A Scoping Review of the Use of Indigenous Food Sovereignty Principles for Intervention and Future Directions

Pediatric produce prescription initiatives in the U.S.: a scoping review

BACKGROUND

To describe pediatric Produce Prescription (PRx) interventions and their study designs, outcomes, and opportunities for future research.

METHODS

A scoping review framework was used to describe PRx interventions published between January 2000 and September 2023. Articles from online databases were uploaded into Covidence. Data on study characteristics, outcomes of interest (health, food insecurity (FI), nutritional and culinary efficacy, and fruit and vegetable (F/V) consumption), and feasibility were extracted. The Mixed Methods Appraisal Tool (MMAT) was used for quality assessment.

RESULTS

19 articles met inclusion criteria. Ten studies were quantitative, five were qualitative, and four used mixed-methods. Interventions included food vouchers (n = 14) or food box/pantries (n = 5). Four studies allowed food items in addition to F/Vs. Six studies measured changes in FI and five reported a statistically significant decrease. Seven studies measured changes in F/V consumption and five reported a statistically significant increase. One study reported a statistically significant reduction in child BMI z-score. Most studies reported high feasibility. Few studies used high-quality methods.

CONCLUSIONS

Pediatric PRx interventions show promising potential to reduce FI and improve diet quality and health-related outcomes. Future studies should utilize rigorous study designs and validated assessment tools to understand the impact of pediatric PRx on health.

IMPACT

This work offers a summary of programmatic outcomes including retention, redemption, incentives, nutrition education, study design and quality limitations to help inform future work. We found positive impacts of pediatric produce prescriptions (PRx) on FI, F/V consumption, and nutritional knowledge and culinary skills. More high-quality, rigorous studies are needed to understand the best delivery and design of PRx and their impact on child behavior and health outcomes. This work provides support for the need for rigorous studies and the potential for PRx to play a role in multi-pronged strategies that address pediatric FI and diet-related disease.

Indigenous food sovereignty assessment-A systematic literature review

AIMS

The aims of this systematic review were to (1) identify assessment approaches of Indigenous food sovereignty using the core domains of community ownership, inclusion of traditional food knowledge, inclusion/promotion of cultural foods and environmental/intervention sustainability, (2) describe Indigenous research methodologies when assessing Indigenous food sovereignty.

METHODS

Guided by Indigenous members of the research team, a systematic review across four databases (Medline, Embase, CINAHL and PsycINFO) was performed. Studies in any language from 1996 to 2021, that used one or more of the core domains (identified from a recent scoping review) of community ownership, inclusion of traditional food knowledge, inclusion/promotion of cultural foods and environmental/intervention sustainability were included.

RESULTS

From 20 062 records, after exclusion criteria were applied, 34 studies were included. Indigenous food sovereignty assessment approaches were mostly qualitative (n = 17) or mixed methods (n = 16), with interviews the most utilised (n = 29), followed by focus groups and meetings (n = 23) and validated frameworks (n = 7) as assessment tools. Indigenous food sovereignty assessment approaches were mostly around inclusion of traditional food knowledge (n = 21), or environmental/intervention sustainability (n = 15). Community-Based Participatory Research approaches were utilised across many studies (n = 26), with one-third utilising Indigenous methods of inquiry. Acknowledgement of data sovereignty (n = 6) or collaboration with Indigenous researchers (n = 4) was limited.

CONCLUSION

This review highlights Indigenous food sovereignty assessment approaches in the literature worldwide. It emphasises the importance of using Indigenous research methodologies in research conducted by or with Indigenous Peoples and acknowledges Indigenous communities should lead future research in this area.

Food Sovereignty and Health: A Conceptual Framework to Advance Research and Practice

Settler colonialism disrupted traditional Indigenous foodways and practices and created high rates of diet-related disease among Indigenous peoples. Food sovereignty, the rights of Indigenous peoples to determine their own food systems, is a culturally centered movement rooted in traditional Indigenous knowledge. This approach directly intervenes upon systems-level barriers to health, making it an important strategy for health equity. While food sovereignty initiatives can be found within many Indigenous communities, the conceptual linkages between food sovereignty and health have not been well documented within the public health literature. We present a practice-informed conceptual framework developed as part of the Center for Indigenous Innovation and Health Equity (CIIHE) initiative, a community-academic partnership with the goal of strengthening Indigenous food systems and practices to promote health and well-being. The framework emphasizes connectedness, including the transmission of knowledge across generations and the restoration of relational responsibilities, as central to Indigenous concepts of health and wellness.

Framing an Indigenous Food Sovereignty Research Agenda

Access to healthy and appealing food is essential for individuals to be able to live a healthy and quality life. For decades, food security has been a priority issue for public health professionals. Food sovereignty expands upon the concept of food insecurity (i.e., having access to nutritious and culturally relevant food) by incorporating people's rights to define their own food system. The expanded focus of food sovereignty on food systems prioritizes public health professionals' role in supporting environmental- and systems-level initiatives and evaluating their implications for health, economics, and the natural environment. Food sovereignty is of particular importance for Indigenous peoples (i.e., American Indian, Alaska Native, Native Hawaiian, and Pacific Islander communities). Colonization had demonstrable consequences, with many Indigenous communities being forcibly relocated from traditional lands, alongside the destruction of traditional food sources. Indigenous food sovereignty aligns with the sovereign nation status that American Indian tribes and Alaska Native communities have with the United States. Furthermore, the worldviews that incorporate Indigenous communities' relational responsibilities to care for their food systems, according to their traditional practices and beliefs (Coté, 2016; Morrison, 2011), uniquely positions Indigenous peoples to lead food sovereignty initiatives. In this article, we explore what is currently known regarding food sovereignty and health. We then discuss opportunities to expand the evidence on Indigenous food sovereignty's relationships with (1) health and well being, (2) economics, (3) the natural environment, and (4) programming facilitators and barriers.

