Cheyenne River Sioux Tribe Cooking for Health

本申请中提出的研究活动解决了美洲印第安人（AI）的迫切需求。 社区-设计、实施和评估符合文化特点的健康食品预算， 购买和烹饪干预，以改善患有2型糖尿病的人工智能患者的饮食和健康。前提 拟议项目的执行情况是从社区中与健康食品供应有关的试点工作中了解到的， 饮食选择和食物购买模式，以及先前的研究表明， 在其他成年人中开展关于饮食和健康的预算编制和烹饪技能培训。目前，没有证据表明- 基于预算或烹饪技能的计划存在，可以在低资源环境中实施，例如 农村AI社区此外，尽管饮食是糖尿病控制的基石， 存在针对2型糖尿病患者的技能项目。 使用随机对照试验，我们将测试文化定制的健康食品预算的有效性， 购买和烹饪程序：（1）饮食（即，（2）营养丰富的食物，（3）营养丰富的食物，（4）营养丰富的食物。 疗效，预算和烹饪技能，以及健康食品的购买与2型糖尿病的居住在 在夏延河苏族保护区-美国第四大人工智能保护区。二次 结果将包括其它饮食因素（即，摄入蔬菜和水果、豆类和全谷物）， 健康食品知识、营养标签阅读、饮食敏感的心脏代谢危险因素（即，腰围体重 周长、血压、血脂）和糖尿病控制（即，空腹血糖、HbA 1c、糖尿病药物 使用/剂量）。此外，我们将进行混合方法过程评估，以评估干预范围， 忠诚度、参与者满意度和有效性。课程将针对患有糖尿病的人工智能人群， 并直接解决社区成员和部落成员确定的健康饮食的主要障碍， 最近焦点小组的领导人包括：（1）低收入者难以为食物预算;（2）识字率低， 购买食物时的计算能力（例如，无法使用店内秤将“每磅”价格的食品转换为 美元价值）;（3）有限的烹饪技能。我们希望制定和实施一个适合文化的 饮食干预将有效促进积极的饮食改变，并增加健康食品自我效能， 预算和烹饪技能，以及健康食品的购买。 控制不佳的糖尿病会影响患者的健康/寿命，并对医疗保健产生深远的影响。 成本需要做出更大努力，鼓励负担沉重的服务不足社区的健康饮食 糖尿病改善糖尿病患者的健康食品预算，购买和烹饪技能， 改善饮食和糖尿病管理。如果成功，该计划可以扩展到其他AI社区。

The research activities proposed in this application address a pressing need in American Indian (AI) communities – the design, implementation, and evaluation of a culturally-tailored healthy food budgeting, purchasing, and cooking intervention to improve diet and health among AIs with type 2 diabetes. The premise of the proposed project was informed by pilot work in the community related to the availability of healthy foods, dietary choices, and food purchasing patterns, and previous studies that indicate positive relationships of budgeting and cooking skills training on diet and health in other adult populations. Currently, no evidence- based budgeting or cooking skills programs exist that can be implemented in low-resource settings, such as rural AI communities. Moreover, despite diet being a cornerstone of diabetes control, no budgeting or cooking skills programs exist that focus on individuals with type 2 diabetes. Using a randomized controlled trial, we will test the effectiveness of a culturally-tailored healthy food budgeting, purchasing, and cooking program on: (1) diet (i.e., intake of SSBs, processed foods) and (2) healthy food self- efficacy, budgeting and cooking skills, and healthy food purchases among AIs with type 2 diabetes who reside on the Cheyenne River Sioux reservation—the fourth largest AI reservation in the United States. Secondary outcomes will include other dietary factors (i.e., intake of vegetables and fruit, legumes, and whole grains), healthy food knowledge, nutrition label reading, diet sensitive cardio-metabolic risk factors (i.e., weight, waist circumference, blood pressure, lipids) and diabetes control (i.e., fasting glucose, HbA1c, diabetes medication use/dosage). Additionally, we will conduct a mixed methods process evaluation to assess intervention reach, fidelity, participant satisfaction, and effectiveness. Curriculum to be tailored to an AI population with diabetes, and directly address major barriers to healthy eating that were identified by community members and tribal leaders in recent focus groups including: (1) difficulty budgeting for food on low-incomes; (2) low literacy and numeracy when purchasing food (e.g., inability to use in-store scales to convert foods priced “per pound” to dollar values); (3) limited cooking skills. We expect that development and implementation of a culturally-tailored diet intervention will be effective in promoting positive diet change, and increase healthy food self-efficacy, budgeting and cooking skills, and healthy food purchases. Poorly controlled diabetes affects the health/longevity of those afflicted, and has profound effects on healthcare costs. Greater efforts are needed to encourage healthy eating in underserved communities with a high burden of diabetes. Improving healthy food budgeting, purchasing, and cooking skills among AIs with diabetes should improve diet and diabetes management. If successful, this program can be extended to other AI communities.