Objective: To describe cardiometabolic risk among a sample of American Indian women with previous gestational diabetes and describe the women's knowledge, risk perception for type 2 diabetes and cardiovascular disease, and self-efficacy beliefs related to preventing these diseases. Design: Mixed methods, cross-sectional, exploratory, descriptive. Setting: Four campuses within one American Indian tribal health care system in a southwestern state. Participants: A purposeful sample of 22 self-identified American Indian women with a history of gestational diabetes. Methods: Qualitative interview data were subjected to content analysis, and descriptive statistics were used to analyze quantitative questionnaire data and biophysiologic data. Results: The majority of participants (13 of 21) were classified as having metabolic syndrome, and 13 of 18 women were found to be insulin resistant. In general, the women had high levels of knowledge related to type 2 diabetes and cardiovascular disease and high risk perception, but low self-efficacy related to preventing cardiometabolic disease. The overarching theme from the in-depth interviews, struggling to change lifestyle behaviors while doubting prevention is possible, encompassed four categories that provided further illumination into participants' risk perceptions and self-efficacy beliefs: concerns, control, beliefs/attitudes, and prevention. Conclusions: High levels of knowledge and risk perception do not necessarily promote increased self-efficacy to prevent cardiometabolic disease among American Indian women with previous gestational diabetes. Findings indicate the need to further explore women's self-efficacy beliefs in the context of American Indian culture prior to developing interventions aimed at increasing self-efficacy to prevent or delay type 2 diabetes and cardiovascular disease. Women with previous gestational diabetes are at increased risk for developing cardiovascular disease, independent of a diagnosis of type 2 diabetes. © 2012 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.