Crystalizing the role of traditional healing in an urban Native American health center

The Health Effects of a Cherokee Grounded Culture and Leadership Program

Introduction: Indigenous youth and young adults endure some of the highest rates of physical and mental health problems in the United States compared to their non-Indigenous counterparts. Colonization, oppression, and discrimination play a substantial role in these inequitable disease rates. However, culture (e.g., identity, participation, and connection) relates to the prevention of and recovery from illness in Indigenous populations. The Remember the Removal program aims to teach Indigenous youth and young adults tribally specific culture, history, and language to put them on a trajectory to become informed and culturally connected community leaders. We examined the program’s effects on health. Method: Thirty Remember the Removal program participants, mainly young adults, completed surveys four times: before the program’s start, at the end of the training period, at the program’s end, and at a six-month follow-up. Various indicators of physical, mental, spiritual, and cultural health and well-being were measured at each time period. Paired t-tests were completed to compare baseline scores to each subsequent time interval. Results: At program completion, and as indicated with an asterisk at the six month follow-up, participants had statistically significantly improved diet and exercise measures (e.g., reduced sugary, salty, and fatty foods, reduced soda consumption, increased fruit consumption, and improved self-efficacy for exercise), improved mental health indicators (e.g., reduced stress, anxiety, depression*, anger*, post-traumatic stress disorder, and microaggressions*, and improved positive mental health) and improved social and cultural connection (e.g., social support, Cherokee identity*, Cherokee values). Discussion: This is one of the first quantitative studies to demonstrate the profound effects that cultural learning and connection have on the health and well-being of Indigenous people and practices. It also demonstrates the specificity and effectiveness of a program created by and for tribal citizens. Future programs with Indigenous populations should work to center cultural connection and ensure that programs are created and directed by tribal community members.

An interview-based evaluation of an Indigenous traditional spirituality program at an urban American Indian health clinic

American Indians suffer from disproportionately high rates of mental health problems. Professional therapies may not meet the specific mental health needs of American Indians, owing to cultural mismatch and long histories of political disempowerment. Instead, Indigenous traditional spiritual practices are often promoted as alternative sources of health and help in these communities. In response to a community needs assessment, we developed a 12-week traditional spirituality curriculum in partnership with the urban American Indian health clinic in Detroit. Centered on the sweat lodge ceremony, the program was pilot tested with 10 community members. Semi-structured interviews were conducted with nine participants following the program. Based on our analyses, all participants endorsed responses within two overarching themes: impact on personal well-being, and suggestions for improvement reflecting their desire for an ongoing program. Participant responses about the program's impact comprised four themes: (1) improved psychological and spiritual well-being, (2) community benefit, (3) increase in cultural knowledge, and (4) a desire for further learning and sharing. Participant responses about their desire for an ongoing program also comprised four themes: (1) drop-in classes may be more practical as regular attendance was difficult for some, (2) future classes should include more areas of knowledge, (3) the program could be expanded to include more knowledge-holders and perspectives, and (4) the program should include a progression of classes to accommodate more diversity. Overall, participants reported benefit from participation in Indigenous spiritual practices; however, the program can be improved by further adapting the curriculum to the sometimes-challenging lives of its participants.

American Indian Behavioral Health Treatment Preferences as Perceived by Urban Indian Health Program Providers

Behavioral health services specifically targeted for ethnoracial clients are typically tailored to the specific needs and preferences of these populations; however, little research has been done with American Indian clients specifically. To better understand how clinicians handle provision of treatment to this population, we interviewed 28 behavioral health staff at six Urban Indian Health Programs in the United States and conducted focus groups with 23 staff at five such programs. Thematic analysis of transcripts from these interviews and focus groups suggests that these staff attempt to blend and tailor empirically supported treatments with American Indian cultural values and practices where possible. Simultaneously, staff try to honor the client's specific preferences and needs and to encourage clients to seek cultural practices and connection outside of the therapy room. In so doing staff members were acutely aware of the limitations of the evidence base and the lack of research with American Indian clients.

Spiritual connectedness through prayer as a mediator of the relationship between Indigenous language use and positive mental health

OBJECTIVE

The objective of this study is to understand how Indigenous language and spirituality revitalization efforts may affect mental health within Indigenous communities. Although Indigenous communities experience disproportionate rates of mental health problems, research supporting language and spirituality's role in improving mental health is under-researched and poorly understood.

METHOD

Data for this study are from a Community-based Participatory Research Project involving five Anishinaabe tribes in Minnesota and Wisconsin. Participants were sampled from clinic records of adults with a diagnosis of type 2 diabetes, living on or near the reservation, and self-identifying as American Indian (mean age = 46.3; n = 191).

