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Liddell JL, Buscaglia A, Doria CM, Weekley A, Mascarena L. "I Need Help With the Abortion, so I Won't Have to Ever See or Hear From Him Again": Relationship Barriers Faced by Abortion Fund Applicants in the Rocky Mountain West. Violence Against Women 2024:10778012241236671. [PMID: 38439713 DOI: 10.1177/10778012241236671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
To explore the factors impacting abortion access for abortion fund clients, data from 816 applicants was analyzed using a summative content analysis approach. Nine relationship themes emerged for applicants who cited their partner as a significant factor in their abortion decision-making, including (a) power and control, (b) fear and safety concerns, (c) leaving the relationship, (d) barriers to accessing care, (e) sexual violence, (f) perpetration and victimization, (g) having an unsupportive partner, (h) being partnerless, and (i) having a supportive partner. Abortion funds are a potential resource for those experiencing intimate partner violence and can support survivors through confidential care and referrals.
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Affiliation(s)
| | - Alex Buscaglia
- University of Montana Department of Psychology, Missoula, MT, USA
| | - Celina M Doria
- Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | | | - Laila Mascarena
- University of Montana School of Social Work-Alumni, Missoula, MT, USA
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Reese SE, Dang A, Liddell JL. "'We'd Just Patch Ourselves up': Preference for Holistic Approaches to Healthcare and Traditional Medicine among Members of a State-Recognized Tribe". J Holist Nurs 2024; 42:34-48. [PMID: 37097906 DOI: 10.1177/08980101231169867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background:Health disparities between Native Americans and white Americans persist due to a variety of factors, including colonization, poverty, and racism. Racist interpersonal interactions between nurses and other healthcare providers and tribal members may also contribute to reluctance among Native Americans to engage with Western healthcare systems. Purpose: The purpose of this study was to better understand the healthcare experiences of members of a state-recognized Gulf Coast tribe. Methods: In partnership with a community advisory board, 31 semistructured interviews were conducted, transcribed, and analyzed utilizing a qualitative description approach. Results: All participants mentioned their preferences, views about, or experiences of using natural or traditional medicine approaches (referenced 65 times). Emergent themes include (a) preference for and use of traditional medicine; (b) resistance to western healthcare systems; (c) preference for holistic approaches to health; and (d) negative provider interpersonal interactions contributing to reluctance in seeking care. Conclusion: These findings suggest that integrating a holistic conceptualization of health and traditional medicine practices into Western healthcare settings would benefit Native Americans.
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Affiliation(s)
- Sarah E Reese
- University of Montana School of Social Work, Missoula, MT, USA
| | - Angie Dang
- Independent Researcher, New York City, USA
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Reese SE, Liddell JL, Mascarena L. "'You Just Want to Give me Some Medicine and be on my Way': Preferences, Beliefs, and Experiences Related to Western Medication among Members of a State-Recognized Tribe". J Holist Nurs 2024:8980101231219357. [PMID: 38419480 DOI: 10.1177/08980101231219357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Background: Native American/American Indian (NA/AI) people have higher rates of chronic disease, including substance use and mental health disorders, compared to White Americans. Though pharmaceuticals can be helpful in addressing many chronic healthcare conditions, many people do not take medications as prescribed. NA/AI identity has been found to be associated with lower rates of medication adherence compared to White Americans. Purpose: The purpose of this study is to better understand NA/AI women's perceptions, beliefs, and experiences related to medication. Methods: Thirty-one semi-structured interviews were conducted with NA/AI women from a state-recognized tribe located in the Gulf South. Interviews were transcribed and analyzed using a qualitative description approach. Results: Eighteen women discussed their experiences using medications when asked about their healthcare experiences. Participants identified the following themes in their discussion of medication: (a) Cost of Medication as a Barrier; (b) Negative Side Effects of Western Medication; (c) Fear of Resistance and Dependence; (d) Preference for Traditional Medicine or None; and (e) Lack of Communication around Medications from Providers. Conclusion: Our findings support the growing call for cultural safety within medical settings and integrating NA/AI conceptualizations of health and well-being and traditional practices into western healthcare settings to better support NA/AI people.
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Liddell JL, Sheffield SM, Johnson KM, Lederer AM. College Student Perceptions of the Root Causes of Sexual Violence Before and After a Curricular Intervention. Violence Against Women 2024; 30:551-574. [PMID: 36310436 DOI: 10.1177/10778012221132300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Campus sexual violence is prevalent and consequential. After a climate survey at our university revealed high rates of sexual violence, a semester-long academic course was designed as a curricular intervention for first-year students. This study examines an assignment completed at the beginning and end of the course. Students were asked: "What are the root causes of sexual violence?" Thematic analysis of papers revealed that many students altered or expanded their thinking to more complex, structural factors compared to their initial perceptions. An academic course may broaden students' understanding of the determinants of sexual violence.
