auger communications, inc.
Gestational Diabetes FAQ
Pregnancy and Diabetes: Lucia's Story

Photonovels (or photonovelas) are a culturally familiar format in Latin American countries and well-suited for those with lower literacy skills.

Embarazo y diabetes (Pregnancy and Diabetes) focuses on the emotional impact on a woman who learns she has gestational diabetes. See FAQs for details.

Key Topics:
  • Common misconceptions about diabetes and insulin.
  • Tips to manage blood sugar.
  • What to do for high and low blood sugar.
Special Sections for Personal Info: Women can enter their own recommended blood sugar levels and emergency information.

Photonovel Description- It's like a magazine!

    Embarazo y diabetes (Pregnancy & Diabetes) was developed through a collaborative public/private/non-profit partnership with the Hispanic Health Initiative at Chatham Hospital (Siler City, NC), Auger Communications, Inc., and Inter-Am English & Spanish CommunicationsDr. Pamela Frasier was the Project Director and Alexis Amsterdam was the Project Coordinator.

    We would like to acknowledge the assistance of the many individuals who reviewed the photonovel and provided helpful suggestions. We appreciate Susana Jaimes for sharing her personal story about having diabetes during pregnancy, upon which this story is based.

    A special thanks to the women and their families who allowed us to photograph them and who also shared their experiences and perspectives with us throughout the development process.

    We want to thank our expert panel members: Tania Connaughton-Espino, Dr. Lemyra DeBruyn, Merry-K Moos, Dr. Mary Ann Morris, and Gloria Sanchez, and the staff at the North Carolina March of Dimes and National March of Dimes offices for their invaluable input.

     FAQS on Embarazo y Diabetes /Pregnancy and Diabetes

    1. What sparked the development of this photonovel and what is its overall purpose?
    2. Who is the primary target audience?
    3. What health behavior is addressed by the photonovel?
    4. How was the material developed including the use of theory and/or needs assessment data?

    5. How was the material evaluated?
    6. What kind of sponsors and advertising will be included?
    7. Where will the advertising be placed in the photonovel?

    To learn more about photonovels

    To learn more about how to teach with photonovels using the empowerment-based TWS Method™  

     Q1. What sparked the development of this photonovel and what is its overall purpose?

    A1. The Latino population in North Carolina has grown 400% in recent years. Many Latinas receive inadequate prenatal care and are at risk for developing gestational diabetes. A nationwide search revealed few culturally relevant materials to educate Latinas on gestational diabetes. A photonovel (or photonovela), which is like a comic book with photographs, was developed to educate Latinas about gestational diabetes. Lucia's story, designed to be reassuring, helps dispel common myths and reinforces the message that diabetes is controllable.

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     Q2. Who is the primary target audience?

    A2. Latinas of childbearing age. Our needs assessment process revealed a major gap in the availability of easy to read, culturally appropriate educational materials for Latinas on this topic. To address this need, we created an easy to read story (approx. 5-8th grade*), with the understanding that this photonovel could be used with the TWS Method in group settings so those who may not be able to read or who have very low literacy levels may still benefit.
    *This is only an estimated reading level. To assess readability and clarity, we relied on field-testing with members of the target audience who seek care in public health settings.

    We did not want to duplicate existing materials. For free materials on diabetes written at even lower literacy levels (in English and Spanish),
    visit: and

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     Q3. What health behavior is addressed by the photonovel?

    A3. This story supports the readiness and movement through stages of change related to gestational diabetes self-care (for women and potentially for family members and other support persons).

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     Q4. How was the material developed? What theories and needs assessment data were used?

    A4.  Several behavior change theories, including the Health Belief Model, Stages of Change Theory, and Theory of Reasoned Action, informed the development process. Relational-cultural theory, which views self-efficacy within the context of relationships and multi-dimensional cultures, was also a critical influence. The development team also incorporated principles related to health literacy and women’s ways of learning.  Consequently, learning objectives for the photonovela were derived from triangulating the information gained from focus groups with Latinas (n=24), an expert panel (n=6), interviews with health professionals and educators with experience working with the target population (n=7), and a review of existing literature, published materials. A review of diabetes programs in Latin American countries was also conducted to develop an appreciation and better understanding of health messages that Latino families may be receiving in their countries of origin.

    The storyline was based on the actual experience of a Latina with gestational diabetes. To make the story more universal, it was adapted to include the voices and experiences of other Latinas in the focus groups and key issues/messages identified in the needs assessment process. To create an easily identifiable feeling and natural look, Latinas from the target audience served as the ‘models’ and were photographed in their homes and community settings. The story was written first in Spanish, translated to English, and then back translated to Spanish.

    Note: Sponsors and advertisers were not involved in the content development.

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     Q5. How was the material evaluated?

    A5.  The development team used the Plan, Do, Study, Act (PDSA) Cycle methodology for evaluation and quality assurance from start to finish.  The PDSA Cycle is a quality improvement tool with four repetitive steps for continuous improvement and learning.  The PDSA Cycle allows for evaluation and improvement under a short time frame and complete participation on the part of experts and target audience throughout the process, ensuring accuracy, accessibility, and quality. This included two cycles of field-testing with members of the target audience (n=28) and expert panel once the story was in draft form with photographs. This process ensures full participation and a high-quality product from the perspective of both experts and Latinas.

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     Q6. What kind of sponsors and advertising will be included?

    A6.  Practical goods and services for pregnant women and their families and for people with diabetes.Advertising not included: Products that pregnant women and those with diabetes should avoid.

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     Q7. Where will the advertising be placed in the photonovel?

    A7. Since this is a health educational book designed for teaching, the advertising will be inserted in the middle of the book and on the back page only.

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