Community involvement in design, implementation and evaluation of nutrition interventions to reduce chronic diseases in indigenous populations in the U.S.: a systematic review

Exploring Self-Report Dietary Assessment Tools Validated for Indigenous Populations Globally: A Scoping Review

ISSUE ADDRESSED

Health promotion for Indigenous populations commonly centres around diet-mediated chronic diseases and is often evaluated with self-report (personal recall)-based tools. Accurate dietary assessment methods are crucial for the evaluation of these health promotion outcomes. Dietary assessment tools may require cultural, contextual and language adaptation, as well as validation within Indigenous populations to ensure efficacy and reliability. Due to the limited literature available for Aboriginal and Torres Strait Islander peoples, this review aimed to explore the range of self-report dietary assessment tools that have undergone validation or reliability testing for Indigenous adult populations globally and their adherence to gold-standard Indigenous research principles.

METHODS

This scoping review was conducted as per the Joanna Briggs Institute (JBI) method. Seven electronic databases were searched with no date or language restrictions. Screening, data extraction and quality appraisal with a validated Aboriginal and Torres Strait Islander research Quality Appraisal Tool (QAT) were undertaken by two reviewers, with a third reviewer engaged for resolving discrepancies.

RESULTS

Twenty-five articles describing 31 instances of validity and reliability testing on 28 unique self-report dietary assessment tools were included in the review. Studies were predominantly conducted in the USA (n = 13), followed by Australia (n = 4), Canada (n = 3) and Greenland (n = 3). The most common method of validation was relative validity (n = 23). Tools were primarily interviewer-administered food frequency questionnaires (FFQs) validated against multiple 24-h dietary recalls. Tools commonly assessed energy, carbohydrate, fat and protein intake; however, they achieved varying strengths of correlation (r = 0-0.82). Tools were predominately paper-based; however, six studies validated a device-based tool; no web-browser app-based tools were validated in the included literature.

CONCLUSION

Interviewer-administered food frequency questionnaires are the most prevalent self-report dietary assessment method validated within Indigenous populations globally. Browser-based e-tools, which are portable and cost-effective, may hold promise for dietary assessment among Indigenous populations. The acceptability and validity of such tools for Indigenous population groups should be explored through future research. Tools validated to capture added sugar, sodium and food group intake may provide for more meaningful evaluation of health promotion programmes for Indigenous peoples.

SO WHAT

Tools that have been validated for use with Indigenous peoples are essential for supporting a reliable and accurate evaluation of health promotion activities. Validating dietary assessment tools to adequately capture the predominant outcome measures targeted in nutritional health promotion strategies within Indigenous populations may contribute a more meaningful evaluation of health promotion programmes for Indigenous peoples.

Community-Engaged Development of a Nutrition Curriculum: The Go Healthy Indigenous-Supported Agriculture Study

OBJECTIVE

To understand how Osage Nation community members define healthy eating and develop a corresponding nutrition curriculum through community engagement.

DESIGN

This project comprised a concurrent embedded mixed methods group concept mapping (GCM) study followed by focus group discussions (FGD) to provide feedback on a nutrition curriculum.

SETTING

Osage Nation, Oklahoma.

PARTICIPANTS

In the GCM study, 54 participants were recruited from a study of an Indigenous-supported agriculture program. GCM study participants and the Go Healthy Advisory Group participated in 2 FGDs.

PHENOMENON OF INTEREST

For the first study, concepts related to healthy eating were explored. In the second study, participants provided feedback on curriculum clarity, perceived efficacy, and relevance.

ANALYSIS

In the first study, a multidimensional scaling algorithm was used to plot statements, and concept clusters were interpreted in a facilitated meeting with participants. A basic content analysis approach was used in the second study.

RESULTS

Five concept clusters related to healthy eating were identified. These clusters were used to generate an 8-module curriculum deemed clear, potentially efficacious, and relevant among FGD participants.

CONCLUSIONS AND IMPLICATIONS

Community members contributed to a framework of healthy eating for the Osage community, which was used to develop a nutrition curriculum that will be integrated into an Indigenous-supported agriculture program. Future research should explore long-term sustainability and the broader cultural impacts of nutrition programs on Indigenous health and food sovereignty.

