'we're changing our ways": Women as primary caregivers and adaptations of food and physical activity related health behaviors in semi-rural and rural American Indian/Alaska Native households

This paper conceptualizes women as primary caregivers as driving forces of the adaptation of food and physical activity related health behaviors in households facing socioeconomic and environmental challenges in semi-rural and rural communities in the US. We conducted a formative study in four American Indian/Alaska Native communities in the Southwest and the Upper Midwest U.S between April 2010 and July 2011. Two hundred and fifty six (256) participants, majority (90%) women and girls, shared narratives about facilitators and barriers of their adaptive health behaviors through semi-structured in-depth interviews, focus groups, household group interviews, and community workshops. Interviews were recorded using handwritten notes and audio recordings, transcribed, and open-coded using thematic content analysis. Our data reveals three key themes. As primary caregivers, women are aware of the paradox of modernity: living in increasingly obesogenic environments promoting the consumption of ‘convenience foods' and sedentary lifestyles, while facing greater needs to prevent their children from premature obesity and diabetes. Women are setting an intention and making a conscientious effort for healthier food choices for their households on a tight budget and encouraging physical activities on limited time and complex working schedules and familial caregiving responsibilities. Young girls are socialized as informal caregivers and, in turn, have positive influence on household adults for health behavior change. Our results underscore the need and offer recommendations for family-centered obesity interventions across similarly disadvantaged, ethnic populations in the US and developing countries where households face a rising need for health behavior adaptations for their members' long-term well-being.