Development of an American Indian Diabetes Education Cultural Supplement: A Qualitative Approach

Abstract

ObjectiveThe purpose of this study was to culturally enhance a diabetes education program for Diné (Navajo) community members with Type 2 diabetes. Though the recommendation to culturally adapt health education curricula was meant to improve health education for American Indians and Alaskan Natives (AIANs), it has inadvertently created a “one size fits all” approach. This approach does not properly address the need for tribe-specific cultural health messaging, defined as incorporating cultural elements deemed relevant to the population. Tribe-specific health information and programming, such as integrating Diné worldviews and Indigenous knowledge among Diné people as described here, are essential to creating a culturally relevant and effective and meaningful approach to disease self-management.MethodsA conversation guide, based on the Hózhó Resilience Model—a Diné framework on healthy living, was used to engage key cultural experts in interviews about traditional stories and teachings regarding health and wellness. Three specific self-care behaviors relevant to Type 2 diabetes self-management were discussed: (1) healthy eating, (2) physical activity, and (3) healthy coping. Interviews were audio-recorded, transcribed and analyzed using a qualitative thematic analysis method.ResultsDiné healers and cultural experts informed the development of an educational tool called Diné Health. Key themes that emerged from the data included the importance of discipline, positivity and mindfulness in the context of Hózhó.ConclusionCulturally safe and meaningful engagement with cultural leaders and the use of qualitative research methods can inform deep-level cultural adaptations essential to developing tribe-specific diabetes education programs. The approaches used here can guide the development, implementation, and testing of culturally-informed health education for AIAN populations.

Diné (Navajo) Traditional Knowledge Holders’ Perspective of COVID-19

“…The Diné community places great trust in TKHs and future public health initiatives would be strengthened if TKHs were consulted during the process of creating health educational materials, and while training health messengers who will educate the community. Previous AI studies integrated cultural knowledge into their materials and emphasized the greater effectiveness when including cultural beliefs, stories, and ceremonial knowledge to help shift behavior change for health promotion [ 25 , 45 , 46 ]. This process could address language barriers when health education materials are presented in Diné bizaad (Diné language) or with use of culturally relevant terms that consider the traditional worldview.…”

The Medicine Wheel as a public health approach to lifestyle management interventions for indigenous populations in North America

“…Progress in lifestyle intervention research and promising interventions with enhanced cultural adaptations are beginning to emerge for Indigenous communities ( 30 ). Holistic and multi-level approaches that consider various health domains are needed to advance standard lifestyle interventions as mortality disparities persist, with retention and participation of Indigenous populations in the Deep South under-examined and likely poor based on available evidence.…”