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Document Type

Thesis - University Access Only

Award Date


Degree Name

Master of Science (MS)

Department / School

Graduate Nursing

First Advisor

William McBreen


Indian Children nutrition, physical fitness for children, non-insulin-dependent diabetes prevention, health and hygiene of Indian Children


Non-insulin dependent diabetes mellitus (NIDDM) is a chronic disease that has reached epidemic proportions among American Indians. The complications of diabetes to the health and welfare of American Indians is devastating. The age-adjusted diabetes mellitus death rate for all American Indians is 2.5 times the U.S. death rate for diabetes. In addition, diabetes mellitus is the fourth leading cause of death among all American Indians. The American Indian community under study is one tribe experiencing this disease in epidemic proportions. Therefore, developing intervention strategies for the prevention of NIDDM is essential to American Indian communities.
The problem under study is: a) what food and activity patterns of children do teachers identify in an American Indian community? b) what interventions do teachers use or recommend to change these patterns to prevent diabetes? and, c) what barriers do teachers perceive to these interventions? The purpose of this study is to ascertain perspective of teachers related to food patterns, activity patterns and obesity among students enrolled in a reservation school. Teacher perspectives and insights are essential in order to design culturally sensitive interventions for the prevention of NIDDM. Leininger's theory of Culture Care and ethnonursing methodologies were used in this study to gain understanding and meaning of the perspective of teachers.
Krueger's focus group technique was utilized in this study to: a) facilitate discussions of the perceptions and beliefs of teachers of children on an American Indian reservation as participants, and b) begin to design culturally sensitive intervention strategies for weight reduction and increase physical activity among American Indian children at high risk for the development of NIDDM. Teachers from all three reservation schools were invited to participate in the focus group sessions. Two focus group sessions were conducted with a total of twenty three participants. Twenty two female teachers and one male teacher participated in the focus group discussions.
A transcript based, qualitative analysis approach was used to interpret the data. Teacher perceptions of food patterns, activity patterns, ideas on how to prevent diabetes, current strategies for decreasing obesity and increasing fitness and reported barriers to implementing diabetes interventions were identified in this study. Summary of findings: Teachers acknowledged the role that the school has in promoting a healthy life style of children. Food patterns of children were identified by teachers. Food is an important part of the socialization of children, school and the community. Teachers also identified food preferences between younger and older children. Food is utilized by teachers as an incentive for children to participate in activities or as a reward for good behavior. Healthy alternatives to candy, sweets, and chips are being provided as well as non-food items. Teachers reported only a few children choose to take the healthy alternatives (juice and fruit). Other rewards such as non-food items (computer time, "book it" and hat permits) were identified by teachers as alternatives to candy. Other non-food item rewards such as stickers and toys are out of pocket expenses for teachers. Teachers need to identify what incentives for participation children value and offer those as an alternative to candy. Teachers identified the need for more physical activity. Children need activities they can achieve in. Overweight children were seen by teachers as wanting more sweets. Teachers viewed overweight children as inactive and identified their weight as a barrier to participate in physical activities. Teachers need to identify what motivates overweight children to participate if they cannot compete with their peers and offer alternative activities which incorporate cultural values.. Teachers also need to identify what value children and parents place on physical activity and offer alternatives which incorporate cultural values. Teachers identified the need for an alternative outdoor winter area, more playground equipment and more assistance to supervise children, to engage in physical activities. This information can now be utilized to implement culturally sensitive family, school and community-based interventions to reduce the rate of diabetes among all American Indian children.

Library of Congress Subject Headings

Indian children -- Nutrition
Physical fitness for children
Type 2 diabetes -- Prevention
Indian children -- Health and hygiene



Number of Pages



South Dakota State University


Copyright © 1996 Paul Klein. All rights reserved