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Brega AG, Stotz SA, Moore KR, McNulty MC, Jiang L. Reliability and Validity of Diabetes Nutrition Self-Efficacy and Behavior Measures for the "What Can I Eat" Diabetes Nutrition Education Program for American Indian and Alaska Native Adults With Type 2 Diabetes. J Acad Nutr Diet 2024:S2212-2672(24)00218-1. [PMID: 38735529 DOI: 10.1016/j.jand.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 05/01/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND American Indian and Alaska Native (AI/AN) people have high rates of diabetes and limited access to nutrition education. The "What Can I Eat? Healthy Choices for People With Type 2 Diabetes" (WCIE) diabetes nutrition education program was culturally adapted for AI/AN adults. OBJECTIVE This analysis was designed to evaluate the reliability and validity of items developed to measure diabetes nutrition self-efficacy (ie, confidence one can engage in specific behaviors) and diabetes nutrition behavior among participants in the WCIE program for AI/AN adults. DESIGN This study was a secondary analysis of data from a randomized controlled trial designed to evaluate the WCIE program for AI/AN adults. Baseline data were used to assess the reliability and validity of the self-efficacy and behavior items, which were collected via survey. Due to COVID-19 safety protocols, the intervention was conducted via Zoom (Zoom Video Communications), and both survey and clinical data were collected at home by participants. PARTICIPANTS/SETTING The study was conducted from January to December 2021 with 5 AI/AN-serving health care programs in Oklahoma, Illinois, North Carolina, California, and New York. AI/AN adults with type 2 diabetes who spoke English and had internet access were eligible. Sixty people participated. MAIN OUTCOME MEASURES Analyses examined validity and reliability of diabetes nutrition self-efficacy and behavior items. STATISTICAL ANALYSIS PERFORMED To test reliability, internal consistency and factor structures of the scales were examined. To evaluate convergent validity, Pearson correlations were computed to examine the association of the self-efficacy and behavior measures with each other and with clinical indicators (ie, body mass index, blood pressure, and hemoglobin A1c). RESULTS Two self-efficacy factors were identified. Each showed strong internal consistency (Cronbach α ≥ 0.85; McDonald ω ≥ 0.88) and was directly associated with diabetes nutrition behavior (P < .001). The factor assessing Confidence in Using the Diabetes Plate was inversely associated with hemoglobin A1c (Pearson correlation = -0.32, P = .0243). The behavior measure capturing Healthy Nutrition Behavior showed strong internal consistency (α = 0.89; ω = 0.92) and was inversely associated with hemoglobin A1c (Pearson correlation = -0.38, P = .0057). CONCLUSIONS Diabetes nutrition self-efficacy and behavior items developed for the WCIE program for AI/AN adults are valid and reliable. These items can facilitate rigorous and consistent evaluation of the AI/AN WCIE program.
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Affiliation(s)
- Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Sarah A Stotz
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado
| | - Kelly R Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Monica C McNulty
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luohua Jiang
- Department of Epidemiology and Biostatistics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, California
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Fort MP, Reid M, Russell J, Santos CJ, Running Bear U, Begay RL, Smith SL, Morrato EH, Manson SM. Diabetes Prevention and Care Capacity at Urban Indian Health Organizations. Front Public Health 2021; 9:740946. [PMID: 34900897 PMCID: PMC8661087 DOI: 10.3389/fpubh.2021.740946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
American Indian and Alaska Native (AI/AN) people suffer a disproportionate burden of diabetes and cardiovascular disease. Urban Indian Health Organizations (UIHOs) are an important source of diabetes services for urban AI/AN people. Two evidence-based interventions-diabetes prevention (DP) and healthy heart (HH)-have been implemented and evaluated primarily in rural, reservation settings. This work examines the capacity, challenges and strengths of UIHOs in implementing diabetes programs. Methods: We applied an original survey, supplemented with publicly-available data, to assess eight organizational capacity domains, strengths and challenges of UIHOs with respect to diabetes prevention and care. We summarized and compared (Fisher's and Kruskal-Wallis exact tests) items in each organizational capacity domain for DP and HH implementers vs. non-implementers and conducted a thematic analysis of strengths and challenges. Results: Of the 33 UIHOs providing services in 2017, individuals from 30 sites (91% of UIHOs) replied to the survey. Eight UIHOs (27%) had participated in either DP (n = 6) or HH (n = 2). Implementers reported having more staff than non-implementers (117.0 vs. 53.5; p = 0.02). Implementers had larger budgets, ~$10 million of total revenue compared to $2.5 million for non-implementers (p = 0.01). UIHO strengths included: physical infrastructure, dedicated leadership and staff, and community relationships. Areas to strengthen included: staff training and retention, ensuring sufficient and consistent funding, and data infrastructure. Conclusions: Strengthening UIHOs across organizational capacity domains will be important for implementing evidence-based diabetes interventions, increasing their uptake, and sustaining these interventions for AI/AN people living in urban areas of the U.S.
