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.
Type 2 diabetes is a leading cause of morbidity and mortality among American Indians in the United States. Although healthy diet is a key component of diabetes management programs, many American Indians face contextual barriers to adopting a healthy diet including: difficulty budgeting for food on low-incomes, low literacy and numeracy when purchasing food, and limited cooking skills. The proposed project will develop, implement, and evaluate a culturally-targeted healthy foods budgeting, purchasing, and cooking skills intervention aimed at improving the cardio-metabolic health of American Indians with type 2 diabetes who live in rural areas.