Walking in two worlds with type 2 diabetes: a scoping review of prevention and management practices incorporating traditional indigenous approaches

Figures & data

Table 1. Evidence Sources.

Reference	Nation and/or Community, Location	Program Type or Main Research Method	Traditional Content Summary	Traditional Content Development	Delivery Model
[43]	Australian Aboriginal, outer suburbs of Western Sydney	Cooking course	Indigenous community member-led, hosted in community relevant space, group feasting	Indigenous health care workers with community member feedback	Indigenous health care workers
[31]	Native American Indian, USA	Tribal school-based diabetes education program	Storytelling, Elder teachings, return to tradition	Curriculum developed by eight American Tribal Colleges and Universities, the National Institute of Diabetes and Digestive and Kidney Diseases Center, the CDC, and Indian Health Services.	Delivered by Tribal educators.
[25]	Norwest American Indian Native Tribe, USA	Community garden and diabetes education workshop	Based on traditional views of health, wellbeing and sustenance. Inclusion of Elder consultation.	Community members designed study and performed initial literature searching.	Program led by community members. Assessments completed by researcher.
[40]	Northeast Native American Indian, USA	Diabetes prevention and management focus groups	Talking Circle, Elders, Land connection	Culturally sensitive recruitment and screening was used. Data was collected in a private space on Tribal Land. The room was set up in a talking circle.	Focus group facilitator in a community centre.
[30]	Native American Indian, Northern Plains Montana, USA	Diabetes prevention program adaptation, community interviews	Themes suggested in interviews include adding cultural content to the existing Diabetes Prevention Program	Feedback from community members.	Indigenous staff members conducted interviews.
[61]	Native American Indian, Northern Plains Montana, USA	Group gardening program feasibility, interviews with community members	Emphasis on Elder advisory related to feasibility of a gardening program. Cultural themes discussed by community members during interviews.	Feedback from community members.	University of Montana researchers in partnership with community educators and Tribal staff collaborated to conduct this research.
[44]	Native American Indian & Alaska Native, Minneapolis, MN	Diabetes self-management program	Prayers/Blessings, talking circles, Wholistic Health, Elder Consult	Diabetes Community Council helped design culturally appropriate community- based activities, became leaders for the Living in Balance classes, led talking circles, suggested intergenerational events, and participated in numerous outreach activities.	Minneapolis American Indian Center (MAIC], Native American Community Clinic [NACCC). Services were delivered by a program coordinator.
[3]	Native American Indian, California & North Dakota, USA	Development of a culturally appropriate nutrition plan for individuals with diabetes	Based on Indigenous food practices, Elder consultations.	Developed by Tribal leaders alongside a nutritionist.	Delivered by nutritionist and diabetes educator.
[7]	Various Native American Indian communities, USA	Community member interviews	Cultural themes were drawn out of interviews. Cultural co-development of interview questions and process.	Community members worked alongside research team members to develop instruments and advise on process and protocols.	Tribal community members delivered interviews with other members
[19]	Various Native American Indian communities, USA	Community garden lifestyle intervention	Focus on traditional foods, cultural and history as integral to success with traditional foods project	Communities differed in the particulars of their programs based on unique values. Largely surrounding community support.	Community implementation with research group assessment.
[62]	Kahnawake Mohawk First Nation, Quebec, Canada	School-based diabetes prevention program	Local concepts of wellbeing incorporated including living in balance, caring for the Seventh Generation.	Intervention activities were designed to be familiar, pertinent, and appeal to participant tastes and interests through traditions (e.g. three sisters, corn, beans and squash] and socially based practices [e.g. gathering at a meal, walking as a family).	Implemented by The Kahnawake Schools Diabetes Prevention Project staff.
[59]	Mvskoke Nation, Oklahoma, USA	Physical activity engagement for diabetic adults in the community	Traditional dance and games	Cultural activities were selected by community participants	Community delivered, assessed by research team for physical health outcomes
[63]	Haida Gwaii Nation, British Colombia, Canada	Diabetes management program	Traditional herbal medicine, traditional diet, culturally safe oral tradition of knowledge sharing via focus groups	Local physicians, Community Health Representatives, Elders and community member collaboration.	Delivered by researchers, medical professionals, with input from community.
[1]	Keweenaw Bay Ojibwe Nation, Lake Superior, Michigan, USA	Summer science camp focused on diabetes prevention	Traditional knowledge sharing, Elders, traditional food consumption and education, storytelling	The American Indian Science and Engineering Society joined Ojibwe community members to provide this camp alongside biologist and ecologists.	Community members, Elders and spiritual leaders taught educational sessions.
[46]	Canada, USA, New Zealand Indigenous Nations	Prevention focused interviews with Indigenous food sovereignty experts on traditional diets and wellness practices	Storytelling	Researchers	Researchers
[64]	Moose Factory Cree Nation, Ontario, Canada	Sharing circles for community input on health interventions	Sharing circles, Indigenous language use.	Cultural content was discussed in sharing circles. They provided participants with childcare, meal, refreshments, held at local building.	Community teacher facilitated sharing circles [fluent in Cree and English].
[65]	Canada	Diabetes education workshop for health care workers	Inclusion of Elders, an Aboriginal Wisdom Committee, and cultural values.	Developed by the Aboriginal Wellness Program team made up if Elders, nurses, a dietitian, and doctors. Worked with communities to identify cultural teachings related to health and nutrition.	Professional Relations in Aboriginal Diabetes Education [PRIADE] organisation implementation of four-day workshop.
