Water is K’é: A multi-level intervention to promote healthy beverage choices among Navajo families: Trial rationale and study protocol

BackgroundFamily-level interventions can promote early child health. Partnering with community stakeholders, we co-developed Water is K'é, a culturally grounded family intervention delivered in early childhood education settings to promote healthy beverage choices and wellbeing among Navajo. (Diné) children ages two to seven. This manuscript describes the rationale, design, and methods of the study.AimTo evaluate the impact of Water is K'é on beverage behaviors among children and families, and on family cohesion and cultural connectedness.MethodsDiné and non-Diné researchers and community advisors developed the intervention and study design using community engagement methods. In this cluster-randomized crossover trial, early childhood education sites on Navajo Nation will be enrolled and randomly assigned to begin the intervention in year one or serve as a waitlist control until year two. Child-caregiver dyads will be enrolled at the start of the school year, with optional participation from other family members. The intervention strengthens the cultural connection to water, encourages behavior change, and addresses water access through 4 monthly lesson plans, social media content, and tailored strategies to increase children's access to drinking water throughout the day. Primary endpoints include beverage habits and family cohesion. Collected data includes surveys, optional health measures, and qualitative interviews.SummaryWater is K'é is a multilevel, community-designed intervention emphasizing Navajo language and culture. Innovative features include participant choice of health measures and family member enrollment. If successful, the program could be scaled across Navajo Nation and adapted for other early childhood programs.