Table 1.

Research Literature.

	Title	Objective/aim	Design	Main findings	Conclusion
1.	Roubideaux et al15	To describe characteristics of culturally appropriate diabetes education materials as informed by stakeholders	• Qualitative	• Five focus group participants (n = 95) recommended updating of current educational materials to make their messaging simpler and clearer, specifically for diet and exercise. • Requested more diabetic materials for cooking classes with traditional foods be made available to communities and schools, videos that are readily understood, workshops, all educational resources available to families • Recommended culturally specific diagrams and individual teaching sessions	• Participants appreciate when they are consulted. • Educational materials need to be tailored to cultural nuances of each tribe/aboriginal community. • Hospitals and clinics, family members, community events, media, and schools are the commonest sources of information on diabetes
2.	Rushing and Stephens16	To evaluate availability and effectiveness and describe characteristics of sexual health technology-based interventions, and required resources. Participants reviewed native youth survey and a systematic review related to technology and strengths-based interventions	Community-based participatory: • several hundred community participants and other tribal members, health advocates, teachers, and students	Delivered with computer or CD-ROM (n = 22), and internet access (n = 12); cell phone using text messages (n = 4), video-based (n = 2), and computer-based video game (n = 3). Embedded risk, needs, or readiness assessments directly into the program (n = 18), required users to participate in multiple sessions (n = 14), involved interactions with peers or peer role models (n = 15), and virtual/in-person communication with health experts (n = 15). Most required (n = 21) interactive user participation. • Most of the literature review interventions were deemed not to be effective	A technology tool must demonstrate: • Sexual risks and protective factors • Frequency and repeated use • Tradition and contemporary AN/AI cultural, values, and teaching • Utility and readability. Consider: “(1) accurate age- and gender-appropriate; (2) early introduction and focus on abstinence; (3) holistic and real; (4) cultural relevance; (5) a focus on assets and skills; (6) dialogue while maintaining privacy; (7) interactivity; and (8) evaluation plans.”
3.	Kattelmann et al17	To determine effectiveness of Northern Plains Indians, type 2 diabetes mellitus educational intervention. Specifically, were there significant physiological changes following receipt of culturally adapted education	• RCT 6-month period with Northern Plains Cheyenne River Sioux Tribe	• The education group (n = 57) randomized to receive culturally adapted educational lessons based on the Medicine Wheel Model for Nutrition had a significant weight loss and decrease in BMI. The usual care group (n = 57) who received the usual education from health providers had no change in weight. There were no between group differences due to intervention in calorie, carbohydrate, protein, fat intake, and physical activity	• The culturally based nutrition intervention can promote small but positive changes in weight. • To achieve a desired change, time and persistence is needed for educational support to influence blood glucose and lipid parameters
4	Simonds et al18	To evaluate Indian Health Services and National Institute of Diabetes, Digestive and Kidney Diseases websites, booklets, and fact sheet educational materials for: readability, vocabulary, complexity, and structure	• Evaluation	• 29% of materials used for diabetes education above grade 6; 71% above grade 8 readability Levels. • Reading difficulty due to language and material structure of uncommon categorical terms, unexplained medical terms, and numeric terms. • Medical terms were used 28 times with only 5 terms defined. Numbers were present in all but 2 documents and used to convey amounts of food or measurement for recipes. 20 included graphs and displays, 5 required arithmetic operations, and 13 contained percentages. Two materials referenced risk	• Materials should be assessed and chosen to align with reading level of the intended population • Educational materials should be reviewed with patients to ensure concepts are clarified and understood • Use of cultural sensitivity assessment tool suggested
5	Browne et al19	To create, distribute, and evaluate an Aboriginal diabetes educational resource* for the prevention and management of type 2 diabetes and to enhance by Aboriginal Health Workers and Aboriginal community	• Mixed methods	• 276 participants trained to use Feltman resources for diabetes training. Online evaluation survey for the trainees (66 participants completed) focusing on satisfaction with the training, level, and types of resources used in the community, cultural appropriateness, and so on • Participants agreed that Feltman was an ideal tool culturally appropriate for the aboriginal people. It was also deemed highly visual, simple to use, and enabled diabetes to be discussed in a nonthreatening manner	• The success of the diabetes education too development was due to consultation with the Aboriginal health workers • Making a visual interactive resource to support healthy literacy and different learning styles, training staff to use the tool was critical to the uptake of the resource • Regular training of staff is needed due to high staff turnover
