Community-Engaged Development of Strengths-Based Nutrition Measures: The Indigenous Nourishment Scales

Mainstream approaches to nutrition typically focus on diet consumption, overlooking multi-dimensional aspects of nutrition that are important to American Indian/Alaska Native (AI/AN) communities. To address health challenges faced by AI/AN communities, strengths-based measures of nutrition grounded in community worldviews are needed. In collaboration with AI/AN communities in Baltimore and Minneapolis, we developed the Indigenous Nourishment Scales through three phases. Phase 1 involved focus group discussions with nine community-research council (CRC) members (n = 2) and four in-depth interviews (n = 4) to gather perspectives on existing models of nutrition. Phase 2 refined scales through two additional focus group discussions (n = 2) with a total of nine participants and two in-depth interviews (n = 2). Finally, in Phase 3, we held ten (n = 10) cognitive interviews with AI/AN community members to refine the scales. Participants appreciated the measures' ability to provoke reflection on their relationship with nutrition and suggested adjustments to better capture cultural nuances, such as incorporating concepts like "being a good relative" to land. The Indigenous Nourishment Scales represent a departure from conventional approaches by encompassing multiple dimensions of nourishment, offering a framework that addresses epistemic injustices in nutrition measurement and grounds health measurement efforts directly in community perspectives and worldviews.