More North American Aboriginal women are being diagnosed with gestational diabetes mellitus (GDM) than the general population. Despite the association of a number of health problems with GDM, there have been few evaluations of GDM prevention projects. Nor have investigators looked at Aboriginal women’s understandings of GDM in an effort to develop appropriate and effective health strategies. A qualitative investigation was therefore proposed to describe the experiences of Aboriginal women with GDM. The study began with unstructured interviews and focus groups with 25 advisors such as maternal care providers and community representatives working with Aboriginal women. Semi-structured explanatory model interviews were then conducted with 29 Aboriginal women in Winnipeg, the capital city of Manitoba, Canada. Fixed-response interviews were also administered and analyzed using cultural consensus analysis to determine whether or not shared cultural understandings existed among the Aboriginal women participants. Results of the consensus analysis revealed biomedical understandings were the most commonly shared. A more variable response was associated with women’s personal interpretations of GDM, leading to weak consensus overall. Thematic analysis of the semi-structured interviews illustrated the fear, anxiety and frustration many participants experienced with GDM. Women discussed their emotional reactions alongside negative relationships with food and other prescribed lifestyle treatments. These perspectives, combined with results from the group of advisors, pointed to communication and cultural barriers which may limit the quality of prenatal care received. Collectively the results suggest living with GDM can be overwhelming and underscore the need for health care providers to encourage self-efficacy and emotional security towards effective management practices. Research contributing to a more comprehensive understanding of Aboriginal women’s experiences with GDM is also required, to provide further perspective for diabetes prevention and positive change.

More North American Aboriginal women are being diagnosed with gestational diabetes mellitus (GDM) than the general population. Despite the association of a number of health problems with GDM, there have been few evaluations of GDM prevention projects. Nor have investigators looked at Aboriginal women’s understandings of GDM in an effort to develop appropriate and effective health strategies. A qualitative investigation was therefore proposed to describe the experiences of Aboriginal women with GDM. The study began with unstructured interviews and focus groups with 25 advisors such as maternal care providers and community representatives working with Aboriginal women. Semi-structured explanatory model interviews were then conducted with 29 Aboriginal women in Winnipeg, the capital city of Manitoba, Canada. Fixed-response interviews were also administered and analyzed using cultural consensus analysis to determine whether or not shared cultural understandings existed among the Aboriginal women participants. Results of the consensus analysis revealed biomedical understandings were the most commonly shared. A more variable response was associated with women’s personal interpretations of GDM, leading to weak consensus overall. Thematic analysis of the semi-structured interviews illustrated the fear, anxiety and frustration many participants experienced with GDM. Women discussed their emotional reactions alongside negative relationships with food and other prescribed lifestyle treatments. These perspectives, combined with results from the group of advisors, pointed to communication and cultural barriers which may limit the quality of prenatal care received. Collectively the results suggest living with GDM can be overwhelming and underscore the need for health care providers to encourage self-efficacy and emotional security towards effective management practices. Research contributing to a more comprehensive understanding of Aboriginal women’s experiences with GDM is also required, to provide further perspective for diabetes prevention and positive change.

Objective: Aboriginal children are disproportionately affected by obesity, as they are twice as likely to be classified as obese compared to their non-Aboriginal Canadian counterparts. Research indicates that income, food insecurity, and diet quality are important predictors of weight status, however these factors are not well explored among Aboriginal children living off reserve. This study aims to identify associations between food insecurity and diet on obesity status among off-reserve First Nations and Métis children. Methods: This study used both quantitative and qualitative research methods. Data from the 2006 Aboriginal Peoples Survey (APS) – Children and Youth component were analyzed using binary logistic regression and the proportional odds model to assess relationships between food insecurity, diet, and body mass index (BMI). Fruit and vegetable intake, as well as junk food consumption, were used as proxy measures for children’s diet quality. Additional analyses involving income instead of food insecurity, as well as food insecurity interaction terms, were also explored. Focus groups were conducted with caregivers of Métis and off-reserve First Nations children in Midland-Penetanguishene and London, Ontario, respectively. The focus groups were planned and carried out in partnership with the Métis Nation of Ontario (MNO) and the Southwest Ontario Aboriginal Health Access Centre (SOAHAC). A thematic analysis was conducted with the qualitative data, and the focus group discussions provided important contextual information to complement the statistical results. Results: Approximately 11% of First Nations and 6.8% of Métis children were food insecure according to the 2006 APS. The quantitative analysis did not find a significant association between food insecurity and diet, or food insecurity and BMI for First Nations or Métis children. Income was a better predictor of weight status than food insecurity. For First Nations children, having a household income higher than $60,000 decreased the risk of being overweight/obese. For Métis children, a household income of less than $20,000 increased the risk of overweight/obesity. Food insecurity was only significant as an interaction with parental education for First Nations children, and with parental education and number of people living in the household for Métis children. The proportional odds model produced similar results to the binary logistic regression procedure, and food insecurity remained insignificant in the analyses. Contrary to the quantitative findings, the focus group discussions indicated that caregivers perceived a positive relationship between low income and food insecurity, as well as adverse impacts on their children’s diets. While caregivers did not use the term “food insecurity” explicitly, conversations about not having enough food or money for food, as well as coping strategies for when these situations occurred, suggested that food insecurity manifests itself in different ways. Caregivers mentioned decreased variety of foods, compromised fruit and vegetable intake, as well as decreased traditional food consumption as examples of how families’ food consumption and purchasing patterns changed when food insecure. Food insecurity negatively impacted children’s diets, and many caregivers attributed the rise in overweight and obesity to poor diet quality. Some of the key barriers to children eating healthfully were unaffordability and limited access to healthy foods. Caregivers also discussed the role of various programs for improving child health within their communities. Conclusions: While food insecurity was not significantly associated with obesity in the quantitative analyses, discussions with caregivers of First Nations and Métis children identified food insecurity and low income as important predictors of poor diet, and consequently decreased well-being. Several limitations associated with the 2006 APS design may have prevented food insecurity from being significantly associated with obesity risk; however, it is clear from both the quantitative and qualitative components of this study that income consistently affects diet and child obesity risk. Findings from this study can inform necessary improvements to existing programs, interventions, and policies targeting obesity and health of Aboriginal children.

