Markup Methodology to Culturally Tailor Preexisting Preconception Counseling (PC) Program for Latina Adolescent Girls with Diabetes and Their Mothers

Latinas with diabetes are at a higher risk for reproductive health (RH) complications. READY-Girls is an evidence-based PC program recommended by the ADA for adolescent girls. PC should be culturally tailored for the Latina population. This reports on qualitative data, including markups of the existing READY-Girls book, that informed the tailoring of READY-Girls PC program. Key pages of READY-Girls book were given to Latina mothers (M) and their daughters (D) with diabetes in either English or Spanish [(18 D: 6 reviewed both, 12 English); (12 M: 4 reviewed both, 2 English, 6 Spanish)]. Daughters were 13 to 21 years old, 44% had T1D. Participants were given paper-and-pencil open-ended questions about readability, understanding and sensitivity to the Hispanic culture; and asked to markup the book by writing comments on the pages and using assigned symbols to communicate thoughts (e.g., * = liked this, ? = don’t understand, XX phrase = inappropriate). Responses to questions and markups were written verbatim, clustered and analyzed to identify major themes, using a qualitative descriptive method, 4 researchers discussed themes and reached consensus. Findings: 1) book was: a) easy to read, understand, and interesting; b) acceptable to Latina culture, but add topics, “talking with parents about being sexually active”, “resources to prevent teen pregnancy”, and c) taught the importance of PC. 2) Illustrations were: a) informative, but removing those of bodily changes during puberty could be less offensive to Latina culture; b) adding facial pictures.

Conclusion: Markup methodology was effective in communicating thoughts about modifying the book and adapting it for Latinas. This methodology could enhance qualitative data collection especially when inquiring about sensitive topics such as reproductive health. Overall, M-D participants liked the program, found it useful and provided helpful suggestions for cultural modifications.