[41]	Kahnawake First Nation, Quebec, Canada	Community-based diabetes prevention program	Traditional cooking lessons, traditional medicines education, knowledge sharing through storytelling, spiritual perspective	Community advisory board assisted research team in developing program.	Executed by community and evaluated by research team.
[57]	Māori, New Zealand	Lifestyle intervention program for diabetes (dietary program & cooking classes, dietary and exercise]	Traditional gatherings in traditional meeting houses. Traditional foods and traditional activities (exercise) included in the program. Indigenous staff ran program sessions.	Researchers consulted with local Maori over a 6–12-month period. Approval was obtained from many community groups (e.g. Ngai Tahu Maori Research Unit, Te Wakahauora, Otakou Maori Womens Welfare League) to initiate a lifestyle program (Te whai matauranga o te ahua noho) specifically designed for Maori. Some research team members held Tribal affiliation.	Researchers led the program (first author, not explicitly stated if Maori). Dietitian, Exercise Trainer [non-Maori, unable to recruit Maori) were involved. Maori staff assisted in running program sessions.
[49]	Native American Indian , USA	Anthropological observation, discussion with community	Talking circles used for storytelling, legends and myths included. Discussion surrounding community views of diabetes as a result of colonialism, traditional food importance, and ideals for education and treatment programs.	Themes arose through conversations with community.	Anthropologist-led conversations.
[22]	Cree and Blackfoot First Nations, Alberta, Canada	Community leader interviews related to culture and diabetes to inform intervention development	Discussion surrounding cultural continuity, self determination, and diabetes. Indigenous advisory group	Interviews were conducted with Cree and Blackfoot leaders living in and working for their Nations in accordance with advising from an Indigenous community group.	Researchers conducted interviews with community members.
[38]	Various First Nations communities, North Ontario, Canada	Interviews with community members living with Type 2 diabetes to understand firsthand experiences	Engagement with key community stakeholders on an ongoing basis throughout the research. Interview questions centred on understanding experiences of community members in the context of being an Indigenous person living with diabetes in Canada.	Some research members had affiliation to a participating community. Data was directly derived from community members. Cultural themes were expressed without prompting.	Research team members conducted interviews.
[66]	Kahnawake Mohawk First Nation, Quebec, Canada	School-based wellness curriculum	Culturally appropriate school-based program, incorporation of traditional feasts and new community activities and enhancement of existing activities. Community engagement.	Observing and learning from each community of values regarding diabetes prevention. Developed with local school nurses and a nutritionist. Consultation with the community.	Partnership including the community of Kahnawake, community-based researchers, and academic researchers. Also supported by other community organisations involved in diabetes prevention, [hospital, teachers, etc.,].
[51]	Various Native American Indian and Alaska Native communities, USA	Community-based diabetes prevention program	Community advisory board, talking circles, and storytelling incorporated.	Developed with community advisory board and national diabetes experts.	Intervention delivered by trained lifestyle coach
[34] *	Various First Nations, Northern Ontario, Canada	Diabetes prevention program in schools	Storytelling	Adapted from two community-based programs, the Sandy Lake School Diabetes Prevention Program and the Apache Healthy Stores program. Activities added in partnership with health and social services.	First Nation educators delivered curriculum in schools.
[28]	Various Native American Indian and Alaska Native communities, USA	Subsidised community-specific traditional foods wellness program	Workshops, playing traditional games and dancing, participating in talking circles, incorporating traditional foods into school cafeterias.	Collaboration between the CDC, and Native Diabetes Wellness Program to provide resources and financial support for programming. Particulars developed at the discretion of individual communities.	Some communities’ programs were delivered by Elders/with Elders and community members. Funding for the programs was provided directly to the communities.
[52]	Gila River, Native American Indian community, USA	Observation of the progression of diabetes in Gila River with emphasis on community involvement in care	Results yielded recommendations for cultural connection and systemic change to restore wellness amid a diabetes crisis in the community.	N/A	N/A
[35]	Wapekeka Oji-Cree First Nation, Northern Ontario, Canada	Community gardening program	Community members were interviewed about traditional food and traditional food practices.	Community based participatory approach using Indigenous research methodologies. The research team worked in partnership with Wapekeka First Nation leaders and community members to determine the scope and direction of the project. Families that practice traditional or land-based subsistence practices were part of the project design.	Researchers set up and build hoop house and leave before planting takes place. Community members plant/upkeep, researchers return to help with harvest, interviews, prep next planting, etc. Research team conducted interviews about community perspectives of the hoop house.
[23]	Atikamekw Nation, Quebec, Canada	Diabetes based talking circles	Talking circles, storytelling	Indigenous individuals and organisation partners co-designed the study with researchers	Discussion led by researchers
[29]	Rapid Lake, Algonquin Nation, Quebec Canada	Culturally adapted health promotion program. Use of interviews and bingo.	Bingo used as a socially unifying tool to encourage learning about nutrition.	McGill nursing school developed the program alongside community for cultural protocol and advising.	McGill University researchers in partnership with community members delivered bingo night and interviews.

