Qungasvik (Toolbox)-Healthy Hearts: A Cultural Approach to Reducing Chronic Disease Risk

ActiGraph accelerometer data will measure the intensity of daily activity that we hypothesize will go up with intervention participation.

Physical activity will be objectively measured using an ActiGraph accelerometer, a validated wearable device that provides reliable estimates of free-living physical activity. Participants will wear the device for the prescribed monitoring period to capture movement continuously throughout daily activities. Accelerometer data will be processed using established protocols to estimate daily minutes of moderate-to-vigorous physical activity. Objective accelerometer data will complement self-reported measures of physical activity by reducing recall bias and providing precise estimates of changes in activity patterns over time.

Traditional Food Intake

Traditional food intake will be assessed using both a self-reported dietary survey and hair nitrogen stable isotope ratio (¹⁵N/¹⁴N; δ¹⁵N) analysis. The dietary survey will capture the frequency and types of traditional foods consumed, providing information on dietary patterns and subsistence food practices. Hair samples will be collected to measure δ¹⁵N, a validated, objective biomarker of long-term traditional marine food intake among Alaska Native populations. Because hair integrates dietary intake over several months, δ¹⁵N provides a reliable estimate of sustained consumption of traditional subsistence foods, particularly marine fish and mammals, and is not subject to recall or social desirability bias. The combined use of self-reported dietary intake and the objective biomarker will strengthen the assessment of intervention-related changes in traditional food consumption by capturing both perceived dietary behaviors and biologically verified intake. These complementary measures

Blood Pressure

Blood pressure will be measured as an objective indicator of cardiovascular health and a key physiological outcome of the intervention. Systolic and diastolic blood pressure will be assessed using standardized protocols via Omron digital blood pressure monitor, including appropriate participant positioning, rest periods prior to measurement, and repeated readings to improve reliability. Primary outcomes will include changes in systolic blood pressure, diastolic blood pressure, and blood pressure categories over time. These measures will be used to evaluate whether participation in the intervention contributes to improvements in cardiovascular health through hypothesized pathways involving increased physical activity, improved dietary practices, reduced stress, and strengthened social and cultural connectedness.

We will assess how intervention participation increases social and cultural connectedness using the Awareness of Connectedness Scale.

The Awareness of Connectedness Scale (ACS), developed by Mohatt and Fok, measures an individual's awareness of their interrelatedness with family, community, and the natural environment. This scale is particularly focused on cultural aspects of wellness and healing among Alaska Native people, providing insights into their social and ecological connections. We will utilize data from the scale to assess the intervention impacts on building connectedness among individual participants.

Food Security

Validated behavioral survey measure: NIH PROMIS

Reasons for Life

Validated behavioral survey measure for mental health

Global Health

Validated behavioral survey measure PhenX Toolkit

We will assess if food security increases using the food security index from the PhenX Toolkit

The PhenX Toolkit includes standardized measures for assessing food security, which is crucial for understanding social determinants of health. We will use items from the standardized food security tools to evaluate how food access impacts health outcomes and if food security increases with individual participation in the intervention.