The contemporary American Indian diet is high in refined carbohydrate, fat, and sodium and low in fruits and vegetables. Proliferation of fast food restaurants and convenience stores on or near reservations encourages consumption of high-fat, high-sugar foods. Research shows that, if tribal members were to eat healthier foods, diet-related diseases, such as type 2 diabetes, heart disease, and obesity, may decrease. Small reservation stores frequently do not stock a full range of food (especially fresh fruits and vegetables), providing instead snack and convenience foods. Having community members identify strategies to improve the food environment of reservation stores can be the first step in implementing healthier food purchases and intakes in tribal members living on rural reservations.
This project implements the community-based strategies identified in a previous study. These strategies are being implemented in a local grocery store on a Northern Plains Indian reservation for the purpose of increasing tribal member awareness and purchase of healthy foods that are now available in the store. Approval from the University of Montana Institution Review Board (IRB) was obtained for the study to (1) survey and interview adolescents and adults living on or near the reservation who shop at the local grocery store and (2) measure the acceptance and purchase of healthy foods that are now available in the store.
The targeted population in the project included adolescents and adults (=10 years old) living on or near the Northern Plains Indian reservation. The participants were recruited for the study while they were shopping at the local grocery store. The survey respondents were asked questions about their age, education level, annual salary, gender, and ethnicity and participated in food taste tests and cooking demonstrations. They answered survey questions regarding (1) promoted foods they would likely purchase or not purchase and (2) how much they like, or dislike, the Healthy Stores point-of-purchase labels and educational materials (for example, posters, recipe cards, and flyers) that were created for the project. Approximately 98 percent of the subjects were American Indians.
All survey measurements were taken at the local grocery store. Seven survey instruments were used for the project, including the following:
Customer Demographic Survey: Project staff approached and asked in-store shoppers to complete a seven-item survey and invited them to participate in taste testing promoted food items. The demographic survey asked customers to provide anonymous information for their age, gender, ethnicity, tribal affiliation, education, and income levels. After completing the survey, the shopper could participate in a food item taste test.
Customer Evaluation Taste Test Survey: This self-administered, three-item survey was completed by the grocery store customers participating in cooking demonstrations and/or taste tests of various promoted food items. Taste test participants were asked to rate how much they liked the food they tasted, whether or not they would buy the food, and an open-ended question requesting suggestions to improve the cooking demonstration and taste test. Incentives, such as chip-clips and recipe card packs, were given to the taste test participants after they filled out the customer evaluation form. At the end of the project, 200 people completed the taste test surveys. Preliminary data show that 92 percent of the taste test participants reported liking the food or liking the food very much. About 82 percent of those surveyed were either considering purchasing or would definitely buy the promoted food item.
Process Evaluation Taste Test Survey: The process evaluation survey was completed several times during the intervention by the onsite project staff. This survey instrument assessed the reach and fidelity of the healthy food strategies. Preliminary data showed that 71 percent of the shoppers had seen the Healthy Stores shelf labels, 43 percent had purchased the food because they saw the shelf label, and 26 percent purchased the food “often” or “almost always” because they saw the shelf label. For specific food items for which shoppers stated they read the shelf label, 52 percent of shoppers purchased baked versus fried chips, 45 percent purchased 100-percent whole wheat bread versus white bread, 31 percent purchased lean (10 percent or less fat) ground hamburger versus regular hamburger, and 37 percent purchased 1-percent milk versus regular milk.
Intervention Exposure Evaluation Survey: This survey assessed the reach and fidelity of the Healthy Store project from the perspective of the grocery store customer. The project staff administered this survey to randomly selected grocery store customers throughout the intervention. The survey asked the customers if they had (1) participated in the taste tests, (2) seen the Healthy Store Project point-of-purchase labels and poster information, (3) heard the radio ads for the project, and (4) received any project incentives and how they liked, or did not like, the Healthy Stores Project. Preliminary data for the intervention exposures showed that 47 percent of the shoppers had read the nutritional information about the promoted foods on the Healthy Stores poster located in the store and 55 percent had heard the radio ads promoting the Healthy Stores project and foods.
Mass Media Process Evaluation Survey: This survey evaluated the fidelity of the intervention audio and visual communication materials as well as the level of these materials provided to the community. The mass media log was completed once per each intervention phase (n=9).
Evaluation of Store Environment Survey: This pre- and post-test survey evaluated the availability of specific food items and shelf labels.
Nutrition Environment Measures Survey: This pre- and post-test survey determined changes in the food environment of the reservation store.
The preliminary findings show the Healthy Stores project has been well received by tribal community members. Although the project did not assess dietary intake in the grocery store shoppers participating in the taste tests and other surveys, data indicate that shoppers like the taste of the healthy foods and are purchasing them. Future studies could assess dietary intake of local shoppers or implement a Healthy Stores project that targets increased intake and sales of food assistance program foods, such as those in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Direct inquiries about this study to the Project Contact listed above.