Patient and public involvement in healthcare: a systematic mapping review of systematic reviews - identification of current research and possible directions for future research

OBJECTIVES

To provide an overview of patient and public involvement (PPI) in the mesolevel and macrolevel of healthcare (different from PPI in research) and identify directions for future research by mapping contexts, terminology, conceptual frameworks, measured outcomes and research gaps.

DESIGN

Mapping review of systematic reviews. A patient coresearcher (JB) was involved in all stages. A broad search strategy was applied to capture the variation in terminology.

DATA SOURCES

MEDLINE, CINAHL and PsycINFO were searched from 1 January 2001 to 5 December 2022.

ELIGIBILITY CRITERIA

We included systematic reviews of empirical studies focusing on PPI in the mesolevel and macrolevel of healthcare.

DATA EXTRACTION AND SYNTHESIS

Three independent reviewers used standardised methods to screen studies and extract data. Thematic categories were created inductively through iteration. The results were organised in narrative, visual or tabular formats.

RESULTS

4419 identified records were screened. 37 systematic reviews were eligible for inclusion. Most studies were narrative syntheses (N=26). Identified context categories were PPI for healthcare quality improvement (22%), patient safety (8%), community-based initiatives (27%), peer support (16 %) and education of healthcare professionals (27%). A wide range of terms was used to discuss PPI, with community participation being the most common. 28 reviews reported on frameworks, conceptual guidance and/or policy documents. Nine different types of outcomes were identified. The research gap pointed out most frequently is the lack of studies of robust designs that allow for replication and long-term follow-up, followed by studies on cost-effectiveness and resources needed. There is a need for consensus on the use of terminology.

CONCLUSIONS

This mapping review sheds light on the evolving landscape of PPI in healthcare. To advance the field, future research should prioritise rigorous study designs, cost-effectiveness assessments and consensus-building efforts to create a more unified and impactful approach for PPI in healthcare.

Facilitators and barriers for implementation of health programmes with Māori communities

BACKGROUND

Addressing health inequities that Māori (Indigenous peoples) communities face in New Zealand is a key aim of researchers and practitioners. However, there is limited understanding of the implementation processes and outcomes of health programmes for addressing these inequities. The aim of this study was twofold: (a) to identify correlates of implementation outcomes and (b) to identify facilitators and barriers to implementation effectiveness.

METHODS

The study involved a concurrent mixed method approach. Through an online survey, 79 participants with experience in implementing a health programme with a Māori community identified outcomes and processes of the programme. Additionally, nine Māori community providers shared their perceptions and experience of facilitators and barriers to implementation effectiveness through an in-depth interview. The quantitative and qualitative findings were integrated to address the aims of the study.

RESULTS

For the first aim, we identified two key outcomes: overall health impacts and sustainability. Three of the variables had significant and positive bivariate correlations with health impacts: cultural alignment, community engagement, and individual skills. The only significant correlate of sustainability was evidence-based. For the second aim, participants described four facilitators (leadership, whanaungatanga [relationships], sharing information, digestible information) and four barriers (system constraints, lack of funding, cultural constraints, lack of engagement) to effective implementation.

CONCLUSION

Overall, leadership, aligning culture, and building on whanaungatanga, while getting financial resources and systems support, are the core elements to supporting implementation efforts in Māori communities.

Policy framework that addresses malnutrition in Namibia: A retrospective qualitative review

BACKGROUND

Although Namibia has made strides in improving the policy enabling environment, eradication of malnutrition is still elusive.

OBJECTIVE

This review was aimed at determining the extent to which food and nutrition-related policies in Namibia address malnutrition.

METHODS

This study used a qualitative approach by retrospectively analysing policy frameworks that address malnutrition in Namibia from 1991 to 2022. The analysis employed the policy triangle framework to elucidate the contextual factors, content, actors and process involved in the policy development. Moreover, a comparative analysis of Namibian policies and those of other southern African countries was undertaken.

RESULTS

The review showed that there is a considerable degree of coherence in policy goals and strategies to address malnutrition despite parallel coordination structures. Policy process involved limited consultations with local communities which might have jeopardised the formulation of community problem-tailored interventions, ownership and participation in policy implementation. There is a strong political commitment to the eradication of malnutrition in Namibia. The Office of the Prime Minister played a leading role in policy development. Influential actors such as the UN agencies elevated the nutrition agenda. Further, the Namibian policy framework was generally similar to those of other southern African countries.

