Culturally Tailoring a Diabetes Nutrition Education Program

Curriculum for Native communities

Partners

1. Indian Health Care Resource Center of Tulsa; Tulsa, OK
2. Zuni Comprehensive Health Center; Zuni, NM 
3. Saint Regis Band of Mohawk; Akwesasne, NY
4. Cherokee Indian Hospital; Cherokee, NC 
5. Lake County Tribal Health Consortium; Lakeport CA
6. American Indian Health Service of Chicago; Chicago, IL

AI/AN WCIE Study Team

G.Austin; D.Bellinger; A. Brega; K.Conti; N.Couture; H.Garrow; T.Hicks; E.Juarez-Colunga; M.McNulty; K.R. Moore; N.O’Banion; H.Pontius; S.Roman; S.Stotz; S. Tewahade

Specific aims

Year 1 – Development of recommendations for adapting WCIE

• Aim 1a. Finalize identification of collaborating tribal communities and engage key partners and stakeholders
• Aim 1b. Conduct literature review to identify barriers and facilitators as well as social and cultural factors that influence dietary behavior in AI/AN communities
• Aim 1c. Conduct key informant interviews and focus groups to obtain input from tribal leaders and elders, health care providers and educators, community members, and other key stakeholders regarding community needs and resources, potential value of technology-based education, barriers and facilitators (e.g., food security), dietary customs, and predictors of dietary behavior
• Aim 1d. Conduct formal health literacy assessment of participant-facing curriculum materials
• Aim 1e. Use findings from Aims 1b-1d to develop recommendations for tailoring WCIE for AI/ANs

Year 2 – Adaptation & pilot implementation of WCIE for AI/ANs

• Aim 2a. In collaboration with ADA, identify final adaptations to WCIE
• Aim 2b. Identify measures to evaluate proximal and distal outcomes (September – December 30, 2019)
• Aim 2c. Develop culturally tailored version of WCIE curriculum (May 1 – December 30, 2019)
• Aim 2d. Begin implementation pilot of adapted version of WCIE curriculum in 6 diverse tribal communities (January 1, 2020 – April 30, 2020)

Year 3 – Implementation of ADA WCIE for AI/ANs / evaluation and reporting

• Aim 3a. Complete implementation pilot of adapted version of WCIE curriculum in 6 diverse tribal communities (May 1, 2020 – December 2020)
• Aim 3b. Evaluate impact of curriculum participation on diabetes nutrition knowledge, self-efficacy and outcome expectancies, behavior (e.g., self-reported dietary intake), and clinical outcomes (e.g., weight, height, A1c, blood pressure), and identify mediators/moderators (e.g., food access and security, engagement with technology) of intervention effectiveness
• Aim 3c. Throughout implementation, continuously evaluate implementation process, collect and review data on participant and trainer satisfaction, and conduct qualitative interviews with recent graduates and trainers 

Research projects 

Qualitative data collected in the first year of this project supported two secondary data analysis pilot projects. Both of these pilot projects were granted to project Co-I, Dr. Stotz under the mentorship of PI, Dr. Moore, and include: 

1. National Institute of Diabetes and Digestive and Kidney Diseases-funded Center for American Indian and Alaska Native Diabetes Translation Research (Grant P30 DK092923; PI: Manson) Food Insecurity and Type 2 Diabetes Among American Indians and Alaska Natives: Multiple Stakeholder Perspectives
2. Native Elder Research Center, Resource Centers for Minority Aging Research, National Institutes on Aging, (Grant #P30 AG15292 PI: Manson) An Online Diabetes Nutrition Education Program for American Indian and Alaska Native Adults with Type 2 Diabetes: Perspectives from Key Stakeholders

Outcomes

Findings from year one were presented in a formal recommendation report to the sponsor on the adaptation of the WCIE program to serve AI/AN communities. This included the findings from focus groups and interviews to understand perspectives of key stakeholders of a culturally targeted AI/AN diabetes nutrition education program, a scan of the peer reviewed literature to understand what published and grey literature may inform this adaptation project, a health literacy evaluation of the current ADA WCIE curriculum, and a graphic design review of the current ADA WCIE curriculum to develop graphic design standards that can appeal to a wide array of AI/AN people, regardless of tribal affiliation, age, or geographic location. The pilot test of AI/AN WCIE launched at 2 of our 6 collaborating tribal sites in January 2020.