Centering the Strengths of American Indian Culture, Families and Communities to Overcome Type 2 Diabetes

Abstract

Type 2 diabetes (T2D) is a critical Indigenous health inequity rooted in experiences of colonization and marginalization including disproportionate exposure to stressors, disruption of traditional family and food systems, and attacks on cultural practices that have led to more sedentary lifestyles. Thus, an important step in redressing inequities is building awareness of and interventions attuned to unique Indigenous contexts influencing T2D and Indigenous culture as a pathway to community wellbeing. Using a dynamic, stage-based model of intervention development and evaluation, we detail the creation and evolution of a family-based, culturally centered T2D preventive intervention: Together on Diabetes (later Together Overcoming Diabetes) (TOD). The TOD program was built by and for Indigenous communities via community-based participatory research and has been implemented across diverse cultural contexts. The TOD curriculum approaches health through a holistic lens of spiritual, mental, physical and emotional wellness. Preliminary evidence suggests TOD is effective in reducing diabetes risk factors including lowering BMI and depressive symptoms, and the program is viewed favorably by participants and community members. We discuss lessons learned regarding collaborative intervention development and adaptation across Indigenous cultures, as well as future directions for TOD.

How is who: evidence as clues for action in participatory sustainability science and public health research

“…From the many existing approaches, the Multiple Evidence Base approach (MEB) (Box 1) exemplifies how Indigenous or local communities have been involved in research related to the management of biodiversity and common resources also towards human wellbeing (Malmer et al, 2020 ; Tengö et al, 2014 ). In public health, different forms of community-based, participatory, and action-oriented research have also engaged with marginalized groups (e.g., disadvantaged women or people from gender and sexual minorities), for example to prevent chronic diseases and obesity or to address the health impacts of social isolation and the spread of diseases (Cusworth et al, 2015 ; Echo-Hawk, 2011 ; Meyer & Northridge, 2007 ; Walls et al, 2022 ). An umbrella term often used to refer to these approaches in public health is Community Based Participatory Research (CBPR) (see Box 2) (Israel et al, 2013 ; Minkler et al, 2010 ).…”