1825-LB: Reproductive Health (RH) and Gestational Diabetes (GDM) Knowledge Mediates the Intervention Effect on the Intention to Communicate in Dyads of American Indian and Alaska Native (AIAN) Female Adolescents and Young Adults (FAYA) at Risk for GDM and their Adult Female Caregivers

AIAN women are unduly impacted by GDM. This secondary analysis of Stopping GDM trial data explored possible mechanisms of action of a psycho-behavioral educational intervention targeting healthy behaviors to reduce GDM risk from pre- to post-test among AIAN FAYA. Dyads of FAYA and their adult female caregivers were recruited from 5 sites. Each dyad member independently completed questionnaires regarding RH and GDM knowledge, health beliefs, and intention to initiate discussion with healthcare providers (HCPs) and their corresponding dyad member. Between assessments intervention participants viewed a 45-minute video, the initial component of the intervention. Dyadic mediation analysis was conducted using the Actor-Partner Interdependence Model extended to Mediation (APIMeM) assuming distinguishable dyad members. The sample (N=149 dyads; intervention; n=79; control: n=70) included FAYA (mean age 16.7±3.0 years) and adult female caregivers (mean age 44.1±9.3 years; 81.0% being mothers of FAYA). APIMeM revealed a positive actor indirect effect of the intervention for improvement in the FAYA’s intention to initiate discussion through increases in FAYA’s RH and GDM knowledge (1.53, 95%CI=[0.27, 2.98]). A positive partner indirect effect was also observed for the intervention on the improvement in the FAYA’s intention to initiate discussion through increases in the adult caregiver’s RH and GDM knowledge (0.61, 95%CI=[0.042, 1.42]). No effects were found for changes in health beliefs of FAYA or adult caregivers as mediators of intervention effects on FAYA’s and adult caregiver’s intention to initiate discussion. These results suggest that enhancing RH and GDM knowledge may improve key downstream outcomes such as communication between FAYA, adult caregivers and HCPs for AIAN FAYA at risk for GDM.