Elements of Successful Food Sovereignty Interventions within Indigenous Communities in the United States and Canada: a Systematic Review

Despite inherent resiliency and strengths, Indigenous Peoples in the United States and Canada have been impacted by colonialism, which has led to a loss of land, culture, and identity. Loss of land in particular has had substantial impacts on Indigenous food system practices. Indigenous food sovereignty (IFS) has been determined to be a mechanism for Indigenous communities to build their capacity to address food insecurity. A systematic review methodology was therefore engaged to gather and analyze the currently published literature to date to identify common elements of successful IFS interventions within Indigenous communities in the United States and Canada. We carried out a systematic search of the following electronic databases: Academic Search Premier, Agricola, PubMed, CINAHL Complete, Indigenous Studies Portal, the Native Health Database, SocIndex, PsycInfo, and Google Scholar. The Mixed Methods Appraisal Tool was used to apply a methodologic quality score to the included articles. We used a 2-stage process for article selection with 2 independent reviewers screening the titles and abstracts of articles identified. Relevant databases were initially searched up to June 2022 with an updated search occurring in January 2023. Content analysis was carried out on the included articles using qualitative analysis software. Twenty articles met the inclusion criteria of the review. Four main categories of successful elements within IFS interventions were identified, including 1) transmission of knowledge and skills within the community through workshops, 2) cultural connectedness through cultivation practices, 3) preparation and consumption of traditional foods through community programs, and 4) community-based partnerships and collaborations. An IFS approach has led to the development of several intervention strategies within Indigenous communities, which have been highlighted in this review. The successful elements identified in this review may serve to support future food sovereignty-related programmatic and intervention development within Indigenous communities. PROSPERO (number: CRD42022342100).

Food Stress and Diabetes-Related Psychosocial Outcomes in American Indian Communities: A Mixed Methods Approach

OBJECTIVE

Explore the relationship between diabetes-related psychosocial outcomes and food stress in American Indian communities.

DESIGN

Convergence model of a mixed methods triangulation study.

SETTING

Five American Indian reservation communities in the Midwest.

PARTICIPANTS

One-hundred ninety-two participants were randomly selected from tribal health centers using clinic patient records and were surveyed about diabetes distress, empowerment, and food stress across 4 different time points. Seventeen focus group discussions were conducted and transcribed, and a mix of purposive and convenience sampling was used.

PHENOMENON OF INTEREST

Psychosocial outcomes associated with (or related to) diabetes and food stress.

ANALYSIS

Quantitative: Multiple linear regression was performed to explore relationships between food stress and diabetes distress and empowerment. Qualitative: Open coding of data identified portions of the transcripts related to food followed by a deductive approach on the basis of the components of quantitative food stress.

RESULTS

Food stress in the forms of (1) not having enough money for food and not having enough time for cooking or shopping (P = 0.08) and (2) inadequate food access and being on a special diet (P = 0.032) were associated with increased diabetes distress. Lower diabetes empowerment was associated with not having enough money for food and being on a special diet (P = 0.030). Our qualitative data mirrored quantitative findings that experiencing multiple forms of food stress negatively impacted diabetes psychosocial outcomes and illuminated the cyclical role mental health can play in relationships to food.

CONCLUSIONS AND IMPLICATIONS

Our findings highlight that experiencing food stress negatively affects diabetes empowerment and diabetes distress. These findings emphasize the importance of improving community food environments and addressing individual food access for diabetes management and prevention initiatives in American Indian communities.

BMI Status and Trends among Native American Family Members Participating in the Growing Resilience Home Garden Study

This research reports the BMI status of 176 adults and 134 children from 96 Native American families who are participating in a randomized controlled trial to assess health impacts of home gardens. Analyses include demographic associations with BMI using a novel approach of analyzing BMI status of children and adults together as one population by using LMS-based z scores generated from NHANES data. Results fit national data, with Native Americans more likely to be overweight/obese than other US demographic groups. This, in turn, makes Indigenous communities more vulnerable to chronic diseases. Ending these health inequities requires substantial public health nutrition investments in, for example, restoration of Indigenous foodways. This trial is registered at clinicaltrials.gov as NCT02672748.

Design and Methods of a Participatory Healthy Eating Intervention for Indigenous Children: The FRESH Study

Objective

To increase vegetable and fruit intake, reduce body mass index (BMI), and improve parental blood pressure among American Indian families.

Design

Randomized, wait-list controlled trial testing a multi-level (environmental, community, family, and individual) multi-component intervention with data collection at baseline and 6 months post-intervention.

Setting

Tribally owned and operated Early Childhood Education (ECE) programs in the Osage Nation in Oklahoma.

Participants

American Indian families (at least one adult and one child in a ECE program). A sample size of 168 per group will provide power to detect differences in fruit and vegetable intake.

Intervention

The 6-month intervention consisted of a (1) ECE-based nutrition and gardening curriculum; (2) nutrition education and food sovereignty curriculum for adults; and (3) ECE program menu modifications.

Main Outcome Measures

The primary outcome is increase in fruit and vegetable intake, assessed with a 24-h recall for adults and plate weight assessments for children. Secondary outcomes included objective measures of BMI among adults and children and blood pressure among adults.