Lynn Engelberg Glenn

Background: Although the overall rate of adherence to postpartum glucose screening is low (less than 50%), the geographical disparities, rural versus urban, in postpartum glucose screening rates for women with gestational diabetes are relatively unknown. Objectives: The purpose of this study was to compare postpartum glucose screening rates between women living in rural versus urban areas. Secondarily, this study evaluated the impact of transfer of maternity care on adherence to postpartum care and glucose screening rates in women with gestational diabetes mellitus. Design: Through retrospective chart review, data were collected from records with a diagnosis of gestational diabetes between January 2015 and October 2020. Methods: Subjects were classified as urban or rural residents. The following data were collected: number of prenatal and postpartum care visits, number of prenatal and postpartum glucose testing, infant birthweight, maternal complications, and demographic data, including race, age, and insurance status. Results: Our final sample consisted of 82 women classified as urban and 67 classified as rural. Overall, the number of postpartum glucose tests was lower in the rural group ( M = 0.30), compared to the urban group ( M = 0.52) and demonstrated statistically significant differences with Poisson regression (coefficient 0.56, Wald chi-square = 4.59, p = 0.03). Women from rural areas, who were referred and transferred maternity care to the Regional Perinatal Health Care Center, had the lowest average postpartum visits ( M = 1.00) and postpartum glucose tests ( M = 0.22) compared to the women from urban areas who were transferred from other providers with mean postpartum visits ( M = 1.46) and mean postpartum glucose tests ( M = 0.29). Conclusions: Rural women received lower postpartum glucose screening than those residing in urban areas. This finding illustrates greater disparities among rural women seeking postpartum care. Larger prospective studies are warranted to examine contributing factors, such as continuity of care and the transition from postpartum care to primary care. The remaining significant need is for healthcare providers to facilitate preventive care following pregnancy, including timely glucose screening and detection of women at high risk for developing type 2 diabetes, especially among rural populations.

The purpose of this qualitative study was to gain a better understanding of the spheres of influence on engagement in recommended diabetes preventive health services among rural, working adults. Additionally, this study sought to understand the unique factors that influence diabetes self-management among rural, working adult populations. The sample included mostly African-American, low-income females with self-reported diabetes, who scored low on the Patient Activation Measure (PAM-10). Semi-structured interviews (N = 20) revealed that most participants struggled with the “ups and downs” of living with diabetes. Four major themes emerged from the data: “the struggle,” “doing things together,” “diabetes is not the priority,” and “we’re lucky to have what we have.” Most participants were developing individual responsibility and motivation for a healthy future, but were overwhelmed by inconsistency in self-management, diabetes distress, lack of effective coping strategies, and lack of social and economic capital. The findings of this study indicate the need to further address psychological well-being among rural, working adults, yet rural populations often lack sufficient access to mental health care and formalized psychological support. Psychological support and resources are essential to facilitate engagement in diabetes self-management and preventive health services for rural, working adults.

Despite notable progress being made in preventing child marriage, a significant proportion of women worldwide are still married before reaching adulthood. Though many aspects of child marriage have been widely studied, little is known on the later life health outcomes of child brides, let alone the critical need for healthcare during adulthood. This paper examines whether child brides at a young adult age bear a greater risk of high blood pressure (HBP) and high blood glucose (HBG) comorbidity than those who were married as adults. Using nationally representative data from India, we categorized married young adult (aged 20-34 years) women in four categories: neither HBP nor HBG, HBP only, HBG only, and both HBP and HBG. We estimated multinomial logistic regressions to obtain unadjusted and adjusted relative risk ratios in favor of these mutually exclusive outcomes for the child marriage indicator. Around 0.5% of the women in our sample had high blood pressure and high blood glucose comorbidity. While the prevalence of comorbidity was 0.4% among women who were married as adults, comorbidity was 40% higher (p < 0.000) among women who were married as children. The relative risk of the comorbidity among child brides was 1.4 (95%CI: 1.2–1.7) times that of their peers who were not married as children. The findings, thus, suggest that child brides at young adult age are at greater risk of having high blood pressure and high blood glucose comorbidity. Concerted public health efforts, therefore, are necessary to improve their long-term health and wellbeing.

Microresearch is an innovative, mentored research experience, originally developed in Africa and adapted for U.S. health professional trainees preparing for rural primary care practice. This report describes program elements (funding, mentorship, and peer support) that others may replicate to develop research and leadership skills through community engagement to address health disparities.

Objective: This secondary analysis examined the relationships between Patient Activation Measure (PAM) scores, use of health services, and HgA1C.Design: A feasibility study was conducted for a community‐based intervention for high‐risk adults with uncontrolled diabetes. Data were collected at baseline and monthly, including PAM and modified Diabetes Self‐Management Assessment Report Tool.Intervention: Participants (n = 58) were randomized to a 3‐month nurse (RN) telephone management or community health worker (CHW) in‐home intervention, focusing on medication adherence, timely follow‐up, diabetes self‐management coaching, and linkage to resources.Results: Sample was mostly female (73%), African‐American (90%), low income (75%), high school education or less (80%), and mean age of 59 years. A positive association between PAM score and self‐reported diabetes care recommendations was found (r = .356, p = .014) and significant correlation between baseline PAM score and HgA1C levels (r = −.306, p = .029). A paired samples t test showed statistically significant increases in PAM scores in the CHW intervention group (mean increase +8.5, CI [+2.49 to +14.65]); baseline (M = 60.31, SD = 13.3) to end of study ([M = 68.89, SD = 16.39], t(22) = 2.924, p = .008 [two‐tailed]).Conclusion: A community‐based approach to diabetes management demonstrated a positive effect on patient activation. Although disparities in health care access among rural, low‐income populations exist, community‐based interventions show potential for improving patient engagement in diabetes management and recommended health services.