A Qualitative Assessment of Healthy Food Access in Navajo Nation

Background: The Navajo population experiences high rates of food insecurity, contributing to high rates of chronic disease. We conducted in-depth interviews with Navajo tribal members in order to understand food insecurity in this community and inform the design of an intervention to improve access to healthy foods. Methods: Thirty individuals were interviewed over a three-month period, including Chapter House officials, Community Health Representatives and heads of households living in the Crownpoint Service Unit in Navajo Nation. Data was coded, grouped into analytical categories and integrated into a thematic framework. Results: Food insecurity in Navajo Nation demonstrates variability at the structural, community, and individual and household levels. Income, transportation, vendors, Chapter Houses, social support and health literacy were the main factors contributing to participants’ access to healthy foods. Responses to food insecurity were explored through coping strategies as well as through food purchasing strategies such as price, proximity, shelf life, family preferences, and ease of preparation. Lastly, participants discussed their endorsement for a proposed intervention to increase access to healthy foods. Conclusion: Food insecurity in Navajo Nation is a complex issue, influenced by the dynamic relationship between determinants of individual behavior and the broader environmental context in which they are embedded. A community-based multi-level intervention is necessary in order to achieve sustainable improvement in access to healthy foods