RESULT

Structural equation modeling illustrates that language use in the home is associated with positive mental health through spiritual connectedness.

CONCLUSION

Results support tribal community expressions of the positive effects of cultural involvement for Indigenous wellbeing, and improve what is known about the interconnectedness of language and spirituality. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) and the United States: A Systematic Review

Despite the health improvements afforded to non-Indigenous peoples in Canada, Aotearoa (New Zealand) and the United States, the Indigenous peoples in these countries continue to endure disproportionately high rates of mortality and morbidity. Indigenous peoples' concepts and understanding of health and wellbeing are holistic; however, due to their diverse social, political, cultural, environmental and economic contexts within and across countries, wellbeing is not experienced uniformly across all Indigenous populations. We aim to identify aspects of wellbeing important to the Indigenous people in Canada, Aotearoa and the United States. We searched CINAHL, Embase, PsycINFO and PubMed databases for papers that included key Indigenous and wellbeing search terms from database inception to April 2020. Papers that included a focus on Indigenous adults residing in Canada, Aotearoa and the United States, and that included empirical qualitative data that described at least one aspect of wellbeing were eligible. Data were analysed using the stages of thematic development recommended by Thomas and Harden for thematic synthesis of qualitative research. Our search resulted in 2669 papers being screened for eligibility. Following full-text screening, 100 papers were deemed eligible for inclusion (Aotearoa (New Zealand) n = 16, Canada n = 43, United States n = 41). Themes varied across countries; however, identity, connection, balance and self-determination were common aspects of wellbeing. Having this broader understanding of wellbeing across these cultures can inform decisions made about public health actions and resources.

Cultural Sources of Strength and Resilience: A Case Study of Holistic Wellness Boxes for COVID-19 Response in Indigenous Communities

The COVID-19 pandemic has had disproportionately severe impacts on Indigenous peoples in the United States compared to non-Indigenous populations. In addition to the threat of viral infection, COVID-19 poses increased risk for psychosocial stress that may widen already existing physical, mental, and behavioral health inequities experienced by Indigenous communities. In recognition of the impact of COVID-19 related psychosocial stressors on our tribal community partners, the Johns Hopkins Center for American Indian Health Great Lakes Hub began sending holistic wellness boxes to our community partners in 11 tribal communities in the Midwestern United States and Canada in summer of 2020. Designed specifically to draw on culturally relevant sources of strength and resilience, these boxes contained a variety of items to support mental, emotional, cultural, and physical wellbeing. Feedback from recipients suggest that these wellness boxes provided a unique form of COVID-19 relief. Additional Johns Hopkins Center for American Indian Health offices have begun to adapt wellness boxes for the cultural context of their regions. This case study describes the conceptualization, creation, and contents of these wellness boxes and orients this intervention within a reflection on foundations of community-based participatory research, holistic relief, and drawing on cultural strengths in responding to COVID-19.

The Urban American Indian Traditional Spirituality Program: Promoting Indigenous Spiritual Practices for Health Equity

Beginning in 2009, Detroit's urban American Indian health center entered into a collaborative and participatory partnership with a university research team. The purpose of the partnership was to incorporate Indigenous traditional healing practices into the health and wellness services at this center. Following extensive consultation with stakeholders at the center, we were commissioned by local decision-makers to develop a program tailored for members of the urban American Indian community that would introduce and orient these individuals to meaningful participation in Indigenous traditional spirituality. The Urban American Indian Traditional Spirituality Program is a structured curriculum for American Indian community members that introduces and orients participants to meaningful engagement with sacred practices associated with the sweat lodge ceremony. The signature innovation of this program was the recasting of traditional socialization practices into a structured, didactic curriculum that could initiate an enduring spiritual devotional life for American Indian participants toward improved health and well-being. Created primarily "by Indians, for Indians," the collaboratively designed curriculum draws on cultural strengths and spiritual empowerment to advance health equity for these marginalized populations.

"Together We Can Return to Balance"-Eastern Woodlands Native Perspectives and Type 2 Diabetes: A Qualitative Study

PURPOSE

To explore the perspectives of Eastern Woodlands Native people with type 2 diabetes (T2DM) in the context of health beliefs, T2DM disease self-management, and family and community connections.

METHODS

A qualitative descriptive method using face-to-face or telephonic semistructured interviews was employed with Native people ages 18 years or older who have a diagnosis of T2DM (N = 12) from an unidentified Eastern Woodlands tribe. The PEN-3 Cultural Model guided the study initially.