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Affiliation(s)
| | | | | | - Alyssa M Lederer
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA, USA
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Lederer AM, Liddell JL, Johnson KM, Sheffield S. 'A profound effect on how I see myself and the world around me': what students found meaningful about taking an academic course intended to reduce campus sexual violence. Health Educ Res 2024:cyad048. [PMID: 38244588 DOI: 10.1093/her/cyad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/13/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
Sexual violence is common on US college campuses and can result in negative health and academic outcomes. Credit-bearing courses are a possible innovative intervention, but few have been studied, and little is known about enrolled students' experiences. Our institution, located in the Southern United States, developed a semester-long class as a curricular intervention after our institutional climate survey results showed high rates of sexual violence among undergraduate students. Students enrolled in the course wrote a final reflection paper on what they found meaningful about the class (N = 62). Qualitative conventional content analysis was used to examine what students found most salient. Three overarching categories emerged: course content, course delivery and course impact, each with multiple themes. For course content, students wrote about 22 different topics from the class. For course delivery, students discussed the open forum to discuss sexuality, the importance of taking the course in their first year of college and the course structure. For course impact, students discussed gaining new knowledge, questioning prior assumptions, experiencing personal transformation and feeling empowered to act. Results indicated that students had a powerful class experience and that this kind of educational intervention has the potential to positively impact enrolled students.
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Affiliation(s)
- Alyssa M Lederer
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, 1025 E. 7th Street, Suite 116, Bloomington, IN 47405, USA
| | - Jessica L Liddell
- School of Social Work, University of Montana, 32 Campus Drive, Missoula, MT 59812, USA
| | - Katherine M Johnson
- Department of Sociology, Tulane University, 220E Newcomb Hall, New Orleans, LA 70118, USA
| | - Sydney Sheffield
- School of Medicine, Duke University, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC 27710, USA
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McKinley CE, Lilly J, Liddell JL, Knipp H, Solomon TA, Comby N, Comby H, Haynes P, Ferris K, Goldberg M. Developing the Weaving Healthy Families Program to Promote Wellness and Prevent Substance Abuse and Violence: Approach, Adaptation, and Implementation. Fam Soc 2023; 104:245-261. [PMID: 37599798 PMCID: PMC10437124 DOI: 10.1177/10443894221146351] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Family prevention programs that enhance mental health, wellness, and resilience-while simultaneously addressing violence and alcohol and other drug (AOD) abuse-among Indigenous families are scarce. This gap in culturally grounded and community-based programs creates a critical need to develop and evaluate the efficacy of such prevention programs. This article fills this gap, with the purpose of describing the structure and content of the Weaving Healthy Families (WHF) program, a culturally grounded and community-based program aimed at preventing violence and AOD use while promoting mental health, resilience, and wellness in Indigenous families. The focus then turns to how to approach this process of developing and implementing the program in a culturally grounded and community-based way.
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Affiliation(s)
| | | | | | | | | | - Nikki Comby
- Tulane University School of Social Work, New Orleans, LA, USA
| | - Harold Comby
- Tulane University School of Social Work, New Orleans, LA, USA
| | - Patricia Haynes
- Tulane University School of Social Work, New Orleans, LA, USA
| | - Kathleen Ferris
- Tulane University School of Social Work, New Orleans, LA, USA
| | - Maple Goldberg
- Tulane University School of Social Work, New Orleans, LA, USA
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Abstract
Although extensive documentation of the health disparities experienced by Native American peoples exists, little research explores experiences of members of non-federally recognized tribes who receive health care outside of the Indian Health Services (IHS) system. Additionally, positive factors that influence relationships between health care providers and tribal members are understudied and are needed to promote health care access. A qualitative descriptive methodologic approach was used to conduct semi structured life history interviews with 31 women who identified as members of a state-recognized, Gulf South Native American tribe. Results identified the following important themes: Do Participants Have a Regular Provider, Personal Relationship With Provider, Feel Provider Cares, Provider Addresses Concern, and Respect for Traditional or Holistic Medicine. These findings suggest health care providers play an important role in impacting the health care experiences of Native American tribal members. Implications for trainings for health care providers are discussed.
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Lederer AM, Johnson KM, Liddell JL, Sheffield S. The Multimethod Evaluation of a Curricular Intervention Intended to Reduce Sexual Violence on a College Campus: A Synthesis of Findings and Lessons Learned. Health Promot Pract 2023; 24:323-331. [PMID: 34743629 DOI: 10.1177/15248399211050349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sexual violence is a major problem on college campuses, and innovative solutions are needed. Our university created a semester-long, credit-bearing, academic course as a curricular intervention intended to reduce sexual violence on campus. In this article, we describe the multiple methods used to evaluate the course, including a pre-post online survey with a quasi-experimental design, a qualitative content analysis of student reflection papers, and semistructured interviews with previously enrolled students conducted by a peer interviewer 3 months after course completion. The synthesis of evaluation findings indicated that an academic course has the potential to positively affect campus climate around sexual violence. Furthermore, using multiple methods enabled us to create a theory of change that illustrates how key course components shaped students' knowledge, attitudes, and behaviors about sexual violence, thereby ideally generating campus change. Results have been used by various stakeholders for both practice-based and scholarly purposes. We provide lessons learned and implications for practice that are transferable to other multimethod curricular intervention evaluations regardless of topical focus, including the many ways in which using multiple methods added value to the study; the considerable investment of time and resources needed when using multiple methods; the challenges that can arise when integrating findings across methods; the major benefits of having a multidisciplinary research team consisting of faculty and students; and the need to engage in critical reflexivity.
