Remembering What We Always Knew: Development of an Indigenous Diabetes Prevention Model.

Background: Although the National Diabetes Prevention Program in the United States demonstrates success in physical health improvements, it lacks efficacy for recruiting and retaining Indigenous participants. In response to its shortcomings, diabetes prevention initiatives that integrate Indigenous traditional ecological knowledge emerged. Nevertheless, these initiatives also face various challenges that undermine their connections to authentic Indigenous needs, and their developments within the context of mainstream organizations are laden with complexity. Objectives: The purpose of this initiative was to develop a culturally relevant diabetes prevention program for Indigenous women in the United States aged 40 and older that would address challenges to existing programs. Methods: Informed by a detailed analysis of culturally relevant diabetes prevention programs in the United States and the Two-Eyed Seeing approach, the University of Minnesota Extension gathered an advisory council of Indigenous women-Elders to cocreate and field-test a culturally centered program model. Extension supported the process through sharing literature review findings, creating connections to national expertise in Indigenous diabetes prevention, and facilitating participatory evaluation. Results: The initiative facilitated reconnection with Indigenous cultural practices and healthy living traditions through Indigenous activities. The program provided a sisterhood of support for the women as they explored and reclaimed their cultural identities. Outcomes reported by participants included increased sense of belonging, increased reliance on cultural ways for healthy living, increased capability to engage in cultural practices, increased confidence in using cultural medicines for health and healing for self and others, and improved confidence in Elder status. Conclusions: Indigenous cultural approaches to health promotion emphasize community values, offer a holistic approach to health that integrates mental, physical, emotional, and spiritual well-being, and consciously recognize historical trauma and racism. Applying the Two-Eyed Seeing approach to program development can successfully integrate Indigenous cultural approaches to health promotion in the context of mainstream systems.