RESULTS

The overarching theme "together we can return to balance" corresponded to 5 subthemes: coming to know life paths with T2DM, acknowledging the imbalance, negotiating my way forward, making important connections, and sticking closer to Mother Earth. Dimensions within the subthemes suggest why Native people may not be reaching T2DM treatment goals. Reasons include incomplete diabetes knowledge, difficulty accessing resources, and contextual variations in adoption of conventional diabetes treatments.

CONCLUSION

This study identified themes from Native perspectives about T2DM self-management and about prospects that may mitigate incomplete knowledge and support. Integrating indigenous health and wellness knowledge with conventional principles of diabetes care presents several opportunities for nurses to advance diabetes self-management (DSM) education and support. Including Native health concepts when educating patients about DSM should be viewed as desirable for holistic family and community involvement that is central toward preventing disease progression.

Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial

To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014-2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14-18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.

Native American Perspectives on Health and Traditional Ecological Knowledge

BACKGROUND

Traditional ecological knowledge (TEK) is a conceptual framework that highlights Indigenous knowledge (IK) systems. Although scientific literature has noted the relevance of TEK for environmental research since the 1980s, little attention has been given to how Native American (NA) scholars engage with it to shape tribal-based research on health, nor how non-Native scholars can coordinate their approaches with TEK. This coordination is of particular importance for environmental health sciences (EHS) research exploring interdisciplinary approaches and the integration of environmental and human health.

OBJECTIVE

Our perspective on TEK arose from a series of Health and Culture Research Group (HCRG) workshops that identified gaps in existing EHS methodologies that are based on a reliance on Euro-American concepts for assessing environmental exposures in tribal communities. These prior methods neither take into account cultural behavior nor community responses to these. Our objective is to consider NA perspectives on TEK when analyzing relationships between health and the environment and to look at how these may be applied to address this gap.

DISCUSSION

The authors—the majority of whom are NA scholars—highlight two research areas that consider health from a TEK perspective: food systems and knowledge of medicinal plants. This research has yielded data, methods, and knowledge that have helped Indigenous communities better define and reduce health risks and protect local natural food resources, and this TEK approach may prove of value to EHS research.

CONCLUSION

NA perspectives on TEK resulting from the HCRG workshops provide an opportunity for developing more accurate Indigenous health indicators (IHI) reflecting the conceptualizations of health maintained in these communities. This approach has the potential to bridge the scientific study of exposure with methods addressing a tribal perspective on the sociocultural determinants of health, identifying potential new areas of inquiry in EHS that afford nuanced evaluations of exposures and outcomes in tribal communities. https://doi.org/10.1289/EHP1944.

Lifetime Trauma and Depressive Symptomatology Among Older American Indians: The Native Elder Care Study

We examined the association between lifetime traumatic events with or without trauma response symptoms and depressive symptomatology in American Indians aged ≥ 55 years from a tribe in the Southeastern US (N = 362). Twenty-three percent of the sample experienced a traumatic event without trauma-response symptoms, whereas 14% experienced a traumatic event with at least one trauma-response symptom. After adjustment for sociodemographic characteristics and social support, participants who experienced a traumatic event with one or more trauma-response symptoms had higher odds of clinically relevant depressive symptomatology compared to (1) those who never experienced a traumatic event [odds ratio (OR) 3.2, p < 0.05], (2) and those who experienced a traumatic event without further symptoms (OR 3.7, p < 0.05). Our results suggest that mental health providers who serve older American Indians should consider the experience of traumatic events followed with response symptoms as a potential risk factor for further disruptions in psychological functioning.

Teaching Tradition: Diverse Perspectives on the Pilot Urban American Indian Traditional Spirituality Program

Many urban American Indian community members lack access to knowledgeable participation in indigenous spiritual practices. And yet, these sacred traditional activities remain vitally important to their reservation-based kin. In response, our research team partnered with an urban American Indian health center in Detroit for purposes of developing a structured program to facilitate more ready access to participation in indigenous spiritual knowledge and practices centered on the sweat lodge ceremony. Following years of preparation and consultation, we implemented a pilot version of the Urban American Indian Traditional Spirituality Program in the spring of 2016 for 10 urban AI community participants. Drawing on six first-person accounts about this program, we reflect on its success as a function of participant meaningfulness, staff support, mitigated sensitivities, and program structure. We believe that these observations will enable other community psychologists to undertake similar program development in service to innovative and beneficial impacts on behalf of their community partners.