CONCLUSIONS

The review showed that Namibia has relevant and comprehensive policies to address malnutrition, however, contextual factors indicated high levels of malnutrition still exist in the communities. Further research is needed to understand the barriers and enablers to optimal nutrition for children under five years in Namibia.

Diet quality is positively associated with intake of traditional foods and does not differ by season in remote Yup'ik communities

This study evaluated whether traditional food intake and diet quality differed by season in Yup'ik communities and examined the relationship between intake of traditional food groups and diet quality. Data were collected from 38 participants, ages 14-79 years, from two Yup'ik communities in Southwest Alaska from 2008 to 2010. Self-reported intake (24-h recalls) and dietary biomarker (nitrogen stable isotope ratio) data were collected twice in distinct seasons. Diet quality was assessed using the Healthy Eating Index. A paired sample t-test was used to test for seasonal differences in traditional food intake and diet quality, and linear regression was used to evaluate associations between traditional food intake and diet quality. Total traditional food intake and overall diet quality did not significantly differ by season, but there were differences in traditional food group intake and diet quality component scores. Diet quality was strongly associated with intake of traditional food groups including fish, tundra greens, and berries. Given the strong relationship between traditional food intake and diet quality, policies should aim to ensure continued access to traditional foods in Yup'ik communities amid environmental changes in the circumpolar North.

Systematic review of Internet of medical things for cardiovascular disease prevention among Australian first nations

Chronic diseases within Indigenous communities constitute the most compelling ill-health burdens and treatment inequalities, particularly in rural and remote Australia. In response to these vital issues, a systematic literature review of the adoption of wearable, Artificial Intelligence-driven, electrocardiogram sensors, in a telehealth Internet of Medical Things (IoMT) context was conducted to scale up rural Indigenous health. To this end, four preselected scientific databases were chosen for data extraction to align with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) technique. From the initially collected (n = 4436 ) articles, a total of 32 articles were analysed, being synthesised from the review inclusion criteria, maintaining strict eligibility and eliminating duplicates. None of the various studies found on this innovative healthcare intervention has given a comprehensive picture of how this could be an effective method of care dedicated to rural Indigenous communities with cardiovascular diseases (CVDs). Herein, we presented the unique concepts of IoMT-driven wearable biosensors tailored for rural indigenous cardiac patients, their clinical implications, and cardiovascular disease management within the telehealth domain. This work contributes to understanding the adoption of wearable IoMT sensor-driven telehealth model, highlighting the need for real-time data from First Nations patients in rural and remote areas for CVD prevention. Pertinent implications, research impacts, limitations and future research directions are endorsed, securing long-term Wearable IoMT sensor-driven telehealth sustainability.

Indigenous women and their nutrition during pregnancy: Study Protocol for co-designed m-health resource for the 'Mums and Bubs Deadly Diets' project

BACKGROUND

Nutrition in pregnancy is pivotal to optimising infant growth and maternal wellbeing. The factors affecting Indigenous people's food and nutrition intake are complex, with a history of colonisation impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or priorities of Indigenous women in Australia is scarce with supportive, culturally appropriate resources developing for and with this group rare. Research suggests mHealth tools are effective in supporting health knowledge of Indigenous people and positive health behaviour changes when designed and developed with the expertise of Indigenous communities.

OBJECTIVE

This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further this project team and its participants will co-design an mHealth digital tool to support these nutrition needs.

METHODS

The Mums and Bubs Deadly Diets study recruits Indigenous women and healthcare professionals who support Indigenous women during pregnancy into two phases. Phase One (pre-design) utilises a mixed methods convergent design utilising a biographical questionnaire and social/focus groups to inform Phase Two (generative). Phase Two will use a participatory action research process during co-design workshops to iteratively develop the digital tool, the exact actions within a workshop will evolve according to the participant group decisions.

RESULTS

To date, this project has undertaken Phase One focus groups at all Queensland sites with New South Wales and Western Australia to begin in early to mid 2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals.

CONCLUSIONS

This study is an iterative and adaptive research program that endeavours to develop real world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities.

CLINICALTRIAL

Not applicable.

Dietary Intake Estimated From a 24-Hour Recall Questionnaire in the Dene and Métis Communities of the Northwest Territories, Canada

Background

Food security and nutrient deficiencies are frequent issues for people living in northern remote regions of Canada.

