Food insecurity is well documented as a social determinant of health and as a barrier to healthful eating and diabetes management. American Indians and Alaska Natives (AI/ANs) are twice as likely to experience food insecurity and type 2 diabetes (T2D) as non-Hispanic Whites. The purpose of this project was to identify themes regarding food insecurity and healthful eating in relation to diabetes management among AI/AN adults with T2D. The reported analysis used qualitative data originally collected to inform adaptation of an existing American Diabetes Association diabetes nutrition education program for AI/AN adults with T2D. Qualitative data were collected through focus groups and interviews with AI/ANs with T2D, their family members, and key stakeholders such as healthcare administrators, registered dietitians, and diabetes educators. Two coders analyzed transcripts in their entirety using the constant-comparison method for qualitative content analysis. Key themes included the following: (1) Rural and urban AI/ANs have different primary food security challenges. AI/ANs who live in rural reservation locations discussed loss of traditional foods and loss of access to land where these foods were once found. Urban-dwelling AI/ANs, on the other hand, highlighted the cost of healthful food as their primary food security challenge. (2) AI/ANs discussed logistical problems with accessing healthy food (i.e., lack of time, need for convenience, easy access to fast and processed food, high cost of healthful food, loss of traditional food) whereas nutrition educators focused on solutions, such as cooking and nutrition education. (3) When discussing the high cost of healthful foods, focus group participants concentrated almost exclusively on the high cost of fresh produce as opposed to other healthful food products. Findings from this analysis will help inform the development of food security resources for AI/ANs with T2D.


S.A. Stotz: None. S. Lockhart: None. A.G. Brega: None. K.R. Moore: None.


American Diabetes Association (4-18-SMSC-01 to K.R.M.); National Institutes of Health (P30DK092923); Center for American Indian and Alaska Native Diabetes Translational Research

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