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Affiliation(s)
- Meredith P Fort
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Margaret Reid
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jenn Russell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Cornelia J Santos
- Environmental Studies-Indigenous Sustainability Studies Program, Bemidji State University, Bemidji, MN, United States
| | - Ursula Running Bear
- Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Rene L Begay
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Savannah L Smith
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elaine H Morrato
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, IL, United States
| | - Spero M Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.,Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Estradé M, van Dongen EJI, Trude ACB, Poirier L, Fleischhacker S, Wensel CR, Redmond LC, Pardilla M, Swartz J, Treuth MS, Gittelsohn J. Exposure to a Multilevel, Multicomponent Obesity Prevention Intervention (OPREVENT2) in Rural Native American Communities: Variability and Association with Change in Diet Quality. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212128. [PMID: 34831884 PMCID: PMC8621011 DOI: 10.3390/ijerph182212128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/22/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Abstract
The OPREVENT2 obesity prevention trial was a multilevel multicomponent (MLMC) intervention implemented in rural Native American communities in the Midwest and Southwest U.S. Intervention components were delivered through local food stores, worksites, schools, community action coalitions, and by social and community media. Due to the complex nature of MLMC intervention trials, it is useful to assess participants’ exposure to each component of the intervention in order to assess impact. In this paper, we present a detailed methodology for evaluating participant exposure to MLMC intervention, and we explore how exposure to the OPREVENT2 trial impacted participant diet quality. There were no significant differences in total exposure score by age group, sex, or geographic region, but exposure to sub-components of the intervention differed significantly by age group, sex, and geographical region. Participants with the highest overall exposure scores showed significantly more improvement in diet quality from baseline to follow up compared to those who were least exposed to the intervention. Improved diet quality was also significantly positively associated with several exposure sub-components. While evaluating exposure to an entire MLMC intervention is complex and imperfect, it can provide useful insight into an intervention’s impact on key outcome measures, and it can help identify which components of the intervention were most effective.
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Affiliation(s)
- Michelle Estradé
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
- Correspondence: (M.E.); (E.J.I.v.D.)
| | - Ellen J. I. van Dongen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
- Correspondence: (M.E.); (E.J.I.v.D.)
| | - Angela C. B. Trude
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Lisa Poirier
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | | | - Caroline R. Wensel
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | - Leslie C. Redmond
- School of Allied Health, University of Alaska Anchorage, Anchorage, AK 99508, USA;
| | - Marla Pardilla
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | - Jacqueline Swartz
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
| | - Margarita S. Treuth
- Department of Kinesiology, School of Pharmacy and Health Professions, University of Maryland Eastern Shore, Princess Anne, MD 21853, USA;
| | - Joel Gittelsohn
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (L.P.); (C.R.W.); (M.P.); (J.S.); (J.G.)
