Urban American Indian/Alaska Native Cultural Eating Values and Behaviors: Community-based, mixed methods research to inform a holistic and culturally-informed diabetes prevention intervention program

点击翻译按钮获取中文摘要

PROJECT SUMMARY/ABSTRACT Background. Type 2 diabetes (T2D) disproportionately affects American Indian and Alaska Native (AI/AN) communities, with even greater burden on under-resourced urban AI/AN communities. Past research has shown that nutrition is deeply important for prevention of T2D, yet achieving proper nutrition requires a healthy mental relationship with eating, something that may be difficult to achieve for many AI/ANs who experience a disproportionate burden of mental illness. A promising intervention for improving holistic wellbeing is Intuitive Eating (IE), an adaptive eating style that utilizes aspects of positive psychology to promote connection to internal physiological cues to hunger and satiety. IE is a promising intervention for improving psychological relationships with food, eating behaviors, and mental health but to date there have been no efforts to assess IE’s compatibility with AI/AN cultural food values or the acceptability of IE to AI/AN communities. Study Goals and Aims. The candidate will collaborate with two urban AI/AN communities in Minneapolis and Baltimore to conduct an Exploratory Sequential Mixed Methods Community-Based Participatory Research (CBPR) study. Specific aims are to: 1) qualitatively explore AI/AN cultural eating values and perceptions of IE; 2) Culturally adapt the Intuitive Eating Scale 2 (IES-2) for urban AI/AN cultural and social contexts using community engaged participatory methods; and 3) Examine construct validity of the adapted IES-2 through factor analysis and its associations with health outcome data. Approach. Aim 1 of the study will utilize in-depth interviews with 30-40 urban AI/ANs to explore cultural eating values, eating behaviors, and perceptions of IE. This qualitative data will be analyzed using an inductive approach to gain a nuanced understanding of cultural eating values and eating behaviors within urban AI/AN communities. Aim 2 will utilize CBPR methods to engage community research councils (CRCs) in the integration of Aim 1 findings into the IES-2. Aim 3 will involve pilot testing the adapted measure alongside relevant health data with 250 AI/AN adults. Confirmatory Factor Analysis will be used to examine the construct validity of the adapted IES-2. Secondarily, multiple linear and logistic regression will be used to assess relationships between intuitive/cultural eating values and health outcome data (mental health, cultural connectedness, fruit/vegetable intake, physical activity). Fellowship Information. The proposed NRSA research will serve as the doctoral dissertation of Ms. Maudrie, an American Indian PhD student at the Johns Hopkins Bloomberg School of Public Health, her research and training are supported by a mentorship team of AI/AN health experts. This NRSA research builds upon the candidate’s previous CBPR research with urban AI/AN communities and is aligned with the NIDDK’s mission to improve the prevention of T2D & advance health equity for a high priority population (Urban AI/ANs).