6	Carter et al20	To determine culturally appropriate content and delivery methods for a Native American diabetes education program called Strong in Body and Spirit	• Participatory Action: Mixed Method Pilot • Focus groups with community advisory group; health care and tribal health workers; patient interviews about quality of life, diet and exercise knowledge, attitudes, behaviors, and family support	• Baseline information obtained from patients on important diabetes information. The collaboration between Indian Health services, professionals, community members, and universities research staff ensured appropriate content and wording prior to community member feedback • Document well received during pilot	• Need input from community, patients, tribal leaders, and the health professionals for insights into cultural presentation • Integration of Western and Indigenous paradigms such as social action theory, the transtheoretical model of change, and empowerment paradigm can help realize outcomes such as healthful diet behaviors, and family and community support • Traditional values and methods of knowledge dissemination are necessary such as stories, prayers, and skills-based learning for increased receptivity
7	Clark et al21	To create a culturally appropriate computer-based educational resource for heart failure knowledge for Aboriginal and Torres Strait Islanders and to conduct a feasibility study regarding effectiveness of tools developed	Mixed methods two-phase study 1st phase developed pilot tool with health professionals and community stakeholders • 2nd phase pilot-tested with 5 patients	• Stakeholder feedback ensured that the resource reflected identity and culture, comprehensiveness for local population. Interface should be user friendly, with voice over presented by Aboriginal and Torres Strait Islanders. • Materials were evaluated by patients who deemed them to be acceptable, comprehensive, and impactful. They also reportedly increased heart failure knowledge with high satisfaction	• Active engagement of Aboriginal and Torres Strait Islander researchers and stakeholders was vital to the success of the project • The touch screen technology was an appropriate alternative of presenting health information. • Cultural recognition is key in developing an educational tool
8	Kaufman et al22	To evaluate circle of life curricula, designed for HIV prevention among AI/AN youth	• Evaluative mixed methods tested in 18 urban and rural schools in classrooms of 12 to 32 students	• Increased vulnerability of AI/ANs to HIV/AIDS and other STIs. • Although curricula well received, implementation of content related to sexual abstinence, substance use, and abuse, homosexuality, and condom use was challenging, given school budget and policy restrictions	• Flexibility and contextualized local enhancements needed to increase engagement and interest among youth. • Effective education tools must integrate expert and community input, be based on sound theoretical underpinnings, and consider appropriate technological advances for the target population
9	Paterson et al7	To explore the “causes of nonadherence” to CKD management amongst community members and to develop a “prototype” for a culturally relevant toolkit to support treatment adherence	• Community-based Participatory Action: Community Advisory Committee (n = 22) and 12 interview participants: Elder (n = 1), patients (n = 5), family caregivers (n = 3) and health care providers (n = 3)	A literature review and individual interviews with community stakeholders, families, and clients were conducted. The principles that guided the research project include: (1) affirming the uniqueness of each Indigenous person, (2) integrating the Indigenous voice and agency in the toolkit, (3) including content that reflects family and community relationships, (4) attending to emotional, spiritual, and physical wellness and, (5) incorporating experiences and stories of those receiving dialysis and their caregivers	• Attend to community advice in the research process, for example, community preferred hand-delivered invitations versus posters to advertise celebration event for toolkit. • Provide interviews by trusted community members and in language of choice. • Adapt tool kit for use by various indigenous groups • Include many different Aboriginal foods in discussion of diet • Use relevant Aboriginal stories, photographs, and pictures in the toolkit

Note. BMI = body mass index; AI/AN = American Indians and Alaska Native; CKD = chronic kidney disease; RCT = randomized control trials.

*Life size resource with movable felt organs. Includes interactive DVD