title: Identifying postpartum intervention approaches to reduce cardiometabolic risk among American Indian women with prior gestational diabetes, Oklahoma, 2012-2013.
abstract: BACKGROUND
  Innovative approaches are needed to reduce cardiometabolic risk among American Indian women with a history of gestational diabetes. We assessed beliefs of Oklahoma American Indian women about preventing type 2 diabetes and cardiovascular disease after having gestational diabetes. We also assessed barriers and facilitators to healthy lifestyle changes postpartum and intervention approaches that facilitate participation in a postpartum lifestyle program.
  
  
  METHODS
  In partnership with a tribal health system, we conducted a mixed-method study with American Indian women aged 19 to 45 years who had prior gestational diabetes, using questionnaires, focus groups, and individual interviews. Questionnaires were used to identify women's cardiometabolic risk perceptions and feasibility and acceptability of Internet or mobile phone technology for delivery of a postpartum lifestyle modification program. Focus groups and individual interviews were conducted to identify key perspectives and preferences related to a potential program.
  
  
  RESULTS
  Participants were 26 women, all of whom completed surveys; 11 women participated in focus group sessions, and 15 participated in individual interviews. Most women believed they would inevitably develop diabetes, cardiovascular disease, or both; however, they were optimistic that they could delay onset with lifestyle change. Most women expressed enthusiasm for a family focused, technology-based intervention that emphasizes the importance of delaying disease onset, provides motivation, and promotes accountability while accommodating women's competing priorities.
  
  
  CONCLUSIONS
  Our findings suggest that an intervention that uses the Internet, text messaging, or both and that emphasizes the benefits of delaying disease onset should be tested as a novel, culturally relevant approach to reducing rates of diabetes and cardiovascular disease in this high-risk population.
authors.affiliation: College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125. E-mail: emily.jones@umb.edu.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Jones
authors.affiliation: Chickasaw Nation Department of Health, Ada, Oklahoma.
authors.forename: Michael
authors.initials: M
authors.lastname: Peercy
authors.affiliation: Institute for New England Native American Studies, University of Massachusetts Boston, Massachusetts.
authors.forename: J Cedric
authors.initials: JC
authors.lastname: Woods
authors.affiliation: Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma.
authors.forename: Stephany P
authors.initials: SP
authors.lastname: Parker
authors.affiliation: Chickasaw Nation Department of Health, Ada, Oklahoma.
authors.forename: Teresa
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Department of Nutritional Sciences, Oklahoma State University, Stillwater, Oklahoma.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Mata
authors.affiliation: Chickasaw Nation Department of Health, Ada, Oklahoma.
authors.forename: Shondra
authors.initials: S
authors.lastname: McCage
authors.affiliation: College of Social Work, University of South Carolina, Columbia, South Carolina.
authors.forename: Sue E
authors.initials: SE
authors.lastname: Levkoff
authors.affiliation: Division of General Internal Medicine, University of Colorado School of Medicine, Boulder, Colorado.
authors.forename: Jacinda M
authors.initials: JM
authors.lastname: Nicklas
authors.affiliation: Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts.
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Seely
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology; D016640:Diabetes, Gestational; D005260:Female; D017144:Focus Groups; D063105:Food Assistance; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007198:Indians, North American / Q000523:psychology* / Q000706:statistics & numerical data; D020407:Internet / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008019:Life Style / Q000208:ethnology; D008875:Middle Aged; D009825:Oklahoma; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D049590:Postpartum Period / Q000208:ethnology; D011247:Pregnancy; D036301:Qualitative Research; D012307:Risk Factors; D011795:Surveys and Questionnaires; D060145:Text Messaging / Q000706:statistics & numerical data; D016387:Women's Health; D055815:Young Adult
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