Cardiometabolic risk and risk perception among Oklahoma American Indian women with previous gestational diabetes

Introduction. Cardiovascular disease (CVD) is the number one killer of women in the United States (US). Increasing rates of CVD have been associated with the epidemic rates of type 2 diabetes mellitus (T2DM) in the US. Minority women, particularly American Indian women, experience a greater burden of health risk factors and significant disparities in health status related to CVD and T2DM. Furthermore, women who have had gestational diabetes mellitus (GDM) during pregnancy are at greater risk for these diseases than women who have not had GDM. However, these women often do not perceive themselves to be at risk, or, if they do, they often do not possess the self-efficacy to carry out lifestyle behaviors that would decrease their risk.

Article Synthesis. The first published article included in this dissertation, titled Type 2 Diabetes – Fueling the Surge of Cardiovascular Disease in Women (Jones & Appel, 2008), describes the cardiometabolic risk conferred by T2DM and CVD and provides a foundational review for the two articles that follow. With a more narrow scope, the second published article included, titled, A Review of the Health Beliefs and Lifestyle Behaviors of Women with Previous Gestational Diabetes (Jones, Roche, & Appel, 2009) examines the health beliefs, risk perceptions, and health behaviors related to diet and physical activity of women with previous GDM (pGDM). Finally, the third article, titled, A Mixed Methods Investigation of Cardiometabolic Risk and Risk Perception among Oklahoma American Indian Women with Previous Gestational Diabetes describes a pilotstudy which examines the cardiometabolic risk factors, risk perceptions, and self-efficacy beliefs of Oklahoma American Indian women with pGDM. The final article addresses gaps in the literature related to the estimation of cardiometabolic risk among American Indian women with pGDM and the description of knowledge, risk perceptions, and selfefficacy beliefs related to prevention of T2DM and CVD. Findings from the descriptive mixed methods study presented in this final article contribute to the growing body of nursing knowledge related to health disparities and women’s cardiometabolic health.

Key words: cardiometabolic risk, gestational diabetes, type 2 diabetes, cardiovascular disease, risk perception, mixed methods