We used a mixed methods approach (i.e., used spatial and qualitative data) to examine the food environment in rural and urban American Indian settings in North Carolina. ZIP Codes (n=78) and counties (n=21) co-locating with the US Census 2010 State Designated Tribal Statistical Areas (SDTSAs) for the seven participating tribes were determined and used to gather information on retail food outlets from five secondary data sources. All primary, secondary, and local roads within the SDTSA were also ground-truthed, using Global Positioning Systems to determine the location and type of all observed food outlets. Evidence for validity of the secondary data sources are reported in our paper entitled: “Evidence for validity of five secondary data sources for enumerating retail food outlets in seven American Indian communities in North Carolina”.
Modified Talking Circles (n=7; in total, 33 participants) and key informant interviews (n=40) provided further insights on food sources, such as the home, land, and gardens, not identified through spatial data. Convenience stores with grills, Super Walmart, dollar stores, and fast food restaurants are common outlets for community members, often challenging them to purchase and prepare healthy, affordable foods on a regular basis. A combination of spatial and qualitative data provided an innovative evidence-based approach to identify policy strategies at the tribal level to improve access to healthy, affordable foods.