Exploring the Role of the Parish Nurse In Providing Diabetes Education and Preconception Counseling to African American Women Using a Community-Engaged Mixed-Methods Approach

摘要

Purpose: The purpose of this study is to explore the experiences of parish nurses (PNs) in providing diabetes education and preconception counseling (PC) to women (especially African American [AA] women) with type 1 diabetes (T1D) and type 2 diabetes (T2D) and their understanding of diabetes as it relates to pregnancy and pregnancy outcomes; and to describe the parish nurses’ knowledge and teaching self-efficacy regarding diabetes, pregnancy and PC. udMethods: A mixed-method concurrent embedded design using focus group methodology as the primary method and a quantitative descriptive design with three self-report measures (demographic, PC self-efficacy, and PC knowledge) as the secondary method was utilized. Forty-eight parish nurses participated in one of eleven focus groups. Qualitative content analysis was conducted and combined with descriptive measure analysis.udResults: Seventeen qualitative themes emerged from the discussions with the PNs: 1) role, 2) approach, 3) challenges, 4) support network 5) practice and programs, 6) diabetes practice and programming, 7) diabetes and pregnancy and PC practice and programs, 8) awareness, 9) experience, 10) formal training, 11) importance and usefulness, 12) willingness, 13) forming a social network of wise women, 14) confidence, 15) need for training, 16) recommendations for PC training for PNs, and 17) recommendations for PC tool for patients. PNs’ knowledge scores were low (mean= 65%, range= 40-100%) with only moderate levels of self-efficacy (mean= 99, range = 27-164). Self-efficacy had a significantly positive association with knowledge, as knowledge increased self-efficacy increased (Pearson r = .292, p =. 05). udConclusions: Quantitative results confirmed PNs’ qualitative statements. PNs were unaware of PC and lacked both knowledge and teaching self-efficacy as it related to PC/diabetes education. Understanding PNs’ experiences with women with diabetes and identifying their needs to provide education and PC will help tailor training interventions that could impact maternal and fetal outcomes. ud