Objective: Aboriginal children are disproportionately affected by obesity, as they are twice as likely to be classified as obese compared to their non-Aboriginal Canadian counterparts. Research indicates that income, food insecurity, and diet quality are important predictors of weight status, however these factors are not well explored among Aboriginal children living off reserve. This study aims to identify associations between food insecurity and diet on obesity status among off-reserve First Nations and Métis children. Methods: This study used both quantitative and qualitative research methods. Data from the 2006 Aboriginal Peoples Survey (APS) – Children and Youth component were analyzed using binary logistic regression and the proportional odds model to assess relationships between food insecurity, diet, and body mass index (BMI). Fruit and vegetable intake, as well as junk food consumption, were used as proxy measures for children’s diet quality. Additional analyses involving income instead of food insecurity, as well as food insecurity interaction terms, were also explored. Focus groups were conducted with caregivers of Métis and off-reserve First Nations children in Midland-Penetanguishene and London, Ontario, respectively. The focus groups were planned and carried out in partnership with the Métis Nation of Ontario (MNO) and the Southwest Ontario Aboriginal Health Access Centre (SOAHAC). A thematic analysis was conducted with the qualitative data, and the focus group discussions provided important contextual information to complement the statistical results. Results: Approximately 11% of First Nations and 6.8% of Métis children were food insecure according to the 2006 APS. The quantitative analysis did not find a significant association between food insecurity and diet, or food insecurity and BMI for First Nations or Métis children. Income was a better predictor of weight status than food insecurity. For First Nations children, having a household income higher than $60,000 decreased the risk of being overweight/obese. For Métis children, a household income of less than $20,000 increased the risk of overweight/obesity. Food insecurity was only significant as an interaction with parental education for First Nations children, and with parental education and number of people living in the household for Métis children. The proportional odds model produced similar results to the binary logistic regression procedure, and food insecurity remained insignificant in the analyses. Contrary to the quantitative findings, the focus group discussions indicated that caregivers perceived a positive relationship between low income and food insecurity, as well as adverse impacts on their children’s diets. While caregivers did not use the term “food insecurity” explicitly, conversations about not having enough food or money for food, as well as coping strategies for when these situations occurred, suggested that food insecurity manifests itself in different ways. Caregivers mentioned decreased variety of foods, compromised fruit and vegetable intake, as well as decreased traditional food consumption as examples of how families’ food consumption and purchasing patterns changed when food insecure. Food insecurity negatively impacted children’s diets, and many caregivers attributed the rise in overweight and obesity to poor diet quality. Some of the key barriers to children eating healthfully were unaffordability and limited access to healthy foods. Caregivers also discussed the role of various programs for improving child health within their communities. Conclusions: While food insecurity was not significantly associated with obesity in the quantitative analyses, discussions with caregivers of First Nations and Métis children identified food insecurity and low income as important predictors of poor diet, and consequently decreased well-being. Several limitations associated with the 2006 APS design may have prevented food insecurity from being significantly associated with obesity risk; however, it is clear from both the quantitative and qualitative components of this study that income consistently affects diet and child obesity risk. Findings from this study can inform necessary improvements to existing programs, interventions, and policies targeting obesity and health of Aboriginal children.

Background: The purpose of this phenomenological study is to explore the existing research on the determinants and influential factors of eating decisions made by Aboriginal peoples and provide insight from the perspective of Aboriginal peoples living off-reserve in Ottawa, Ontario. Methods: This study was comprised of a convenience sample of 12 Aboriginal individuals from a local Aboriginal community centre. Participants were asked to conduct a personal food diary of their meals for a period of 3 days, followed by a one-on-one semi-structured interview. The interviews were designed to explore: 1) knowledge and perspectives of healthy eating 2) knowledge and perspectives of Health Canada’s Eating Well with Canada’s Food Guide – First Nations, Inuit and Métis, 3) perception of influential factors 4) self-efficacy and 5) common barriers in making food choices. Results: 1) Except for the senior participants, healthy food knowledge did not translate into healthy food choices for most participants; 2) Most participants had not seen a copy of the Eating Well with Canada’s Food Guide – First Nations, Inuit and Métis, and all participants felt they were not influenced by it when making eating decisions; 3) The main themes of influential factors were concluded to be: taste preference, availability, convenience, “had no choice”, health reasons, “easy to make”, low in cost, following a diet or “food schedule,” hunger or thirst, “needed something quick”, nearby location (of store or restaurant), being tired or lazy and being in a routine; 4) Most participants perceived themselves as having control over their eating decisions regardless of situational factors and level of motivation varied between participants; 5) Time, financial constraints, having a busy schedule and being unprepared for meals were identified as possible barriers. Conclusions: Either version of the food guide should be developed into a more flexible and convenient tool such as a mobile application. Local community centres should consider providing workshops in food preparation, and to strengthen skills such as understanding food labels of market foods to ease the transition to living off-reserve. Future Implications: Policy makers at the federal, provincial and municipal levels should work together and strengthen their communication strategies in order to coordinate the development and implementation of future interventions.