The purpose of this study was to culturally adapt a standard diabetes education program originally designed to broadly address DM education needs for AIAN populations collectively. Promising approaches to diabetes management include nationally recognized guidance for self-care, medication management, diabetes education, regular check-ups, and ongoing support ( 6). Poor glucose management may lead to diabetes complications and premature death, including vision loss, kidney failure, heart disease, limb amputation, and death ( 3вЂ“ 5). The age-adjusted diabetes mortality rate for the DinГ© (Navajo) population is more than double (2.29 times higher) the US population rate ( 3). Diabetes is the fourth leading cause of death for the Navajo Nation ( 2), and is the seventh leading cause of death for the United States in general (US). The approaches used here can guide the development, implementation, and testing of culturally-informed health education for AIAN populations.ДЄlthough diabetes prevention and control efforts have increased in American Indian and Alaskan Native (AIAN) communities, AIAN people continue to experience disproportionality higher rates of diabetes-related morbidity and mortality ( 1).

Key themes that emerged from the data included the importance of discipline, positivity and mindfulness in the context of HГіzhГі.Д¬onclusion: Culturally safe and meaningful engagement with cultural leaders and the use of qualitative research methods can inform deep-level cultural adaptations essential to developing tribe-specific diabetes education programs. Results: DinГ© healers and cultural experts informed the development of an educational tool called DinГ© Health. Interviews were audio-recorded, transcribed and analyzed using a qualitative thematic analysis method. Three specific self-care behaviors relevant to Type 2 diabetes self-management were discussed: (1) healthy eating, (2) physical activity, and (3) healthy coping. Methods: A conversation guide, based on the HГіzhГі Resilience Model-a DinГ© framework on healthy living, was used to engage key cultural experts in interviews about traditional stories and teachings regarding health and wellness. Tribe-specific health information and programming, such as integrating DinГ© worldviews and Indigenous knowledge among DinГ© people as described here, are essential to creating a culturally relevant and effective and meaningful approach to disease self-management. This approach does not properly address the need for tribe-specific cultural health messaging, defined as incorporating cultural elements deemed relevant to the population. Though the recommendation to culturally adapt health education curricula was meant to improve health education for American Indians and Alaskan Natives (AIANs), it has inadvertently created a вЂњone size fits allвЂќ approach. Objective: The purpose of this study was to culturally enhance a diabetes education program for DinГ© (Navajo) community members with Type 2 diabetes. 3Diabetes Education and Clinical Education, Tuba City, AZ, United States.2Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.1Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States.

Jamie Wilson 1 *, Cynthia Thomson 1, Samantha Sabo 2, Anathea Edleman 3 and Michelle Kahn-John 2

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