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Stotz S, Brega AG, Lockhart S, Hebert LE, Henderson JN, Roubideaux Y, Moore K. An online diabetes nutrition education programme for American Indian and Alaska Native adults with type 2 diabetes: perspectives from key stakeholders. Public Health Nutr 2021; 24:1449-1459. [PMID: 32677608 PMCID: PMC8132168 DOI: 10.1017/s1368980020001743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/10/2020] [Accepted: 05/06/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To explore stakeholder perspectives regarding online diabetes nutrition education for American Indians and Alaska Natives (AI/AN) with type 2 diabetes (T2D). DESIGN Qualitative data were collected through focus groups and interviews. Focus group participants completed a brief demographic and internet use survey. SETTING Focus groups and community participant interviews were conducted in diverse AI/AN communities. Interviews with nationally recognised content experts were held via teleconference. PARTICIPANTS Eight focus groups were conducted with AI/AN adults with T2D (n 29) and their family members (n 22). Community participant interviews were conducted with eleven clinicians and healthcare administrators working in Native communities. Interviews with nine content experts included clinicians and researchers serving AI/AN. RESULTS Qualitative content analysis used constant comparative method for coding and generating themes across transcripts. Descriptive statistics were computed from surveys. AI/AN adults access the internet primarily through smartphones, use the internet for many purposes and identify opportunities for online diabetes nutrition education. CONCLUSIONS Online diabetes nutrition education may be feasible in Indian Country. These findings will inform the development of an eLearning diabetes nutrition education programme for AI/AN adults with T2D.
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Affiliation(s)
- Sarah Stotz
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela G Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Lockhart
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), Children’s Hospital Colorado, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Luciana E Hebert
- Elson S. Floyd College of Medicine, Institute for Research and Education Advancing Community Health (IREACH), Washington State University, Seattle, WA, USA
| | - J Neil Henderson
- Department of Family Medicine and Biobehavioral Health, The University of Minnesota Medical School, Duluth, MN, USA
| | | | - Kelly Moore
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, The University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Ferranti EP, Hartman TJ, Elliott AJ, Mitchell DC, Angal J, Nickleach D, Bellissimo M, Breslow R. Diet Quality of Pregnant American Indian Women in the Northern Plains. Prev Chronic Dis 2019; 16:E53. [PMID: 31022368 PMCID: PMC6513482 DOI: 10.5888/pcd16.180536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We examined diet quality and intake of pregnancy-specific micronutrients among pregnant American Indian women in the Northern Plains. METHODS We conducted an analysis of nutrition data from the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network Safe Passage Study and the PASS Diet Screener study (N = 170). Diet intake, including dietary supplementation, was assessed by using three 24-hour recalls conducted on randomly selected, nonconsecutive days. Diet intake data were averaged across the participant's recalls and scored for 2 dietary indices: the Healthy Eating Index 2010 (HEI-2010) and the Alternate Healthy Eating Index for Pregnancy (AHEI-P). We also assessed nutrient adequacy with Dietary Reference Intakes for pregnancy. RESULTS On average, participants were aged 26.9 (standard deviation [SD], 5.5) years with a pre-pregnancy body mass index of 29.8 (SD, 7.5) kg/m2. Mean AHEI-P and HEI-2010 scores (52.0 [SD, 9.0] and 49.2 [SD, 11.1], respectively) indicated inadequate adherence to dietary recommendations. Micronutrient intake for vitamins D and K, choline, calcium, and potassium were lower than recommended, and sodium intake was higher than recommended. CONCLUSION Our findings that pregnant American Indian women are not adhering to dietary recommendations is consistent with studies in other US populations. Identifying opportunities to partner with American Indian communities is necessary to ensure effective and sustainable interventions to promote access to and consumption of foods and beverages that support the adherence to recommended dietary guidelines during pregnancy.
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Affiliation(s)
- Erin P Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322.
