Diabetes prevention among American Indians: the role of self-efficacy, risk perception, numeracy and cultural identity

Abstract Background According to the Risk Perception Attitude (RPA) framework, classifying people according to their perceptions of disease risk and their self-efficacy beliefs allows us to predict their likelihood for engaging in preventive behaviors. Health interventions can then be targeted according to RPA group. We applied the framework to type 2 diabetes prevention behaviors among American Indians and expanded it to include culture and numeracy. Methods Using a cross-sectional study design, we surveyed a sample of Northern Plains American Indians in a reservation community setting on self-reported perceptions of diabetes risk, objective diabetes risk, self-efficacy, engagement in healthy behaviors, knowledge of diabetes risk factors, and covariates including demographics, numeracy, and cultural identity. We used the RPA framework to classify participants into four groups based on their perceptions of risk and self-efficacy. Analyses of variance and covariance estimated inter-group differences in behaviors associated with type 2 diabetes prevention. Results Among 128 participants, our only finding consistent with the RPA framework was that self-efficacy and risk perception predicted knowledge about diabetes risk factors. We found limited evidence for the influence of cultural identity within the RPA framework. Overall, participants had lower numeracy skills which tended to be associated with inaccurate perceptions of higher levels of risk. Conclusions The theoretical framework may benefit from inclusion of further contextual factors that influence these behaviors. Attention to numeracy skills stands out in our study as an important influence on the RPA framework, highlighting the importance of attending to numeracy when targeting and tailoring risk information to participants segmented by the RPA framework

Children as Agents of Change: Parent Perceptions of Child-Driven Environmental Health Communication in the Apsáalooke (Crow Indian) Community

While previous research suggests children have successfully acted as health change agents, no studies have examined the role of children in promoting environmental health knowledge and awareness. This study describes parent perceptions of the impact of a five-day water-focused environmental health summer camp on elementary school children in an American Indian community. We interviewed parents about their perception of changes in their child\u27s environmental health knowledge, attitudes, and behaviors. Parents in this study confirmed that their child had shared information related to the camp activities. In addition, parents perceived that their children had increased knowledge and positive changes in attitudes and behaviors related to environmental health. We recommend programs promoting children as change agents develop and use materials for parents that facilitate bidirectional communication with youth so to not place the onus wholly on the child. Our study highlights parental perceptions of the ways the voices and actions of children have the potential to be valuable assets in addressing environmental-related health disparities