The Okla Achukma Project

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.