Objective

The objective of this study is to describe the nutrient intake of residents living in the Dene/Métis communities of the Dehcho and Sahtú regions of the Northwest Territories.

Methods

A 24-h dietary recall survey was used to collect information from participants of a study completed in 9 communities during the winter seasons of January 2016 to March 2018. Intakes for food groups, vitamins, macroelements, and microelements were calculated. Nutrient intakes were compared with the available DRIs.

Results

In total, there were 197 participants. On average, 37% of their energy was consumed from fat, and fruit/vegetable consumption was low (2.8 servings). Some vitamin levels (i.e., folate and vitamins A, B-6, C, and D) indicated a risk of nutritional deficiency for at least half of the participants. Of the nutrients examined, the nutrients least likely to meet the DRIs, according to the age/sex category of respondents were vitamin D (6%-20%), fiber (0%-11%), and calcium (4%-30%). Males tended to have a higher rate of nutrient adequacy above the DRIs. Importantly, 52% of the childbearing age female participants appeared deficient in folate, 48% deficient in zinc, 41% deficient in B12, and 22% deficient in iron, which might affect pregnancy and children's development.

Conclusions

A focus on supporting a higher intake of nutrient-dense foods would benefit the health of these communities. Nutrition and health promotion programs should be implemented to improve public health efforts in the region.

Dietary Intake, Nutritional Adequacy, and Food Sources of Selected Antioxidant Minerals and Vitamins; and Their Relationship with Personal and Family Factors in Spanish Children Aged 1 to <10 Years: Results from the EsNuPI Study

Minerals and vitamins involved in the antioxidant defense system are essential for healthy growth and proper development during infancy. Milk and dairy products are of particular importance for improving the supply of these nutrients to children. Indeed, the present study aimed to evaluate the nutrient intake and food sources of zinc (Zn), selenium (Se), retinol and carotenoids (sources of vitamin A), and vitamins C and E, and to analyze their relationships with personal and familiar factors in Spanish children from the EsNuPI study. One subpopulation representative of the Spanish population from 1 to <10 years old (n = 707) (reference group, REF) who reported consuming all types of milk over the last year, and another subpopulation of the same age who reported consuming fortified milk formulas (FMFs) (including follow-on formula, young child formula, growing up milk, toddler’s milk, and enriched and fortified milk) (n = 741) (fortified milk consumers, FMCs) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Dietary Reference Values (DRVs). The REF reported higher median intakes than FMCs for Se (61 µg/kg vs. 51 µg/kg) and carotenoids (1079 µg/day vs. 998 µg/day). Oppositely, FMCs reported higher intakes than REF for Zn (7.9 mg/day vs. 6.9 mg/day), vitamin A (636 µg/day vs. 481 µg/day), vitamin E (8.9 mg/day vs. 4.5 mg/day), vitamin C (113 mg/day vs. 71 mg/day), and retinol (376 µg/day vs. 233 µg/day). In the REF group, more than 50% of the children met the EFSA recommendations for Zn (79.6%), Se (87.1%), vitamin A (71.3%), and vitamin C (96.7%), respectively. On the other hand, 92.2% were below the EFSA recommendations for vitamin E. In the FMC group, more than 50% of the children met the EFSA recommendations for Zn (55.2%), Se (90.8%), vitamin A (75.7%), vitamin E (66.7%), and vitamin C (100%). We found statistically significant differences between subpopulations for all cases except for Se. In both subpopulations, the main sources of all antioxidant nutrients were milk and dairy products. For carotenoids, the main sources were vegetables and fruits followed by milk and dairy products. A high percentage of children had vitamins A and E intakes below the recommendations, information of great importance to stakeholders. More studies using intakes and biomarkers are needed, however, to determine an association with diverse factors of oxidative damage.

