title: Patient and caregiver perspectives of health provision practices for First Nations and Métis women with gestational diabetes mellitus accessing care in Winnipeg, Manitoba.
abstract: BACKGROUND
  More North American Indigenous women are diagnosed with gestational diabetes mellitus (GDM) than the general population. Despite the number of health problems associated with GDM, few studies have been conducted that explore Indigenous women's understandings of GDM in an effort to develop appropriate and effective health strategies.
  
  
  METHODS
  A qualitative investigation was conducted to describe the experiences of First Nations and Métis women with GDM. Unstructured interviews and focus groups initially took place with 25 advisors such as maternal care providers and community representatives. Semi-structured explanatory model interviews were subsequently carried out with 29 First Nations and Métis women in Winnipeg, Manitoba, Canada.
  
  
  RESULTS
  Divisions in health services, communication and cultural barriers exist, and limit prenatal care access as well as the consistent interpretation of diabetes education messages.
  
  
  CONCLUSIONS
  Collectively the results suggest living with GDM can be overwhelming and underscore the need for health care providers to encourage self-efficacy towards effective management practices in the context of cultural safety.
authors.affiliation: Department of Geography, Western University, London, Ontario N6A 5C2, Canada. hneufel2@uwo.ca.
authors.forename: Hannah
authors.initials: H
authors.lastname: Tait Neufeld
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D017028:Caregivers / Q000523:psychology*; D016640:Diabetes, Gestational / Q000208:ethnology* / Q000628:therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D008350:Manitoba; D017060:Patient Satisfaction; D011247:Pregnancy; D036301:Qualitative Research; D055815:Young Adult