Community involvement in design, implementation, and evaluation of interventions to reduce chronic diseases in indigenous populations in the US: a systematic review.
Community involvement in design, implementation, and evaluation of interventions to reduce chronic diseases in indigenous populations in the US: a systematic review.
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Date
2018
Authors
Banna, J.C.
Bersamin, A.
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BMC
Volume
17
Number/Issue
1
Starting Page
116
Ending Page
116
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Abstract
Background:
Indigenous peoples of the United States disproportionately experience
chronic diseases associated with poor nutrition, including obesity and
diabetes. While chronic disease related health disparities among
Indigenous people are well documented, it is unknown whether
interventions adequately address these health disparities. In addition,
it is unknown whether and to what extent interventions are culturally
adapted or tailored to the unique culture, worldview and nutrition
environments of Indigenous people. The aim of this review was to
identify and characterize nutrition interventions conducted with
Indigenous populations in the US, and to determine whether and to what
degree communities are involved in intervention design, implementation
and evaluation.
Methods:
Peer-reviewed articles were identified using MEDLINE. Articles included
were published in English in a refereed journal between 2000 and 2015,
reported on a diet-related intervention in Indigenous populations in the
US, and reported outcome data. Data extracted were program objectives
and activities, target population, geographic region, formative research
to inform design and evaluation, partnership, capacity building,
involvement of the local food system, and outcomes. Narrative synthesis
of intervention characteristics and the degree and type of community
involvement was performed.
Results:
Of 1060 records identified, 49 studies were included. Overall,
interventions were successful in producing changes in knowledge,
behavior or health (79%). Interventions mostly targeted adults in the
Western region and used a pre-test, post-test design. Involvement of
communities in intervention design, implementation, and evaluation
varied from not at all to involvement at all stages. Of programs
reporting significant changes in outcomes, more than half used at least
three strategies to engage communities. However, formative research to
inform the evaluation was not performed to a great degree, and fewer
than half of the programs identified described involvement of the local
food system.
Conclusions:
The extent of use of strategies to promote community engagement in
programs reporting significant outcomes is notable. In planning
interventions in Indigenous groups, researchers should consider ways to
involve the community in intervention design, execution and evaluation.
There is a particular need for studies focused on Indigenous youth in
diverse regions of the US to further address diet-related chronic
conditions.
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