Table 1

Summary of main themes and associated subthemes among sample if Eeyou Iscthee mothers with a recent gestation diabetes mellitus (GDM) pregnancy

Main themeSubthemeSample quotes
1. Worry, anxiety, and guilt1.1 Insulin injections
1.2 Complications with baby
1.3 Recurrent GDM and diabetes
1.4 Guilt
1.5 Anticipation of GDM diagnosis
1.6 Disbelief of GDM diagnosis
  • “I kind of getting scared because, like, poking yourself every day, and my mum—it’s really known in my family too, to have diabetes. So my mum kind of scared me a little bit too, telling me that if you don’t take care of yourself or you don’t even try, it’s just going to stick with you.”

  • “I cried. I didn’t—like, I was worried, like, everything I eat, what’s going to happen to my baby”

  • “I experienced being diabetic for sure. But yeah, I don’t know, I’m—it makes me worried that I might just have it again, even without being pregnant.”

  • “I felt a lot of guilt. You know, like, you know, it was my fault, and then I just, like, was very, very meticulous about what I was eating and—and that kind of brought me into a depression as well.”

  • “I was devastated the first time I found out because I thought, you know, like, I—I’m healthy. You know, I’m—I’m active. I eat healthy. You know, like, I don’t—I don’t get it. How do I have GDM when I see all these other pregnant women, and they don’t have it, but I do? You know, like, what’s going on?”

2. Understanding of GDM and its implications2.1 Awareness of future diabetes risk
2.2 Knowledge of GDM
2.3 Need for ongoing education on diabetes prevention
  • “Yeah, it goes away shortly after birth, but then you have a higher risk of—so it’s better to keep the good habits that you had.”

  • “It was a lot to take in, but I got through it as they were telling me it was going to be okay. They were really good.”

  • “It was more like, “Oh, your blood sugar’s a little high. You have to watch. Here’s a glucometer.”

3. Sources of support3.1 Clinic staff
3.2 Partner
3.3 Family
3.4 Peers with GDM
  • “I met with the nutritionist, and I had my nurse’s cell phone number. So, like, when I had weird numbers or something, I was able to call and ask them.”

  • “He (partner) really helped me a lot. Like, we would go for walks and tell me it’s okay, just how do you say it—watch what you’re eating.”

  • “If I had any questions, I’d go to my family, or if they couldn’t answer, I would just go to the clinic and they would have the answers for me.”

  • “I think for women with GDM, I think a support group. Because everybody has different ways of dealing with things, and sometimes people don’t know what questions to ask. And then when they hear somebody else ask the question, they’re, like, oh, okay, yeah.”

4. Awareness of necessary health behavioral changes4.1 Diet changes
4.2 Regular physical activity
  • “Picking better protein choices, because we live in an area where we can have choices, and that’s great. So, like, goose, bear meat, anything, anything traditional, I try and stick to that.”

  • “Like having vegetables daily. Like, half of the plate is supposed to be full of vegetables and a quarter of it should be, like, meat or chicken and a quarter of carbs, because we need still carbs. So yeah, that’s eating fruits and vegetables, snacks and—healthy snacks.”

  • “Being more active, walking more to work (…) Doing more than I’m doing now. It doesn’t mean I have to run a marathon or do a fitness challenge. It just means doing more.”

5. Health behavioral change challenging5.1 Time constraints
5.2 Lack of childcare
5.3 Safety concerns
5.4 Cost
5.5 Worry of being judged
  • “When you work nine to five and you have two kids, you’re just, like, totally drained out.”

  • “I hear a lot of parents say—like, let’s say if I asked them, let’s go for a walk and they would say, oh, I don’t have a babysitter.”

  • “A lot of people(just don’t)walk on the highway, and then when you walk on the skidoo trail, there’s skidoos going.”

  • “Like, healthy food, it could be more expensive.”

  • “At the gym to have a bigger gym workout and not to pay. Because I know other communities (…) don’t pay the gym fee. But here we pay, like, $300 or something.”

  • “I’ve went in there (local gym) once. But there’s too many people there. They’re all, like, strong, built people and then here you come and you’re, like, this chunky short person. I’m just, like, no, I can’t.”

6. Needs and preferences for a T2DM prevention program6.1 Partner involvement
6.2 Childcare
6.3 Group activities
6.4 Scheduled activities
6.5 Education on increasing healthy behaviors
6.6 Traditional elements
  • “We have to do things together in order to have a healthy life and a healthy baby.”

  • “(Onsite childcare) would be really helpful because Mom and Dad would be able to focus, and a lot of times around here, it’s just really hard to find a sitter.”

  • “Well, to do it alone, it would be nice. But I think that being with other people, you get to learn other people’s—like, how they do it and it might help you do it at home better or if you help them out. Like, everyone gets to talk.”

  • “A lot of activities, like constantly, like, every day having to go walk or something.”

  • “I would love to learn, like, exercises too, exercises I can do at home or while I’m with my kids. It would be something fun to do with our kids.”

  • “Traditional food too because a lot of—like, there’s healthy ways to cook traditional food and there’s unhealthy ways to cook traditional food.”

  • GDM, gestational diabetes mellitus; T2DM, type 2 diabetes mellitus.