[Comparison of a community-based nutritional intervention and a conventional nutritional intervention in Mayan communities in Mexico]

Poor nutritional conditions persist in many Mayan communities in Yucatán, Mexico, even though various programs have been implemented. The study aimed to compare the effects of a community-based nutritional intervention with an intercultural focus versus a conventional nutritional intervention on body mass index (BMI) and diet in women in Mayan communities in Yucatán. The sample included adult women with BMI ≥ 25kg/m2 from neighboring rural Mayan villages. Both interventions lasted three months with 11 sessions and followed the prevailing guidelines. The community-based intervention used an intercultural tool called Good Mayan Food [Plato del Bien Comer Maya], besides strategies designed according to information obtained from a prior qualitative study phase using interviews. The group that received the community-based intervention (n = 7), compared to the conventional intervention group (n = 9), showed larger decreases in BMI (-0.58 ± 0.70 kg/m2 and +0.27 ± 0.64kg/m2; p = 0.042), waist circumference (-2.15 ± 2.60 cm and -0.50 ± 0.75 cm; p = 0.042), and consumption of fats (-53.23 ± 21.92 grams and -7.34 ± 25.77 grams; p = 0.004), as well as higher increases in weekly consumption of some local foods such as nance fruit (p = 0.012), tamarind (p = 0.001), and chili peppers (p = 0.004). The community-based intervention was the only one to show a significant decrease in daily calorie intake (baseline: 2,067 ± 91 kcal/day, at three months: 1,474 ± 31 kcal/day; p = 0.018), and both groups showed decreases in the consumption of ultra-processed foods, but without significant differences between the two groups. The community-based intervention group showed better results than the conventional intervention group.

Applying citizen science to engage families affected by ovarian cancer in developing genetic service outreach strategies

Citizen science (CS) approaches involving non-professional researchers (citizens) as research collaborators has been used infrequently in health promotion generally and specifically, in cancer prevention. Standardized CS approaches may be especially useful for developing communication interventions to encourage families to consider cancer genetic services. We engaged survivors of ovarian cancer and their close relatives as CS collaborators to collect and help interpret data to inform content for a website, printed invitation materials, and short-message reminders. We applied an implementation quality framework, and posed four research questions regarding the feasibility of CS: recruitment, data collection, data quality and evaluation of the experience. CS members were recruited through three networks: clinical sites, local and national cancer support organizations, and online ovarian cancer patient support groups. The professional research team operationalized theory-aligned CS tasks, five data collection options, question banks/scripts for creating surveys, structured interviews, online training and ongoing support from research coaches. 14 CS members agreed to the 12-week and 20-hour commitment for an honorarium. CS members opted to do both qualitative and quantitative assessments. CS members collected 261 surveys and 39 structured interviews. The largest number of surveys were collected for Task 1 (n = 102) to assess survivors' reactions to different possible options for motivating survivors to visit a study website; 77% of this data were complete (i.e., no missing values). Data collected for tasks 2, 3, 4, and 5 (e.g., assessment of survivors' and relatives' respective communication preferences) ranged from 10 to 58 surveys (80% to 84% completeness). All data were collected within the specified time frame. CSs reported 17 hours of work on average and regarded the experience positively. Our experience suggests that CS engagement is feasible, can yield comprehensive quantitative and qualitative data, and is achievable in a relatively a short timeline.

Enacting Treaty Rights through Restoring Shoshone Ancestral Foods on the Wind River Indian Reservation

Despite great loss in gathering and consumption of traditional foods among Indigenous communities, there is great hope for reclaiming and preserving knowledge. The Restoring Shoshone Ancestral Food Gathering (RSAFG) is a community group leading grassroots efforts on the Wind River reservation to reclaim Shoshone ancestral foods and promote food sovereignty. The story of the RSAFG promotes equitable, decolonized, and community empowered methods of reclaiming Indigenous foods by sharing three of RSAFG's acts of decolonization: 1) enacting treaty rights through gathering traditional plants, 2) demanding equitable partnerships in community-based research, and 3) sharing the story through radical authorship via layered narratives. A pesar de la gran pérdida en la recolección y el consumo de alimentos tradicionales entre las comunidades indígenas, existe una gran esperanza para recuperar y preservar el conocimiento. El Restoring Shoshone Ancestral Food Gathering (RSAFG) es un grupo comunitario que lidera los esfuerzos de base en la reserva wind river para recuperar los alimentos ancestrales shoshone y promover la soberanía alimentaria. La historia de la RSAFG promueve métodos equitativos, descolonizados y empoderados por la comunidad para recuperar los alimentos indígenas al compartir tres de los actos de descolonización de RSAFG: 1) promulgar los derechos de los tratados mediante la recolección de plantas tradicionales, 2) exigir asociaciones equitativas en la investigación basada en la comunidad, y 3) compartir la historia a través de la autoría radical a través de narrativas en capas.

