Date of Award

August 2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Indigenous Health

First Advisor

Shawnda Schroeder

Abstract

Background: This dissertation examines gluten intolerance, particularly celiac disease (CD), within American Indian communities. Although CD has been traditionally considered more common among people of European descent, emerging evidence suggests increasing rates among American Indian populations as dietary patterns have shifted from traditional, naturally gluten-free foods to diets containing higher levels of gluten. These dietary changes, along with possible genetic factors and historical underdiagnosis, highlight the importance of understanding how gluten-related health concerns are recognized and discussed within American Indian communities. Lower rates of diagnosis may reflect limited awareness of symptoms and challenges in communicating gluten-related health experiences rather than low prevalence. However, little research has explored how American Indian populations understand the symptoms and impacts of gluten intolerance. Methods: Data were collected through culturally appropriate in-person Talking Circles (focus groups). with up to five participants per group. Eligible participants were adults (18 years and older). residing on the Mandan, Hidatsa, and Arikara (MHA). Nation who identified as American Indian. At least five Talking Circles were planned, with additional sessions conducted as needed to achieve data saturation. Recruitment used convenience and snowball sampling through community channels including social media, local radio, the tribal college, clinics, and community events. Results: The findings revealed three interconnected themes: (1). limited biomedical knowledge of gluten alongside experiential understandings of symptoms, (2). health information grounded in trust, relationships, and community-based resources, and (3). food choices shaped by local food availability and structural barriers to access. Participants primarily relied on lived experiences, family knowledge, and trusted community initiatives to understand gluten-related health concerns. Conclusions: This research contributes to the limited literature on gluten-related knowledge and experiences among American Indian populations and has important implications for healthcare and public health practice. The findings emphasize the need for culturally responsive health education, community-based initiatives, and improved food access to support greater awareness of gluten-related disorders and nutritional health within Tribal communities. The results also provide a foundation for future research, public health efforts, and ongoing food sovereignty initiatives aimed at promoting healthy lifestyles among Indigenous peoples.

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