Table 3.

CAIANDTR examples of representation and community priority outcomes to promote equity in addition to classic translational science benefit outcomes

Name of Initiative	Example 1 – Alaska Satellite Center Community Health Learning	Example 2 – Central Plains Satellite Center Food Sovereignty Efforts [26]	Example 3 – Rocky Mountain Satellite Center “What Can I Eat?” (WCIE) Diabetes Nutrition Education for AI/AN Adults with T2D [32–34]	Example 4 – Rocky Mountain Satellite Center SNAP-Ed Nutrition Education in Native Communities	Example 5 – Southeast Satellite Center Cultural Tailoring of Advance Care Planning [44]	Example 6 – Southwest Satellite Center Indigenous Knowledge Translation
General initiative description	Diabetes Wellness Fair and annual symposium to educate individuals about what services are available locally to support diabetes prevention and care.	Center for Indigenous Innovation and Health Equity (CIIHE) initiative is a community-academic partnership with the goal of strengthening Indigenous food systems and practices to promote health and well-being.	Diabetes nutrition education curriculum for AI/AN Adults living with T2D that includes Indigenous strengths and values-based approaches	SNAP-Ed in Native Communities in Colorado focuses on innovative translation of SNAP-Ed guidance to provide decolonized Indigenized nutrition education to Native communities as informed by Native-led organizations.	Cultural tailoring framework with use case example: tailoring Make Your Wishes About You (MY WAY) – an intervention to improve advance care planning access and completion for American Indian peoples.	Indigenous knowledge translation [45] (knowing, doing) to examine inter-relatedness of diabetes and hypertension and diabetes and dementia (“Type 3” diabetes) within community, traditional healer, tribal health provider worldviews/practices and Western science ways of knowing.
Representation – ways that communities inform and generate solutions	A health needs assessment survey was administered to participants and included questions regarding information community members would like to hear about related to diabetes and preferences for mode of communication.	Food Sovereignty is a culturally centered movement rooted in traditional Indigenous knowledge – these efforts directly intervene upon systems-level barriers to health for Indigenous peoples, making it an important strategy for health equity.	WCIE is developed for Native people – by Native people. The idea of WCIE came from Native community members, and WCIE development, implementation, and evaluation is led by and in partnership with Native communities [32,33].	Successful ongoing negotiation with state SNAP-Ed leadership to authentically work within “allowable costs,” re-define nutrition education evaluation, and creatively support nutrition education activities not typically supported by SNAP-Ed guidance.	15-step process of cultural tailoring MY WAY in partnership with a local tribal community advisory board and a professional advisory board – this process considered the 4 core values of individual, familial, and Tribal autonomy, as well as self-determination.	Participatory strategic planning: process is grounded in consensus building, honoring existing and prior efforts, and conducting a critical co-evaluation of “what is possible” to identify a set of priorities and a plan that is realistic and achievable (promise keeping) [46].
Outcomes prioritized by community (includes representativeness when appropriate)	Approximately 40 community members (customer-owners) attended the fair to learn about healthy eating habits, how to use a glucometer, mindfulness techniques, and more wellness factors Attendees enjoyed activities, prizes, healthy snacks, and presentations from departments/ services that encompassed a holistic approach to health	↑ Physical, emotional, and spiritual health Exposure to healthy, traditional and Indigenous foods ↑ Cultural connections, family relationships, and Tribal identity Presence of community members on the land (e.g., hunting, fishing, gathering, foraging) ↑ Transmission of traditional knowledge across generations	High satisfaction with in-person and remote WCIE classes and peer-to-peer learning and support opportunities[34] Preference for Native nutrition educators Improvement in self- efficacy of healthy eating behaviors	Multiple case study evaluation of Native/Indigenous sub- award grantees centered on using qualitative data collection to center Native storytelling values as a traditional way of knowing	Feasibility of delivering MY WAY by the local tribal community Cultural acceptability, readability, and cultural prioritization of MY WAY content	Reach those at high-risk (i.e., limited trust in healthcare) (e.g., men, youth) Integrate traditional healing in healthcare Practice patient and provider co-learning Access local data to define local priorities Implement health policy across life cycle [46]
Representativeness – Translational Science Benefits – Community, Clinical, Economic, and/or Policy	Community (actual): Activities allowed collaboration with departments across the entire ANHC and was open to the public, which includes anyone affected by diabetes (i.e., caregivers, and loved ones of those with a diabetes diagnosis) Clinical (actual): Created opportunity for community members to hear about services offered at ANHC, discuss questions with clinic staff, and learn about prevention resources Economic (expected): ↓ Societal costs of illness due to decreased diabetes incidence/complications	Community (actual): Restoration of traditional foodways, relational responsibilities between people and place, and improved biodiversity Economic (expected): ↓ Societal costs of illness due to decreased diabetes incidence and complications Policy (actual): Advocacy for federal, state, and Tribal policy and practices to support efforts related to Indigenous food sovereignty	Community (actual): new activities and increased representativeness of adoption and reach of diabetes education in Native communities Economic (expected): ↓ Societal costs of illness due to decreased diabetes incidence and complications Policy (actual): Successful negotiation with American Diabetes Association to provide WCIE materials at no charge for Native communities	Community (actual): Equitable reach – delivered to all members of Native communities without specific “inclusion criteria” to decrease stigma and honor Indigenous values of inclusivity and connection between community members Economic (expected): ↓ Societal costs of illness due to decreased diabetes incidence and complications Policy (actual): Successful support from state SNAP-Ed on innovative use of this funding to reach Native communities	Community (actual): New materials, trained champions (Support Stars) and processes to deliver MY WAY with cultural tailoring Clinical (expected): ↑ Access and receipt of quality end of life care Economic (expected): ↓ End-of-life costs of illness	Community/ Clinical (expected): ↑ acceptance of disease management messages by co-delivery from traditional healer and Western science perspectives Economic (expected): Local data use to predict morbidity, disease progression and accordingly ↓ healthcare cost, ↑ prevention effort Policy (actual): Co-created and tribal leader-vetted Tribal Health in all Policies policy; (expected) ↑ awareness of adoption of life cycle policies esp. ↑ support for health self-efficacy and in-home monitoring and technology

Note: AI/AN (American Indian/Alaska Native); SNAP-Ed (Supplemental Nutrition Assistance Program Education); ANHC (Alaska Native Health Campus – Jointly Managed by and Inclusive of Southcentral Foundation and Alaska Native Tribal Health Consortium); T2D (type 2 diabetes); WCIE (What Can I Eat? Diabetes Nutrition Education for AI/AN Adults with Type 2 Diabetes).