美国印第安人和阿拉斯加原住民 2 型糖尿病成年患者健康饮食的促进因素与障碍：利益相关者观点
Facilitators and Barriers to Healthy Eating Among American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives.
作者信息
Stotz Sarah A, Brega Angela G, Gonzales Kelly, Hebert Luciana E, Moore Kelly R
机构信息
The University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian and Alaska Native Health, Aurora, CO, USA.
Oregon Health Sciences University-Portland State University School of Public Health , Portland State University, Portland, OR, USA.
出版信息
Curr Dev Nutr. 2021 May 14;5(15):22-31. doi: 10.1093/cdn/nzaa114. eCollection 2021 Jun.
BACKGROUND
American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education.
OBJECTIVE
To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum.
METHODS
Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based key informants, including tribal health administrators, nutrition/diabetes educators, Native elders, and tribal leaders. Four focus groups were conducted with AI/AN adults with T2D ( = 29) and 4 focus groups were conducted with their family members ( = 22). Focus groups and community-based key informant interviews were conducted at 4 urban and reservation sites in the USA. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytic process.
RESULTS
Three key themes emerged. First, a diabetes nutrition education program for AI/ANs should accommodate diversity across AI/AN communities. Second, it is important to build on AI/AN strengths and facilitators to healthy eating (e.g. strong community and family support systems, traditional foods, and food acquisition and preparation practices). Third, it is important to address barriers to healthy eating (e.g. food insecurity, challenges to preparation of home-cooked meals, excessive access to processed and fast food, competing priorities and stressors, loss of access to traditional foods, and traditional food-acquisition practices and preparation) and provide resources and strategies for mitigating these barriers.
CONCLUSIONS
Findings were used to inform the cultural adaptation of a nutrition education program for AI/AN adults with T2D.
背景
与非美国印第安人和阿拉斯加原住民（AI/AN）成年人相比，美国印第安人和阿拉斯加原住民成年人患2型糖尿病（T2D）及相关并发症的患病率更高。由于健康饮食是糖尿病自我管理的基石，营养教育在糖尿病自我管理教育中发挥着重要作用。
目的
了解利益相关者对患有T2D的AI/AN成年人健康饮食的促进因素和障碍的看法，以便为现有糖尿病营养教育课程的文化适应提供信息。
方法
对9名糖尿病营养教育领域的全国性内容专家（如注册营养师、糖尿病教育者、AI/AN粮食不安全问题专家）和10名社区关键信息提供者进行了个人访谈，后者包括部落卫生管理人员、营养/糖尿病教育者、原住民长者和部落领袖。对29名患有T2D的AI/AN成年人进行了4次焦点小组访谈，对22名他们的家庭成员进行了4次焦点小组访谈。焦点小组访谈和社区关键信息提供者访谈在美国的4个城市和保留地进行。焦点小组访谈和访谈进行了录音，并逐字转录。我们采用持续比较法进行数据分析，并使用Atlas.ti（Mac版本8.0）将分析过程数字化。
结果
出现了三个关键主题。第一，针对AI/AN人群的糖尿病营养教育项目应适应AI/AN社区的多样性。第二，利用AI/AN的优势和健康饮食的促进因素（如强大的社区和家庭支持系统、传统食物以及食物获取和制备方式）非常重要。第三，解决健康饮食的障碍（如粮食不安全、在家做饭面临的挑战、过度接触加工食品和快餐、相互竞争的优先事项和压力源、无法获取传统食物、传统食物获取方式和制备方式）并提供减轻这些障碍的资源和策略很重要。
结论
研究结果为患有T2D的AI/AN成年人营养教育项目的文化适应提供了信息。
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