| | - Terryl J Hartman
- Department of Epidemiology, Rollins School of Public Health, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Amy J Elliott
- Avera Research Institute for Pediatric and Community Research, Sioux Falls, South Dakota
| | - Diane C Mitchell
- Diet Assessment Center, Department of Nutritional Sciences, Penn State University, University Park, Pennsylvania
| | - Jyoti Angal
- Avera Research Institute for Pediatric and Community Research, Sioux Falls, South Dakota
| | - Dana Nickleach
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | - Rosalind Breslow
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Houghtaling B, Byker Shanks C, Ahmed S, Rink E. Grandmother and health care professional breastfeeding perspectives provide opportunities for health promotion in an American Indian community. Soc Sci Med 2018; 208:80-88. [PMID: 29772397 PMCID: PMC6015548 DOI: 10.1016/j.socscimed.2018.05.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 11/17/2022]
Abstract
RATIONALE While breastfeeding is well recognized as beneficial, rates of breastfeeding among American Indian women are below average and contribute to health inequities. Culturally specific approaches to breastfeeding research are called for to inform appropriate interventions in American Indian communities. Specifically, a grandmother's role in breastfeeding promotion is of great import particularly in American Indian (AI) groups, although is an understudied topic to date. OBJECTIVE This research seeks to fill a prominent literature gap by utilizing a grounded theory and community-based research approach to inform breastfeeding practices from the voices of grandmothers and health care professionals in a rural AI community in the United States. METHODS A community-based approach guided the research process. Convenience and snowball sampling was used to recruit for semi-structured and follow up member checking interviews with AI grandmothers (n = 27) and health care professionals (n = 7). Qualitative data were transcribed, characterized into meaning units, and coded by a review panel. Data were reconciled for discrepancies among reviewers, organized thematically, and used to generate community-specific breastfeeding constructs. RESULTS Three major themes emerged, each with relevant subthemes: (1) importance of breastfeeding; (2) attachment, bonding, and passing on knowledge; and (3) overburdened health care system. Multiple subthemes represent stressors and impact breastfeeding knowledge, translation, and practice within this community including formula beliefs, historical traumas, societal pressures, mistrust, and substance abuse. CONCLUSIONS Interventions designed to raise breastfeeding rates in the study site community would ideally be grounded in tribal resources and involve a collaborative approach that engages the greater community, grandmothers, health care professionals, and scientific partners with varying skills. More research is needed to determine stressors and any potential impact on infant feeding practices among other AI groups. Application of the research approach presented here to other AI communities may be beneficial for understanding opportunities and challenges to breastfeeding practices.
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Affiliation(s)
- Bailey Houghtaling
- Department of Human Nutrition, Foods, and Exercise, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA.
| | - Carmen Byker Shanks
- Food and Health Lab at Montana State University, Department of Health and Human Development, 960 Technology Blvd., Room 215, Bozeman, MT 59717, USA.
| | - Selena Ahmed
- Food and Health Lab at Montana State University, Department of Health and Human Development, 960 Technology Blvd., Room 215, Bozeman, MT 59717, USA.
| | - Elizabeth Rink
- Department of Health and Human Development, Montana State University-Bozeman, P.O. Box 173540, Bozeman, MT 59717, USA.
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Warren-Mears V, Ritchey J, Larson B, English K, Provost E, Hill K, Wimsatt M, Grismala K, Andreini M, Yazzie D, Beaudry PJ. Tribal Epidemiology Centers and Native American Health. J Acad Nutr Diet 2016; 116:769-70. [PMID: 27126149 DOI: 10.1016/j.jand.2016.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Victoria Warren-Mears
- Director, Northwest Tribal Epidemiology Center, Northwest Portland Area Indian Health Board, Portland, OR
| | - Jamie Ritchey
- Director, Inter-Tribal Council of Arizona, Inc Tribal Epidemiology Center, Inter-Tribal Council of Arizona, Inc, Phoenix, AZ
| | - Byron Larson
- Director, Urban Indian Health Institute, Seattle Indian Health Board, Seattle, WA
| | - Kevin English
- Director, Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Albuquerque, NM
| | - Ellen Provost
- Director, Alaska Native Tribal Epidemiology Center, Anchorage, AK
| | - Kristin Hill
- Director, Great Lakes Tribal Epidemiology Center, Lac du Flambeau, WI
| | - Maureen Wimsatt
- Director, California Tribal Epidemiology Center, California Rural Indian Health Board, Sacramento, CA
| | - Kate Grismala
- Assistant Director, United South and Eastern Tribes Tribal Epidemiology Center, United South and Eastern Tribes, Nashville, TN
| | - Mike Andreini
- Director, Rocky Mountain Tribal Epidemiology Center, Billings, MT
| | - Del Yazzie
- Acting Director, Navajo Tribal Epidemiology Center, Window Rock, AZ
| | - P J Beaudry
- Director, Northern Plains Tribal Epidemiology Center, Great Plains Tribal Chairmen's' Board, Rapid City, SD
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