Assessment of the contextual factors that influence adoption of a gestational diabetes mellitus nutrition education curriculum in American Indian and Alaska Native-serving healthcare organizations - PROJECT ABSTRACT Between 5-9% of all pregnancies in the U.S. are affected by gestational diabetes mellitus (GDM) each year. GDM is defined as glucose intolerance during pregnancy and can cause complications for both mother and infant, such as maternal high blood pressure, preeclampsia, high birth weight, hypoglycemia, preterm birth, and a higher risk of developing type 2 diabetes (T2D) in the future. Interrupting the intergenerational cycle of diabetes is vital, particularly among American Indian and Alaska Native (AI/AN) communities, as AI/AN women have twice the risk of developing GDM as compared to the general U.S. population. GDM can be prevented and managed through diet modifications, physical activity, and lifestyle support. Nutrition education is most effective when it is tailored to meet the unique contextual needs of AI/AN women with a history of GDM. Currently, there are no multilevel nutrition education programs tailored for pregnant AI/AN women with GDM. To fill this gap, our team is developing What Can I Eat? Healthy Choices for AI/AN Women with GDM (WCIE GDM), an adaptation of our American Diabetes Association–endorsed curriculum we created for AI/AN adults with T2D, What Can I Eat? Healthy Choices for AI/ANs with T2D (WCIE T2D). WCIE T2D includes interactive, theory-based, hands-on nutrition education activities including use of the Diabetes Plate for meal planning, increasing intake of AI/AN traditional healthful foods, mindful eating strategies. To achieve greatest impact of WCIE GDM, the first step is to identify barriers and facilitators that AI/AN maternal and child-serving healthcare organizations may have for implementing the adapted WCIE GDM. Aim #1: Employ a community-informed approach to understand potential barriers, facilitators, and outcomes of WCIE GDM (1a) and refine WCIE GDM core components Aim #2: Apply the CFIR 2.0-Expert Recommendations for Implementing Change (ERIC) mapping guide to identify a preliminary set of implementation strategies to support WCIE GDM adoption, implementation, and sustainment. Additionally, this F31 predoctoral fellowship will provide training to support independence in key focus areas: 1) conducting community-engaged research, 2) applying dissemination and implementation science frameworks, and 3) using rigorous qualitative methods. This research has the potential to improve maternal and infant health outcomes among AI/AN communities and disrupt the intergenerational cycle of T2D. By understanding contextual factors to implementation and sustainment, the team will be positioned to adapt WCIE for GDM and to conduct a future fully powered R01 to evaluate the implementation strategies in AI/AN- serving healthcare organizations that offer maternal health care. Further, the training and development activities will enable the candidate to launch her career as an independent scientist.
