Engaging with the All My Relations Advisory Board in a healthy food incentive randomized controlled trial: a qualitative process evaluation

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BACKGROUND: The FoodRx randomized controlled trial (RCT) studied the impact of a healthy food incentive program among adults with type 2 diabetes and food insecurity (including an Indigenous subset), and engaged an advisory board (All My Relations [AMR]) to advise on aspects relevant to Indigenous Peoples. We sought to explore the evolution of the board's role and its contribution and influence on the RCT. METHODS: We conducted a qualitative process evaluation within community-based participatory research. We conducted semistructured interviews with AMR board members and FoodRx academic members, and sourced AMR board meeting notes. We analyzed these data iteratively using directed content analysis and continuous engagement with the AMR board. RESULTS: Seven AMR board members, 3 FoodRx academic members, and 4 AMR board members and FoodRx academics participated in interviews. Our analysis showed 4 key interconnected themes: Culture and ceremony (celebrating the importance of Indigenous languages, naming ceremonies, and spiritual practices fostering inclusivity and connection); Transformative environment (emphasizing a sacred gathering space where voices are equal, trust thrives, and personal growth is cultivated); Indigenous Ways of Knowing (embracing the application of Indigenous wise practices, challenging Western research ideals, and advocating for RCT design equity); and Equitable partnership (affirming the centrality of relationship building, acknowledging Indigenous knowledge, redistributing decision-making power, and increasing transparency). INTERPRETATION: Our findings emphasized the importance of authentic involvement of Indigenous community representatives in the conduct of research. Research involving Indigenous participants requires a commitment to respect for Indigenous values and incorporating Indigenous Ways of Knowing, as well as involving Indigenous partners early in the planning of the project.

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