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

Indigenous food sovereignty (IFS) represents a community-led movement with potential to reduce health inequities, but no scoping review of the impact of taking an IFS approach on intervention research has been conducted. This review sought to: 1) describe intervention studies that employ IFS principles, and 2) describe the impact of studies using IFS principles on food access, eating patterns, diet quality, physical activity, and health. Through a literature review, 4 IFS principles were identified: 1) community ownership, 2) inclusion of traditional food knowledge, 3) inclusion and promotion of cultural foods, and 4) environmental/intervention sustainability. Twenty intervention studies published between January 1, 2000 and February 5, 2020 were included. Most of the studies that scored high in IFS principles saw a positive impact on diet. This review found evidence supporting the value of IFS principles in the development, implementation, and evaluation of health interventions for Indigenous communities.

What do you mean by engagement? - evaluating the use of community engagement in the design and implementation of chronic disease-based interventions for Indigenous populations - scoping review

BACKGROUND

Indigenous populations have remained strong and resilient in maintaining their unique culture and values, despite centuries of colonial oppression. Unfortunately, a consequential result of facing years of adversity has led Indigenous populations to experience a disproportionate level of poorer health outcomes compared to non-Indigenous populations. Specifically, the rate of Indigenous chronic disease prevalence has significantly increased in the last decade. Many of the unique issues Indigenous populations experience are deeply rooted in their colonial history and the intergenerational traumas that has subsequently impacted their physical, mental, emotional and spiritual well-being. With this, to better improve Indigenous health outcomes, understanding the local context of their challenges is key. Studies have begun to use modes of community engagement to initiate Indigenous partnerships and design chronic disease-based interventions. However, with the lack of a methodological guideline regarding the appropriate level of community engagement to be used, there is concern that many interventions will continue to fall short in meeting community needs.

OBJECTIVE

The objective of this study was to investigate the how various community engagement strategies have been used to design and/or implement interventions for Indigenous populations with chronic disease.

METHODS

A scoping review guided by the methods outlined by Arksey and O'Malley was conducted. A comprehensive search was completed by two reviewers in five electronic databases using keywords related to community engagement, Indigenous health and chronic disease. Studies were reviewed using a descriptive-analytical narrative method and data was categorized into thematic groups reflective of the main findings.

RESULTS

We identified 23 articles that met the criteria for this scoping review. The majority of the studies included the use a participatory research model and the procurement of study approval. However, despite the claimed use of participatory research methods, only 6 studies had involved community members to identify the area of priority and only five had utilized Indigenous interview styles to promote meaningful feedback. Adapting for the local cultural context and the inclusion of community outreach were identified as the key themes from this review.

CONCLUSION

Many studies have begun to adopt community engagement strategies to better meet the needs of Indigenous Peoples. With the lack of a clear guideline to approach Indigenous-based participatory research, we recommend that researchers focus on 1) building partnerships, 2) obtaining study approval and 3) adapting interventions to the local context.

Determining Effective Nutrition Intervention Strategies and the Subsequent Impact on Nutrition Knowledge, Dietary Adherence, and Health Outcomes among American Indian/Alaska Native Youth (2-18 Years of Age): a Systematic Review

The PRISMA style literature review was used to determine effective nutrition intervention strategies and their subsequent impact on nutrition knowledge, dietary adherence, and health outcomes among American Indian/Alaskan Native (AI/AN) youth. Peer-reviewed articles published between January 1980 and December 2019 were extracted from PubMed, CINAHL, Cochrane, and PsychInfo databases. A 4-point inclusion criterion was established to include articles with AI/AN youth, nutrition intervention, and presented health outcomes. A quality criteria checklist was used to assess the articles. A total of 12 studies were included in this study. Interventions that incorporated cultural adaptations (e.g., storytelling), theoretical frameworks (e.g., community-based participatory), active learning (e.g., cooking), tribal partnership, and caregiver involvement slightly improved nutrition knowledge, dietary adherence, and health outcomes. Overall, this review revealed that incorporating cultural aspects with input from the community in a nutrition program has a positive impact on AI/AN youths. Steps can be taken at the policy level to direct obesity and non-communicable disease prevention efforts among AI/AN youth.

