An Application of the Food Choice Process Model—Understanding Factors Influencing Food Choices on American Indian Lands
Authors: Oddo Vanessa M , Kodish Stephen R , Antiporta Daniel , Chodur Gwen , Jones‐Smith Jessica C 
Published: November 2023

Objective

American Indians are disproportionately burdened by diet‐related diseases, such as obesity and diabetes. Drawing on accounts by tribal community members, we sought to better understand food‐choices among American Indians and provide new insights into their perceptions around food, in order to inform future intervention strategies.

Methods

We used an inductive, qualitative research design to conduct semi‐structured, in‐depth interviews with a purposive sample of tribal leaders (n =12) and tribal members (n =24) from federally‐recognized tribes in California. Data were analyzed in an iterative process, drawing from tenets of Grounded Theory. We first conducted initial line‐by‐line coding in order to identify emergent themes. Then, we applied focused codes to analytic categories that were most relevant to the research questions. Constant comparisons between themes were made throughout the analytic process until a rich description of the food environment and an emergent theory grounded in data was constructed.

Results

Tribal communities described their food choices with respect to life events/experiences, influences, and personal food systems. As a life event/experience, tribal members perceived modifications to the food environment, including an increase in restaurants, fast food establishments, convenience stores, and grocery stores and a community shift from traditional foods. These modifications to the environment were seen both as barriers and facilitators to making food choices. Tribal members described their socioeconomic status as a primary influencer of their food choices. Many participants indicated receiving Supplemental Nutrition Assistance Program benefits and explained that food price is the driving factor for their food procurement behaviors. Within these present contexts, some tribal members described stores or restaurants located on tribal lands as more convenient, as they were previously located far way, where as other members negatively perceived the addition of fast food and convenience stores to the community. Food choice values within the personal food system are influenced by local concepts of ‘healthy’ and ‘unhealthy’ foods, as well as decision‐making based on perceptions of their children's health or preference related to changes to the built environment.

Conclusions

Food‐choice decisions depend on a complex interplay of multi‐level determinants. On American Indian lands, choices can be partially understood through the lens of the Food Choice Process Model. This study did not elucidate all factors offered at each level of this model, revealing other potential points of inquiry for understanding food choices among American Indians. Understanding tribal community members’ perceptions, prior to public health efforts to improve nutrition and health, may allow for more thorough planning and better programming in these environments.

Support or Funding Information

Supported by the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development (4R00HD073327).