American Indians and Alaska Natives (AIAN) suffer the highest rates of health disparities, such as obesity, where lifestyle is a key risk factor. Previous interventions to change the behavior of AIAN have had Native cultural components incorporated into them in the hope of making the intervention culturally relevant. For this study, however, we incorporated the interventions into the Native culture. In other words, the study started with Native culture and indigenous wisdom as the community strength and foundation upon which to stimulate the motivation for, and design of, an intervention. This study was developed from the groundwork of the Community Health and Development Department, in which a social marketing campaign entitled Ancestors’ Choice™ was launched. Ancestors’ Choice promotes the choice for healthy foods and lifestyles based on the wisdom of traditional Native values and culture. Ancestors’ Choice is a strategy to assist Native people living in contemporary times to make healthier diet and lifestyle choices that in essential ways honor and emulate the practices that produced the health benefits for the people who lived during ancestral times. Considerable evidence indicates that an approach that encourages Native people in the direction of Ancestors’ Choice may result in improved health outcomes.
The hypothesis for this study was that children will choose and consume healthier foods, snacks, and drinks if (1) messages attempting to motivate healthy eating habits in Native children, youth, and teens are culturally congruent, (2) products have packaging and taste appeal, and (3) healthy foods are made readily available in the environments where children congregate.
The three aims of the study were to (1) tailor the campaign to address children, youth, and teens of the Flathead Indian Reservation, (2) evaluate the campaign’s impact on brand-name recognition and sales/consumption of items with the Ancestors’ Choice label by children, youth, and adults, and (3) further develop a RezChef™ cooking class to include cooking shows with children, youth, and teens. These shows would be aired on public television and made available with a healthy eating curriculum, teacher’s guide, and DVD to Northern Plains and plateau tribes.
Participants in the study included people of Native American or Alaska Native descent between the ages of 3 and 75 currently residing on or near the Flathead Reservation. Participants were invited to (1) taste products being considered for endorsement by the Ancestors’ Choice Social Marketing campaign, and (2) through focus groups, provide input on the social marketing messages that had roots in and connections to traditional culture that would address market appeal, channels of distribution, tastes, and preferences. A family-friendly indigenous nutrition class, plus the development of a play and public performance promoting Ancestors’ Choice healthy diet and lifestyles, premiered. Future showings are scheduled with children and youth actors and audiences throughout the Reservation.
Surveys were conducted before and after the study with various children, youth, and adults throughout the Reservation to ascertain brand name recognition for Ancestors’ Choice and RezChef. Youth Groups were interviewed through focus groups at the beginning of the study to enlist their involvement in developing the Social Marketing Campaign for promoting healthy eating messages to children and youth. Taste-testing events were conducted for snacks, drinks, and menus developed through the RezChef programs. Recipes receiving youth approval were included with the RezChef DVDs.
As this was a preliminary study, methods did not involve a control group, placebo, or blinding. Data collection included in-person questionnaires, focus groups, or tasting events at which people were invited to sample the foods offered through Ancestors’ Choice. All questionnaires and data collection procedures were developed and reviewed as part of the study.
Only 6 percent of participants recognized the Ancestors’ Choice (AC) logo prior to the study, but that percentage increased to 25 percent recognition after the study. Similar results were demonstrated for recognition of the RezChef logo. These results indicate that the intended message is being delivered. Responses to the question “What comes to mind when you look at the AC logo?” included traditional lifestyles, togetherness, unity, smoothies, Native culture, Indian wisdom, healthy traditional choices, and “heritage in the now.” Responses for the question “What is it trying to get you to do?” included live strong, balance your life, choose ancestral ways, and live a healthier lifestyle. The most common responses to “What would help you make healthier choices on a daily basis?” were availability of healthy local food and better nutritional education.
The biggest exposure to Ancestors’ Choice took place during the smoothie sales held throughout the Reservation. A cooking show that involves children in making smoothies is in final editing as a half hour DVD program. Focus group results included suggestions for further activities involving the community, such as a “biggest loser” contest, a play about making healthy choices using Native themes and humor, and weigh-in and run competitions.
Limitations of the study are the nonrandomized samples, difficulty coordinating children and parental schedules, difficulty in accessing children for surveys, and high staff turnover. Enthusiasm for the various projects that promote a Native-based diet and healthy lifestyle continues to grow as more connections within the community are developed. The play Beansy and Peasy Choose Ancestors’ Choice™ is being requested by the local schools and Head Start Programs throughout the Reservation and is expected to become the primary vehicle for increasing brand name recognition for Ancestors’ Choice™.
Direct inquiries about this study to the Project Contact listed above.