylvania. The self-instructional program included selected readings, such as the American Diabetes Association's position statement on PC of women with diabetes and an interactive CD-ROM, "Reproductive-Health Awareness for Teenage Women With Diabetes" ("READY-Girls"). Paper-and-pencil knowledge and self-efficacy questionnaires regarding PC and pregnancies of women with diabetes were completed by the CDEs before and immediately following the self-instructional program. Upon completion, participants received 5.0 Continuing Nursing Education contact hours (CNEs) from the State Nurses Association.

Results: Prior to receiving the program, all of the participants indicated they would benefit from further training on PC. Pretest knowledge scores averaged in the 70th percentile; following the program, the participants significantly increased (P < .01) PC knowledge and self-efficacy in providing PC to women with diabetes, including adolescents.

Conclusions: Although CDEs knew relevant information, they lacked some specific knowledge about PC, and they lacked confidence in their knowledge and in their ability to counsel patients. Diabetes educators can benefit from an education program to provide PC to their female patients, including adolescents. Computer or Web-based accessibility could make this a low-cost and easily disseminated program.
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http://dx.doi.org/10.1177/0145721709334516DOI Listing
September 2009
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