Exploring the Food Environment on the Spirit Lake Reservation

Nov 9th, 2014 | By | Category: 26-2: Workforce Development, Features, Health & Wellness
By Swaha Pattanaik, M.P.H.; Abby Gold, Ph.D., M.P.H., R.D.; Lacey McKay, B.A.S.; Lane Azure, Ph.D.; and Mary Larson, Ph.D., M.P.H., L.R.D.


The purpose of this research project was to understand the food environment of the Fort Totten community on the Spirit Lake reservation in east-central North Dakota, as perceived by tribal members and employees at Cankdeska Cikana Community College (CCCC). According to a 2010 report from the Center for Disease Control and Prevention, the food environment includes the physical presence of food that affects a person’s diet, and a connected system of food services within the community that enables procurement of food. This collaborative research project between CCCC and the North Dakota State University Extension Service utilized community-based, participatory research methodology. Participatory research strategies recognize that an outsider can work best in partnership with community representatives who are themselves experts in the research topic. Thus, the methodology enables researchers and community members to positively impact the community through collective identification of healthcare needs (Hergenrather et al., 2009). To gain a greater understanding of the food environment on the Spirit Lake reservation and maximize community participation, this research project employed a technique known as Photovoice, a


Photovoice empowers participants by using photography to capture environmental factors that may place them at risk for various health conditions.

method which enables people to share the rich contexts of their everyday lives by narrating the stories relating to photographs that they take. The strategy documents the research topic, hence shifting participants from a passive role to that of empowered activists (Thomas & Irwin, 2013). Photovoice is a group process that engages people in telling stories through photography, and builds on the Native tradition of storytelling (Markus, 2012).

Photovoice allows those with limited power—due to poverty, language barriers, race/ethnicity, gender, or culture—to use photographs to capture environmental factors that may place them at risk for various health conditions (Findholt et al., 2011; Teti et al., 2013). Wang (1999) and colleagues used Photovoice for the first time to assess issues faced by women in rural China. Since then the technique has been used with culturally diverse groups for a range of health issues, including quality of life among African American breast cancer survivors, Black and Latino youth awareness of the AIDS epidemic in the San Francisco Bay Area, and with American Indian youth to spread awareness of sexually transmitted infections (Hergenrather et al., 2009; Markus, 2012).


Twenty-five participants, who were staff, faculty, and students at CCCC, were recruited for this research project through network sampling or word of mouth. Both male and female participants over 18 years of age were included in the study. The Institutional Review Board at North Dakota State University gave prior approval. Researchers introduced the participants to the concept of Photovoice and brainstormed about the role of food in their daily lives. Participants reflected on where their food comes from, their access to healthy foods, and their food preparation. All participants received digital cameras as an incentive to take part in the study. However, they could withdraw from the project at any time without any consequences. Participants signed consent forms to authorize researchers to use their photographs in an appropriate way. Steps were taken to ensure the anonymity of the photographers throughout the process. Names were not used in any written materials developed for the project.


Some unhealthy dietary habits have been held since childhood, making them especially difficult to overcome.

After one month, 20 participants returned to the tribal college with their photographs. Photographs were displayed during the discussion, as each participant narrated the story behind the photograph. The facilitator also asked participants to reflect on their peers’ photographs. An exhibit of the photographs was displayed during an art show at CCCC. Following the exhibition, viewers discussed their assessment of the display. Each viewer who participated in the discussion was provided with a $25 gift card. Researchers audiotaped, transcribed, and analyzed discussions, along with the corresponding photographs. Analysis involved coding the qualitative data, including approximately 100 photographs and six group-session transcripts.


Research participants were creative and thoughtful in presenting photographs that provided a compelling portrayal of food in their lives. In analyzing their findings, researchers identified six themes: the perceived high cost of healthy foods, the belief that preparing healthy foods was time-consuming, lack of food variety in the community, difficulty in breaking longheld dietary habits, awareness of healthy food options, and the role that CCCC can play in facilitating healthy food choices.


Through their photographs, participants expressed their desire to improve the quality of the food that they and their families consumed, and advocate for healthier food choices.

The first theme centered on the perceived high cost of eating healthy foods, which served as a barrier to making healthy food choices. One mother stated, “Financially, like when we were looking at fruit, I would love to get fruit. . . . It’s just [that] the healthy stuff is so expensive. But the rotten stuff that’s not good for you–that’s cheap and that’s what I can afford, you know? . . . And my nine-year-old, we’re trying to get her to eat healthy, but yet I can’t provide that healthy [food].” Other participants in the discussion related to her story and said that all of them had been through a similar situation. They added that healthy foods were expensive because the local grocery store had a monopoly. One participant suggested a way to afford perishable fruits and to avoid waste was to purchase smaller amounts of an assortment of fruits.

The second theme highlighted participants’ preference for foods that are less time-consuming to prepare. One of the women said, “Because I have six children I feel like fast food is easier for me sometimes, because I’m so tired at the end of the day, I just want something quick and [to] take care of the baby. Having to cook for eight people just gets to be too much sometimes so for me a lot lately is the easy stuff that you can warm up, the kids can warm up.” Other participants, however, considered certain fruits convenient snacks, since they come packaged in their own skin.

Participants reported a lack of food variety in the community, which served as a third theme in the study. One participant stated, “I grew up in Seattle, and there supermarkets will have these new foods I never saw, they were from other parts of the world and I tried them…that opportunity was there, you know, to try different things.” The participant suggested that CCCC could include a greater variety of foods during fundraisers and at the cafeteria.

The fourth theme illustrated how participants connected their present-day food habits with the food they grew up eating. As one of the participants put it, “We have a lot in memories. When you’ve company, when you’ve family, and any kind of event, it always has some kind of food to be served, so we all have connections to that.” A woman who displayed a photograph of tea in a clear tall glass mentioned how it brought back fond memories of her grandmother, who would always ask her for a cup of tea when she visited. For many viewers of the exhibition, the photograph of a bowl of soup reminded them of a traditional Native meal. As one of the participants elaborated, “I like the soup picture too, just because when I was growing up, that’s all my mom made was soups…that’s Native people, you know, soup people…corn soup, taniga…we’re soup eaters.” Another person reckoned that it was a tradition on the New Year for his grandmother to prepare “bullets” (meatball soup) and “bangs” (fry bread) to share with everyone in her family and neighborhood. Participants remembered that food brought Native families together, and how this tradition is becoming increasingly rare.

The fifth theme underscored the awareness community members had about unhealthy and healthy foods. As one participant pointed out, “I would guess that at least for everybody in this room, the five of us here, I think we all know what foods are good and what foods are bad, it’s just you know, having the will power.” Another participant noted, “We are what we are and we’re probably going to eat whatever, but I think we can be trained—we need to change what we’re doing and small things can make a difference.” While referring to her photograph of frozen fruits in a blender, one participant maintained that people have to change the way they think because healthy eating has to become a way of life.

The last theme was the participants’ recommendation that CCCC facilitate healthier food choices in the community. They also agreed that the photographs from the research study should be displayed at sites outside the college, such as wellness centers and commodity distribution sites. The facilitator reminded the participants that they owned the photographs and that they should use them for positive advocacy. The participants also suggested that recipes could accompany the photographs, to encourage viewers to try the photographed, home-cooked food preparations. Participants suggested that the college use its radio station to spread awareness on health and nutrition. They displayed an increasing interest in community gardens and in gaining greater support from the college for growing their own foods.

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