Culturally-Informed Food Insecurity Screening: Evidence From Northern Navajo Medical Center

OBJECTIVE: To develop and evaluate an alternative strengths-based and culturally-informed screener for food security among American Indian respondents. DESIGN: Two-phase mixed methods sequential exploratory study with a qualitative phase followed by a quantitative phase. SETTING: Northern Navajo Medical Center. PARTICIPANTS: Twenty-five qualitative participants and 97 quantitative participants. PHENOMENON OF INTEREST: Participants' impressions of the existing food insecurity screener compared with an alternative set of questions focused on the type and amount of food consumed. ANALYSIS: Cognitive interviews were thematically analyzed and integrated with mixed methods in developing the quantitative survey, and survey responses on the 2 food insecurity screening questionnaires were analyzed for equivalent-form reliability with a Pearson correlation coefficient. RESULTS: The prevalence of food insecurity was high. Interviewees had concerns about the existing screener. Respondents provided suggestions for alternative food security questions. When feedback was integrated into the alternative screener for the quantitative phase, the correlation between screeners was weak to moderate (0.3). CONCLUSIONS AND IMPLICATIONS: Findings suggest the screeners may be collecting data related to unique concepts. Rampant food insecurity supports the need for future food access initiatives in the Navajo Nation to provide a foundation for a food-secure future.