* = Paediatric population.

** = Adult population.

*** = Both paediatric and adult population.

Table 2. Review articles.

Author	Population or Type of Program Reviewed	Purpose of Review	Key Findings
[24]	Various Native American Indian and Alaska Native communities, USA	Knowledge mobilisation surrounding the state of health and quality of healthcare among American Indian and Alaska Native individuals and communities in the USA.	Evidence for the need of culturally specific care for diabetes-inflicted Indigenous people. Emphasis on importance of traditional views of wellbeing.
[6]	Various Indigenous Nations across Australia, New Zealand, Canada and the USA	To describe traditional healing and wellness usage among Indigenous Peoples with diabetes across Australia, New Zealand, Canada and the USA.	Indigenous Peoples seek out traditional healing approaches, such as plant medicines and ceremony, to support wellbeing alongside mainstream diabetes treatments.
[56]	Navajo Nation, Utah, Arizona, New Mexico, USA, community gardening programs	To explore the role that community gardening can play in the reduction of diabetes among the Navajo Nation.	Community gardening programs have promise in both prevention and intervention strategies related to diabetes. A multi-disciplinary approach is recommended including public health officials, nutritionists and horticulturists.
[37]	Kahnawake First Nation, Quebec; Sandy Lake First Nation, Ontario, Canada. Review of the Sandy Lake Health Diabetes Program and the Kahnawake Schools Diabetes Prevention	To review community-based projects in Indigenous communities of Canada with high rates of diabetes.	Community participation in designing and developing wellness interventions is critical to positive uptake and outcomes.

* = Paediatric population.

** = Adult population.

Figure 1. Electronic database searches – COVIDENCE.

Table 3. Traditional content summary.

Traditional Content	References
Prayers and Blessings	11, 55
Programs addressing holistic health [body, mind, spirit, emotion]	2, 5, 11, 40
Talking Circles	6, 11, 52, 55, 60
Storytelling	2, 41, 52, 53, 60
Traditional Foods and Feasts	21, 22, 30, 31, 38, 41, 42, 49, 55
Traditional Activities [dance, hunting, etc.]	21, 22, 24, 31, 41, 42, 55

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