Use of cognitive interview techniques in the development of fruit and vegetable nutrition education for low-income American Indians aged 18--24 years

The health status of American Indians (AI) is characterized by high rates of diabetes, heart disease, and obesity. Fruits and vegetables may reduce the risk or prevent development of diabetes, heart disease, and obesity. AI are shown to have low fruit and vegetable intakes and may benefit from fruit and vegetable nutrition education. Little research has been published on the development of nutrition education interventions that are culturally relevant for AI. Dialog with AI is needed to develop culturally appropriate nutrition programs and materials. The purposes of this study were to (1) elicit AI young adults' cognitive reactions to fruit and vegetable nutrition education and (2) formulate recommendations to assist nutrition educators in developing fruit and vegetable nutrition education programs for AI young adults. Cognitive interviews were conducted to elicit AI and non-American Indian (NAI) young adults' cognitive reactions to: (1) stage-based fruit and vegetable newsletters and magazine, (2) fruit and vegetable assessment telephone survey, and (3) recruitment process. Twenty-six AI (15 female) and 12 NAI (8 female) young adults aged 18--24 years participated in the study. Mean body mass index was 30.5 +/- 2.2 (S.E.) for male and 29.9 +/- 1.9 for female AI, and 23.9 +/- 1.3 for NAI males and 20.1 +/- 1.0 for NAI females. AI and NAI young adults were primarily full- or part-time students, lived off-campus, and were in post-action stage of change for fruit intake and pre-action stage of change for vegetable intake. AI preferred group formats and verbal delivery for learning about fruits and vegetables; NAI young adults preferred print materials and the internet. Family was discussed by AI, but not NAI young adults in relation to fruit and vegetable consumption. AI had fewer negative comments about fruit and vegetable newsletters than NAI young adults. Social liberation was a highly used process of change by AI from interview and assessment survey data. Money was suggested for recruiting AI and NAI young adults into research studies. Study findings provide insight into important cultural factors to consider when developing and implementing nutrition education programs for AI audiences.