Abstract

As health disparities among Native Americans persist, promoting better health outcomes is of paramount concern among Indigenous populations. A variety of programs exist that try to alleviate problems resulting in higher rates of diet-related chronic diseases and premature death. For this study, we collaborated with an Indigenous-led nonprofit that implemented a series of nutrition education courses designed to empower community members to make healthier food choices. The theoretically based curriculum, which provided learners with information in the form of sensory-based modules, e.g., food preparation, food handling, cultural awareness, and practical cooking skills, was introduced in various communities in the Great Plains and Southwest. The nutrition education programs were modeled after a canonical educational learning model, Bloom’s Taxonomy, designed to provide participants with information and resources necessary to make healthier food choices across three cognitive domains (i.e., tiers). We used a mixed-methods approach, coupling Principal Components Analysis with a qualitative SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis, to assess each program’s capacity to enhance learning retention, i.e., to assess the salience of information provided and the extent to which each program was more or less successful in participants’ learning. We found that course content and instruction are strongly correlated with program satisfaction. In addition, from the qualitative analysis, we found that as each successive module of the program challenged higher cognitive domains, participants were more likely to indicate satisfaction in the course material as well as state a desired change in their behavior, which we attribute to participants’ ability to synthesize and evaluate information. Aspects of this programming framework have the potential to be adapted to and integrated into other Native communities striving for the successful adoption of healthier diets.

Highlights

  • Native Americans are disproportionately affected by many diet-related chronic health problems, including diabetes and obesity [1]

  • Limited research exists that examines the levels of food insecurity among Native Americans, yet at least one study finds that food insecurity is higher among Native Americans compared to non-Natives [5]

  • We found that designing a curriculum with objectives characterized according to Bloom’s Taxonomy appeared to improve overall participant satisfaction and retention of information—two outcomes that are linked with behavioral change and improved health outcomes [15,16,17]

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Summary

Introduction

Native Americans are disproportionately affected by many diet-related chronic health problems, including diabetes and obesity [1]. According to the Centers for Disease Control (CDC), Native American adults have the highest rates of diabetes compared to any other race or ethnicity [2]. The CDC explains that social determinants of health, including access to and availability of food options, are major predictors of health outcomes [3]. The inability to achieve optimal health within and beyond Native communities has been largely attributed to insufficient access to places that sell healthy, affordable foods, and this is burdensome to low-income communities. Coupled with high rates of poverty and unemployment prevalent in reservation communities, these populations may be at an increased risk of food insecurity, where households are unable to acquire enough food for their families to lead an “active, healthy life” [4]. Limited research exists that examines the levels of food insecurity among Native Americans, yet at least one study finds that food insecurity is higher among Native Americans compared to non-Natives [5]

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