An overview of reviews on strategies to reduce health inequalities

BACKGROUND

Governments are incentivized to develop and implement health action programs focused on equity to ensure progress with effective strategies or interventions.

OBJECTIVE

Identify and synthesize strategies or interventions that facilitate the reduction of health inequalities.

METHODS

A systematic search strategy was carried out up until August 2019 in MEDLINE (Ovid), Embase (Elsevier), Cochrane Database of Systematic Reviews, LILACS, Scopus, Scielo and Epistemonikos. In addition, a snowball strategy was used. Literature reviews (LRs) of experimental and quasi-experimental studies were included. The identified interventions and outcomes were categorized based on the recommendation by the Cochrane group in "Effective Practice and Organization of Care". The quality of the included LRs was evaluated using the AMSTAR 2 tool.

RESULTS

Four thousand ninety-five articles were identified, of which 97 were included in the synthesis of evidence. Most of the studies included focused on the general population, vulnerable populations and minority populations. The subjects of general health and healthy lifestyles were the most commonly addressed. According to the classification of the type of intervention, the domain covered most was the delivery arrangements, followed by the domain of implementation strategies. The most frequent group of outcomes was the reported outcome in (clinical) patients, followed by social outcomes.

CONCLUSION

The strategies that facilitate the reduction of health inequalities must be intersectoral and multidisciplinary in nature, including all sectors of the health system. It is essential to continue generating interventions focused on strengthening health systems in order to achieve adequate universal health coverage, with a process of comprehensive and quality care.

Partnerships, Processes, and Outcomes: A Health Equity-Focused Scoping Meta-Review of Community-Engaged Scholarship

In recent decades, there has been remarkable growth in scholarship examining the usefulness of community-engaged research (CEnR) and community-based participatory research (CBPR) for eliminating health inequities.This article seeks to synthesize the extant literature of systematic reviews, scoping reviews, and other related reviews regarding the context, processes, and research designs and interventions underlying CEnR that optimize its effectiveness. Through a scoping review, we have utilized an empirically derived framework of CBPR to map this literature and identify key findings and priorities for future research. Our study found 100 reviews of CEnR that largely support the CBPR conceptual framework.

Strategies for Promoting Healthy Nutrition and Physical Activity Among Young Children: Priorities of Two Indigenous Communities in Canada

BACKGROUND

Indigenous people in Canada carry a disproportionate burden of obesity and obesity-related diseases compared with non-Indigenous Canadians, which could be related to intergenerational trauma exposures. Implementing effective health promotion strategies to improve nutrition and physical activity behaviors during early childhood could be a strategy to mitigate the burden of intergenerational trauma exposures that have the potential to impact the trajectory to obesity and related complications throughout the lifecycle.

OBJECTIVES

The aim of this study was to support 2 Indigenous communities in identifying priorities and strategies for promoting healthy nutrition and physical activity for young children.

METHODS

Using a formative approach, we conducted a 2-phase study that started with 2 community engagement workshops (n = 37 participants), followed by a qualitative descriptive study. In this latter study, in-depth interviews were conducted with a purposeful sample of 23 community parents, health care providers, and traditional knowledge holders. Data from both study phases were analyzed and synthesized using conventional content analysis.

RESULTS

To promote healthy nutrition and physical activity among young children living in Indigenous communities, it was identified that the primary pathway to health and well-being must prioritize the integration of knowledge about Indigenous ways of life including traditional Indigenous foods and physical activities. Participants also identified individual/family and community/contextual factors that ultimately influence the nutrition and physical activity of children in their communities.

CONCLUSIONS

Informed by this formative study conducted to better understand community members' strategies for healthy eating and physical activity for young children, we argue for the continued recognition of the unique Indigenous context, incorporating the history of inequity and injustice and looking toward Indigenous-led interventions that incorporate this history and ways of life as solutions in the future.

Interventions Focusing on Indigenous Populations May Improve Oral Health Outcomes

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Reducing indigenous oral health inequalities: a review from 5 nations. Tiwari T, Jamieson L, Broughton J, Lawrence HP, Batliner TS, Arantes R, Albino J. J Dent Res 2018;97(8):869-77.

SOURCE OF FUNDING

None.

TYPE OF STUDY/DESIGN

Literature review.