An Exploratory Analysis of Factors Associated with Low Risk Perception for Developing Type 2 Diabetes amongst Low-income, Primarily Latina Women with prior Gestational Diabetes Mellitus

Abstract Background: Gestational diabetes mellitus (GDM) is a significant contributor to the development of diabetes (DM2) post-partum, with higher rates amongst low-income and Latina women. Understanding one’s risk perception for developing DM2 postpartum amongst women with GDM can help target preventive interventions that promote positive health behaviors and lifestyle changes. This study aims to assess how the interplay of individual level factors, healthcare based factors, and structural factors influence risk perception for developing DM2 amongst low-income, primarily migrant Latina women with recent gestational diabetes mellitus. Methods: Data is from the baseline assessment of the STAR MAMA intervention. Women (N=171) receiving prenatal care at low-income urban clinics in San Francisco Bay Area were surveyed for basic demographics, healthcare access, and health-related behaviors. The outcome variable, risk perception for developing DM2 post-partum, was measured using the RPS-DM tool. Associations between risk perception for developing DM2 and individual, health-care based and structural (eg. health insurance, food insecurity, educational attainment) covariates were estimated using descriptive statistics and logistic regression. Results: Although all participants had a high risk for subsequently developing DM2, 76% reported lower risk perception for developing diabetes within the next 1, 5, and 10 years. Migrant status, less than high school education, and food insecurity were associated with lower risk perception (p<0.05). Spanish-speaking women with GDM who did not have family histories of DM2 were at greatest risk of underestimating their DM2 risk (OR=6.5; CI= (1.149, 11.795)). On the other hand, Spanish-speaking women who had family histories of DM2 were more likely to correctly assess their DM2 risk (OR=0.16; CI= (0.031, 0.824)). Conclusions: Structural and individual factors, rooted in migrant status and cultural backgrounds, influence personal risk perception. The majority of high-risk GDM women in this sample underestimate their risk for developing diabetes. This poses an opportunity for the healthcare system to improve patient-provider communication to improve risk perceptions and motivation for behavioral risk reduction. Improved counseling regarding risk perception for vulnerable, migrant populations with GDM is critical to accurately convey risk and engage individuals in preventive behaviors. Trial Registration: The clinical trial registration number is: NCT02240420 and date of registration: 9/11/2014.