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Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives
Open accessAbstract
Objective: To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native (AI/AN) adults with type 2 diabetes (T2D). Methods: Focus groups and interviews were conducted with purposively selected stakeholders: AI/ANs with T2D, their family members, healthcare administrators, nutrition and diabetes educators, and national content experts on AI/AN health. Two coders analyzed transcripts using the constant-comparison method. Results: Key themes included (1) rural- and urban-dwelling AI/ANs experience different primary food security and associated challenges; (2) factors contributing to food insecurity extend beyond cost of healthy food; and (3) barriers to consuming fresh, healthy food include cost, preparation time, limited cooking knowledge, and challenges with gardening. Discussion: Resources for AI/ANs with T2D who experience food insecurity and associated challenges to healthy eating should be tailored based on urban versus rural location and should address cost and other barriers to consumption of fresh fruits and vegetables.
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“Stakeholder interviews conducted among American Indian and Alaska Native adults living with type 2 diabetes identified pervasive practical skill gaps, including impaired ability to evaluate standard food portion sizes, insufficient culinary skills for preparing fresh fruit and vegetable dishes, and the absence of time-saving meal planning strategies. Many participants declined to purchase fresh”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [33]
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“American Indian and Alaska Native tribal communities face dual social support deficits (33).”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [33]
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“Mismatches between universal mainstream dietary guidelines and indigenous sociocultural food traditions constitute persistent sociocultural barriers that undermine diabetic dietary adherence among low-income, Indigenous and African patient cohorts (24, 27, 33).”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [33]
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“For rural American Indian reservation communities, colonial policies have caused long-term erosion of Indigenous traditional food systems, leading to profound sociocultural value conflicts.”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [33]
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“Embedded voluntary and community social enterprise (VCSE) institutions, participatory group learning models, and culture-based peer support constitute core sociocultural enablers that advance diabetic dietary self-management among marginalized ethnic, low-income and rural populations (33, 54, 91).”
From Implementation and translation of evidence-based dietary strategies for type 2 diabetes in resource-limited settings: a scoping review based on the CFIR framework (2026) · cites this paper as [33]
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References 60 · Cited by 16
Research works printed but not linked: 6
- Centers for Disease Control and Prevention (2017). National diabetes statistics report.
- 10.1038/nm.2451.A · DOI
- Gundersen C, Dewey A., Crumbaugh A., Kato M., Engelhard E. (2016). Map the meal gap 2016: Food insecurity and child food insecurity estimates at the county level. Feeding America.
- 10.3945/jn.109.112573.number · DOI
- Share our Strength (n.d.). Cooking Matters. https://cookingmatters.org.
- Stemler S. (2000). An overview of content analysis. Practical Assessment, Research, and Evaluation, 7(17). doi: 10.7275/z6fm-2e34. · DOI
Metadata
- Authors
- Stotz, S., Brega, A. G., Henderson, J. N., Lockhart, S., Moore, K., & AI/AN WCIE Study Group
- Affiliations
- Colorado School of Public Health (US)
- University of Minnesota (US)
- Children's Hospital Colorado (US)
- Corresponding author
- Stotz, Sarah
- Venue
- Journal of Aging and Health
- Publisher
- SAGE Publications
- Published
- 2021-06-24
- Volume
- 33
- Issue
- 7-8_suppl
- Pages
- 31S-39S
- ISSN
- 0898-2643 (ISSN-L)
- 1552-6887
- PMC
- PMC8647808
- OpenAlex
- W3174262275
- Cited by
- 16
- References
- 60
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 1
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Aging and Health (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- American Diabetes Association (4-18-SMC-01)
- National Institute on Aging (P30 AG15292)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092923)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Food Security and Health in Diverse Populations
- Social Sciences › Health › Indigenous Health, Education, and Rights
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- food insecurity, type 2 diabetes, American Indians and Alaska Natives, healthy eating, cooking knowledge, gardening, urban-rural differences, stakeholder perspectives, diabetes education
- MeSH terms
- Diet, Healthy, Alaska Natives, Self-Management, Food Insecurity, Diabetes Mellitus, Type 2, Female, Humans, Indians, North American, Male, American Indian or Alaska Native
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- CoChat. (2026). Citation check: Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives. https://app.cochat.ai/papers/10.1177/08982643211013232
- The paper
- Stotz, S., Brega, A. G., Henderson, J. N., Lockhart, S., Moore, K., & AI/AN WCIE Study Group. (2021). Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives. Journal of Aging and Health. https://doi.org/10.1177/08982643211013232
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
