The objective of the present study was to identify barriers to and facilitators of physical activity among American Indian adults living on a rural, U.S. Northern Plains reservation using the nominal group technique (NGT). NGT is a method of data generation and interpretation that combines aspects of qualitative (free generation of responses) and quantitative (systematic ranking of responses) methodologies. Adults participated in one of two NGT sessions asking about either barriers to (n = 6), or facilitators of (n = 5), being physically active. Participants nominated and ranked 21 barriers and 18 facilitators. Barriers indicated lack of knowledge of how to fit physical activity into a daily schedule, work, caring for family members, and prioritizing sedentary pursuits. Other responses included environmental barriers such as lack of access and transportation to a gym, unsafe walking conditions, and inclement weather. Facilitators to following recommendations included knowledge of health benefits of physical activity and the perception of physical activity as enjoyable, including feeling good when working out. Environmental facilitators included being outdoors walking and biking as well as parks and exercise facilities. Responses provided direction for locally designed community-based programs to promote facilitators and decrease barriers to individual’s engagement in physical activity.

Objective: The Dietary Guidelines for Americans (DGA) promote healthy dietary choices for all Americans aged 2 years and older; however, the majority of Americans do not meet recommendations. The goal of the present study was to identify both barriers and facilitators to adherence to DGA recommendations for consumption of five recommended food groups: grains (specifically whole grains), vegetables, fruits, meat/beans and milk (specifically reduced-fat/non-fat), among American-Indian children. Design: Nominal group technique sessions were conducted to identify and prioritize children's perceived barriers and facilitators to following the DGA, as presented in the 'MyPyramid' consumer education icon. After response generation to a single question about each food group (e.g. 'What sorts of things make it harder (or easier) for kids to follow the MyPyramid recommendation for vegetables?'), children individually ranked their top five most salient responses. Ranked responses are presented verbatim. Setting: A rural Northern Plains American-Indian reservation, USA. Subjects: Sixty-one self-selected fifth-grade children. Results: Core barriers for all food groups studied included personal preference (i.e. 'don't like') and environmental (i.e. 'cost too much'; 'store is too far to get them'; 'grandma don't have'). Core facilitators included suggestions, i.e. 'make a garden and plant vegetables'; 'tell your friends to eat healthy'. Conclusions: Barriers and facilitators are dissimilar for individual food groups, suggesting that dietary interventions should target reduction of barriers and promotion of facilitators specific to individual food groups recommended by the DGA. Keywords American-Indian children Nominal group technique Dietary Guidelines for AmericansBarriers and facilitatorsEstimates of obesity among US children aged 6-11 years range from 14 to 24 %, depending upon racial/ethnic group, with the highest prevalence observed in minority children (1) . Recent estimates of the prevalence of obesity among Northern Plains American-Indian (AI) children is 28 % (2) ; similar to that reported in other studies (3)(4)(5) . The number of obese AI children is increasing despite an apparent levelling off among other racial/ethnic groups in the USA (1,2,6) . Obesity is a major risk factor in the development of chronic diseases such as type 2 diabetes (T2DM) and CVD (7) . The prevalence of T2DM in AI children is one of the highest in the country and continues to increase (8,9) . Recent predictions estimate that, without a reduction in obesity, the prevalence of T2DM in AI/Alaska Native youth will increase by 129 %, from 0·56/1000 youths in 2010 to 1·28/1000 youths in 2050 (10) , and AI/Alaska Native adults have the highest prevalence of T2DM of all racial/ ethnic groups in the USA (11) . Considering that obesity in childhood is likely to persist into adulthood (12) , early prevention may be the only way to decrease the significant individual and societal burden of poor health in AI communities (13)(14)(15)(16) . Excess e...

Ninety‐two American Indian 5th graders from a rural, northern plains reservation community completed Nominal Group Technique (NGT) sessions designed to understand both barriers and facilitators to following DGA. Individually and in small groups, children generated lists of responses to specific questions, then ranked responses as a group. Environmental concerns were perceived as barriers to being physically active (“cops yell at us”; “it's too cold”; “too much glass”; “dogs”), to fruit, (“there is only a little bit at home”) and vegetable (“cost too much”; school don't have the kind I like”) consumption. Children also reported intrinsic barriers to consuming fruits (“don't like them much”) and vegetables (“they smell funny”). Facilitators to following DGA recommendations for fruit consumption referred to hedonic values (“fruit is good”; “fruits make me happy”), while facilitators for vegetable consumption were prescriptive (“put vegetables out for lunch”; “make a garden and plant vegetables”). While it is clear that features of the food and built environment contribute to children's lack of compliance to the DGA, responses indicate that room exists for improving children's health behavior knowledge, attitudes, and behaviors.