Barriers and Strategies for Healthy Food Choices among American Indian Tribal College Students: A Qualitative Analysis.

BACKGROUND: American Indian and Alaskan Native individuals experience disproportionate levels of chronic health conditions such as type 2 diabetes and overweight and obesity that are influenced by dietary patterns and food choices. Understanding factors that influence healthy food choices among tribal college students can enrich education and programs that target dietary intake.

OBJECTIVE: To build an understanding of factors that influence healthy food choices among tribal college students at increased risk for college attrition.

DESIGN: A nonexperimental cohort design was used for qualitative descriptive analysis.

PARTICIPANTS/SETTING: Participants (N=20) were purposively sampled, newly enrolled, academically underprepared tribal college students enrolled in a culturally relevant life skills course at an upper Midwest tribal college between September 2013 and May 2015. Participant demographic characteristics included various tribal affiliations, ages, and number of dependents.

MAIN OUTCOME MEASURES: Participant responses to qualitative research questions about dietary intake, food choices, self-efficacy for healthy food choices, psychosocial determinants, and barriers to healthy food choices during telephone interviews were used as measures.

ANALYSIS: Qualitative analysis included prestudy identification of researcher bias/assumptions, audiorecording and transcription, initial analysis (coding), secondary analysis (sorting and identifying meaning), and verification (comparative pattern analysis).

RESULTS: Qualitative analysis revealed a variety of themes and subthemes about healthy food choices. Main themes related to barriers included taste, food gathering and preparation, and difficulty clarifying healthy food choices. Main themes related to strategies included taste, cultural traditions and practices, and personal motivation factors.

CONCLUSIONS: Qualitative analysis identified barrier and strategy themes that may assist nutrition and dietetics practitioners working with tribal/indigenous communities, tribal college educators and health specialists, and tribal community health workers who target health and dietary intake of American Indian and Alaskan Native students.