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Relationships Among Neighborhood Poverty, Access to Healthy Food, and Diabetes Self-Management in Women Who Received Perinatal Nurse Home Visits

Published:November 03, 2021DOI:https://doi.org/10.1016/j.jogn.2021.10.004

      Abstract

      Objective

      To examine the relationships among neighborhood poverty, access to healthy food, and diabetes self-management in pregnant women in an urban setting who received perinatal nurse home visits.

      Design

      Exploratory descriptive secondary analysis of existing individual-level and neighborhood-level data.

      Setting

      Philadelphia, Pennsylvania, United States.

      Participants

      Women who were pregnant, had diabetes, and were enrolled in the citywide perinatal nurse home visiting program because of their diabetes (N = 264).

      Methods

      We retrieved neighborhood-level aggregated data on poverty and access to healthy food from PolicyMap, a geographic information system. We retrieved individual-level data from a clinical research database. Access to healthy food was operationalized at the individual level by reported use of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We operationalized diabetes self-management as good or poor glycemic control. We conducted descriptive and logistic regression analyses.

      Results

      We found no relationship between neighborhood-level poverty and neighborhood-level access to healthy food with women’s glycemic control. However, at the individual level, use of the WIC program was associated with glycemic control (p = .034). Participants who reported not using this program were two times more likely to have poor glycemic control than those who did (OR = 2.045, 95% confidence interval [1.003, 2.045]).

      Conclusion

      It is important to understand how the complex interplay between neighborhoods and individual factors of poverty and access to healthy food influences health outcomes among pregnant women. The WIC program may mediate neighborhood influence on diabetes self-management. Future research is warranted on how this program and nurse home visiting services can optimize maternal health outcomes among women who have diabetes during pregnancy.

      Keywords

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      Biography

      Yosefa Birati, PhD, RN, is a postdoctoral research fellow, Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.

      Biography

      Joan Rosen Bloch, PhD, CRNP, FAAN, is an emerita professor, College of Nursing and Health Professions and School of Public Health, Drexel University, Philadelphia, PA.

      Biography

      Amy McKeever, PhD, CRNP, WHNP-BC, is an associate professor, M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA.

      Biography

      Beth D. Chiatti, PhD, RN, CTN-B, CSN, is a clinical associate professor, College of Nursing of Health Professions, Drexel University, Philadelphia, PA.