Article B:

Greenhalgh, T., Clinch, M., Afsar, N., Choudhury, Y., Sudra, R., Campbell-Richards, D., Claydon, A., Hitman, G.A., Hanson, P., & Finer, S. (2015). Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach. BMC Medicine, 13(1), 1-15. https://doi.org/10.1186/s12916-015-0360-

1. Evaluate the purpose statement: The issue to research was the high prevalence of gestational diabetes in South Asian Women due to demographic, behavioral, and socio-cultural beliefs. The authors explained South Asian women had a higher prevalence of gestational diabetes than white European or US women (Greenhalgh, Clinch, Afsar, Choudhury, Sudra, Campbell-Richards,... and Finer, 2015).

The purpose of this study was to see an investigation of a phenomenon.

• Does the statement begin with signaling words?
• Does the statement identify the research approach (quantitative, qualitative, or mixed)?
• Does the statement clearly state the intent of the study?
• Does the statement mention the participants?
• Does the statement mention the research site?
• Is the statement framed in a way that is consistent with the identified problem?

2. Analyze alignment among the theory, research problem, and purpose.

3. Explain your position on the relationship between research and social change.

See Abstract of the Study:

Background: Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions.

Methods: Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories.

Results: Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food insecurity. While peer advice was familiar, meaningful, and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning.

Conclusions: 'Behaviour change' interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural 'choices' are made.