JMIR Publications

ABSTRACT

Background:

Targeting reproductive-aged women at high risk for Type 2 Diabetes (T2D) provides an opportunity for prevention earlier in the life course. A woman’s experiences during her reproductive years may have a large impact on her future risk of T2D. Her risk is 7 to 10 times higher if she has had gestational diabetes (GDM). Despite these risks, T2D is preventable. Evidence-based programs, such as the National Diabetes Prevention Program (DPP), can reduce the risk for developing T2D by nearly 60%. However, only 0.4% of adults with prediabetes have participated in the DPP to date and reproductive-aged women are 50% less likely to participate than older women. In prior work, our team developed a mobile 360° video to address diabetes risk awareness and promote DPP enrollment among at-risk adults; this video was not designed, however, for reproductive-aged women.

Objective:

To obtain feedback from reproductive-aged women with cardiometabolic disease risk about a 360° video designed to promote enrollment in the DPP; and to gather suggestions about tailoring video messages to reproductive-aged women.

Methods:

Focus groups and a qualitative descriptive approach were used. Women with at least one previous pregnancy, aged 18 to 40, participated in 1 of 3 focus groups stratified by the following health risks: 1) history of GDM or a hypertensive disorder of pregnancy, 2) a diagnosis of prediabetes, or 3) a BMI classified as obese. Focus group questions addressed several topics, with this report sharing findings regarding video feedback. The three focus-group discussions were conducted via Zoom and were recorded and transcribed for analysis. Deductive codes were used to identify concepts related to the research question and inductive codes were created for novel insights shared by participants. The codes were then organized into categories and themes.

Results:

The main themes identified were positive feedback, negative feedback, motherhood, and the importance of storytelling. While some participants said the video produced a sense of urgency for healthy behavior change, all participants agreed that design changes could improve the video’s motivating effect on health-behavior change in reproductive-aged women. Participants felt a tailored video should recognize the complexities of being a mother and how these dynamics contribute to women’s difficulty engaging in healthy behaviors without stirring feelings of guilt. Women desired a video with a positive, problem-solving perspective, and recommended live links as clickable resources for practical solutions promoting health-behavior change. Women suggested using storytelling both to describe how complications experienced during pregnancy impact long-term health and to motivate health-behavior change.

Conclusions:

Tailoring of health behavior-change messaging is required to address the unique needs of reproductive-aged women and to promote lifestyle change. Optimally, messages should address commonly encountered barriers by providing realistic solutions and a positive tone, combined with storytelling linked to human connection.