PROJECT SUMMARY
Deep South Native Americans (DSNA) have high rates of diabetes, obesity, and hypertension, and
consequently, are dying prematurely. Standard lifestyle interventions that advance knowledge and skills to
promote healthier eating and activity behaviors mitigate chronic disease risk by improving cardiometabolic
health outcomes. The standard lifestyle intervention approach predominantly targets the intellectual and
physical domains of health at the individual level. However, there are major limitations of standard lifestyle
interventions targeting tribal communities. These include large dropout rates and poor session attendance,
largely attributed to lack of family social support and disinterest in the program. Our research has shown
DSNAs feel helpless about preventing chronic disease and eat better when they have family social support.
Social and cultural enhancement of standard interventions should address social and spiritual domains of
health, respectively, by bolstering family support of diet and physical activity behaviors and reframing fatalistic
thinking with positive views that leverage traditional cultural values and highlight strengths from traditional
practices. Thus, the long-term goal of the Okla Achukma Project is to produce a culturally and socially
enhanced intervention that can be sustained within Deep South tribes to reduce chronic disease disparities
and premature mortality. Our central hypothesis is that the integration of spiritual and social domains of health
into the standard lifestyle intervention approach will significantly improve attendance, retention, and
cardiometabolic profiles of DSNA. We will use a community based participatory approach to build on past
research, existing infrastructure, and collaborations with tribal leaders to accomplish the proposed aims. Our
aim is to assess the feasibility and effectiveness of the spiritual and social domains of health as multi-level,
cultural and social enhancements of a standard lifestyle intervention on health outcomes and program
engagement among DSNA. A randomized control trial will be implemented to assess the impact of social and
cultural enhancements on a standard lifestyle intervention. The NDPP-based Move & Eat 2 Live (ME2L)
program will be the standard approach that targets two domains at the individual level. A social enhanced
intervention (yes, no) x cultural enhanced intervention (yes, no) X 5 time periods (pre-intervention, post-
intervention, 6-month, 9-month, 12-month) mixed model MANOVA with between subjects (social
enhancement, cultural enhancement) and within subjects (time period) factors will be used to analyze these
data. The proposed work will determine what social and cultural enhancements contribute both individually and
collectively to health outcomes and program engagement of DSNA. Overall, the intervention will provide new
advancements in lifestyle management approaches that are sustainable within tribal communities to reduce
morbidity and premature mortality among DSNA.