Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States.
Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.
Front Public Health. 2022 Feb 8;10:790015. doi: 10.3389/fpubh.2022.790015. eCollection 2022.
The 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.
A 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.
Diné 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.
Culturally 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.
本研究旨在对针对患有 2 型糖尿病的迪奈（纳瓦霍）社区成员的糖尿病教育计划进行文化增强。尽管文化适应健康教育课程的建议旨在改善对美洲印第安人和阿拉斯加原住民（AIAN）的健康教育，但它无意中造成了一种“一刀切”的方法。这种方法不能正确解决部落特定文化健康信息传递的需求，即纳入被认为与人群相关的文化元素。部落特定的健康信息和计划，例如这里所述的将迪奈世界观和本土知识融入迪奈人群中，对于创建一种文化相关、有效且有意义的疾病自我管理方法至关重要。
基于 Hózhó 韧性模型（一种关于健康生活的迪奈框架）的对话指南，用于让关键的文化专家参与有关健康和健康的传统故事和教义的访谈。讨论了与 2 型糖尿病自我管理相关的三个特定的自我保健行为：（1）健康饮食，（2）体育活动，（3）健康应对。采访进行了录音、转录，并使用定性主题分析方法进行了分析。
迪奈治疗师和文化专家为名为“迪奈健康”的教育工具的开发提供了信息。数据中出现的主要主题包括在 Hózhó 背景下纪律、积极性和正念的重要性。
与文化领袖进行文化安全和有意义的互动，并使用定性研究方法，可以为开发部落特定的糖尿病教育计划提供必要的深层次文化适应。这里使用的方法可以指导为 AIAN 人群制定文化知情的健康教育计划的开发、实施和测试。
