Social and Environmental Barriers to Nutrition Therapy for Diabetes Management Among Underserved Pregnant Women: A Qualitative Analysis.

OBJECTIVE To identify social and environmental barriers to nutrition therapy for diabetes management during pregnancy among a population of low-income, minority pregnant women. DESIGN Prospective, in-depth, semi-structured interviews performed serially during pregnancy and continued until thematic saturation was reached. SETTING Urban academic medical center. PARTICIPANTS Ten pregnant low-income, minority women with gestational diabetes and type 2 diabetes mellitus. PHENOMENON OF INTEREST Social and environmental barriers to nutrition therapy for diabetes management during pregnancy. ANALYSIS Qualitative analysis of interview data using electronic coding software was performed using theme analysis. RESULTS Participants perceived limited ability and self-efficacy to adopt nutrition recommendations. Specific themes identified as barriers included (1) feeling overwhelmed by the unfamiliar; (2) using and decoding nutrition labels; (3) managing nutrition choices and seeking control in the setting of food insecurity; (4) experiencing lack of control and motivation, and limited self-efficacy; (5) balancing recommendations with taste preferences and cultural food norms; (6) maintaining a healthy eating schedule; and (7) accommodating diabetes in family and social life. CONCLUSIONS AND IMPLICATIONS Pregnant women with diabetes encounter a number of knowledge-based, attitudinal, and resource-related barriers that reduce capacity for nutrition therapy adherence. Provision of culturally informed, practical nutrition support that addresses the needs of women in low-resource communities is an important component of comprehensive diabetes care during pregnancy.