Process evaluation of a multi-institutional community-based program for diabetes prevention among First Nations

Area of Science:

• Public Health
• Community Health
• Indigenous Health

Background:

• Diabetes rates are alarmingly high among Native North Americans, necessitating innovative prevention strategies.
• Existing health interventions require adaptation to be effective within Indigenous communities.

Purpose of the Study:

• To evaluate the implementation and cultural relevance of the Zhiiwaapenewin Akino'maagewin (Teaching to Prevent Diabetes) program.
• To assess the fidelity, dose, reach, and context of a community-based diabetes prevention program in First Nations settings.

Main Methods:

• A community-based participatory approach was used in schools, food stores, and health offices across seven First Nations.
• Interventions included healthy lifestyles curricula, modified food stocking/labeling, cooking demonstrations, and mass media campaigns.
• Qualitative and quantitative data were collected via surveys, logs, and interviews to assess implementation.

Main Results:

• School curriculum implementation achieved moderate fidelity (63%).
• Food store interventions showed moderate fidelity (70% food availability, 60% label posting).
• Cooking demonstrations had 71% fidelity with high dose; the program was perceived as culturally acceptable.

Conclusions:

• The Zhiiwaapenewin Akino'maagewin program demonstrated feasible implementation with moderate fidelity in a First Nations context.
• The program's cultural relevance was confirmed, providing valuable data for refining and expanding future diabetes prevention efforts.
• Findings support planning for an expanded trial in multiple Native North American communities.