Indigenous traditional foods and culturally appropriate care: exploring community experiences and developing a tool to assess healthcare provider knowledge

Abstract

The prevalence of gestational diabetes mellitus (GDM) is three times higher among Indigenous women than non-Indigenous women in Canada. While culturally appropriate programs exist to promote healthy pregnancies, they are often designed for rural contexts where traditional foods and activities are more readily accessible. Considering the steady migration of Indigenous populations to urban centers, it is vital to assess the availability and clinical support regarding traditional foods within urban healthcare systems. This necessitates an evaluation of the care provided by healthcare professionals to ensure it meets the unique needs of urban Indigenous women. To explore the experiences of urban Indigenous women with prenatal programs and healthcare, a multi-method and Community-Based Participatory Research (CBPR) approach was utilized. The research team conducted focus groups and in-depth interviews and analyzed the data using Classical Grounded Theory, revealing six themes from the focus groups and two additional themes from the interviews. These themes highlighted the vital importance of traditional foods during pregnancy, the challenges of accessing them in urban settings, and a significant inability among healthcare providers to offer culturally appropriate care or recommendations. This finding pointed to a critical lack of foundational knowledge on the topic, which led to the initiation of a second study to develop a valid and reliable Indigenous Traditional Foods Knowledge Questionnaire. Guided by an advisory board of Indigenous knowledge keepers from across Canada, a modified eight-step psychometric approach was used to develop the survey instrument. The advisory board established the definitions for traditional foods and related knowledge, and the research team developed questionnaire items using academic and grey literature, including Indigenous traditional food guides, Indigenous organizations websites, and organizational reports and books. Five registered dietitians evaluated the first draft for content validity, and ten healthcare practitioners assessed its face validity. While the psychometric evaluation of the questionnaire remains to be completed, this solution-focused project will provide a reliable instrument to identify specific knowledge gaps and improve healthcare professionals’ knowledge of traditional foods.