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Sheffield SM, Liddell JL. “If I Had a Choice, I’d Do It Natural”: Gulf South Indigenous Women’s Preferences and Experiences in Childbirth. Int J Childbirth 2023. [DOI: 10.1891/ijc-2022-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background:The definition of natural birth remains nebulous for birthing people. There is a lack of consensus regarding the factors that render a birth experience no longer natural or normal. In the United States, Indigenous birthing people experience some of the highest rates of maternal mortality, morbidity, and mistreatment during childbirth, yet there remains a paucity of research on the root causes of these findings.Some Indigenous birthing people have continued to use midwives throughout the past century, indicating that even before the organized 1970s Indigenous movement to remove any connotation that pathologized birth, individual birthing people were demonstrating their resistance to the medicalization of Indigenous birth practices.Theres a gap in understanding, however, of indigenous birthing people’s use of medication pain relief. We argue that understanding the intricacies of Indigenous birthing people’s notions of and preferences for “natural” birth can guide the development of interventions that increase access to desired options and thereby support autonomy. Moreover, existing literature on birthing people’s preferences and birth outcomes in the United States tends to examine the experiences of American birthing people generally, but to the authors’ knowledge, there remains no research specifically exploring Indigenous preferences regarding the mode of delivery, hospital versus home birth, pain management, and use of midwives.Aim:This study’s aim was to fill this gap, contribute to an understanding of the full scope of North American Indigenous birthing people’s preferences, and catalyze further discussion regarding interventions to increase Indigenous birthing people’s access to the birthing options they need and desire.Methods:A qualitative descriptive research design was used to investigate and convey the insights of Indigenous birthing people surrounding their birth experiences and desires. A qualitative description is an approach to naturalistic investigation often used in the examination of health topics because of its strength in relaying complex experiences in everyday language.Sample:All adult, women-identifying, self-identified members of a specific state-recognized Indigenous tribe in the Gulf Coast region of the United States were eligible for inclusion in this study. Thirty-one interviews were conducted.Data Analysis:The interview transcripts were analyzed using qualitative content analysis, which entails categorizing and grouping pieces of a broader data set based on common themes.Results:Three major themes emerged from the analysis of participants’ interviews: (a) beliefs about and desire for a vaginal birth, (b) pain management methods and preferences, and (c) beliefs about and use of midwives. This study found that Indigenous birthing people in the Gulf South have varying definitions of “natural” birth, ranging from home birth to vaginal birth to unmedicated birth to midwife-attended birth.
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Liddell JL, Stiffarm AL. "I Think [Western] Healthcare Fails Them": Qualitative Perspectives of State-recognized Women Tribal Members on Elders' Healthcare Access Experiences. Am Indian Alsk Native Ment Health Res 2023; 30:70-96. [PMID: 37523642 DOI: 10.5820/aian.3002.2023.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
Elder tribal members are important cultural and spiritual leaders and experts among many American Indian and Alaska Native (AI/AN) cultures. AI/AN Elders play a key role in the maintenance and transmission of traditional cultural knowledge and practices and are highly valued members of AI/AN communities. AI/AN populations face disparities in healthcare outcomes, and the healthcare needs of AI/AN Elders remain an understudied area of research, particularly among tribes in the South and for tribes who do not have federal recognition. Qualitative data was collected through semi-structured interviews among 31 women, all of whom are members of a state-recognized Tribe in the Southern United States. While the interview questions were specific to their own reproductive healthcare experiences, repeated concerns were voiced by the women regarding the health of the Elders in their community. Key findings captured several concerns/barriers regarding Elders' healthcare experiences including: (a) Language and communication barriers between Elders and healthcare workers; (b) Prior negative experiences with Western medicine; (c) Lasting impacts of educational discrimination; (d) Concerns over self-invalidation; (e) Transportation barriers; and (f) Need for community programs. Issues related to these barriers have resulted in a concern that Elders are not receiving the full benefit of and access to Western healthcare systems. The purpose of this analysis was to highlight the concerns voiced by women tribal members on the health and wellbeing of Elders in their community. Opportunities related to the importance of prioritizing and improving AI/AN Elders' healthcare experiences and access are also described.
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Hicks E, Liddell JL. "When you hear the noise, you know it's love": Family Support in American Indian Communities. Am Indian Alsk Native Ment Health Res 2023; 30:82-104. [PMID: 37027501 DOI: 10.5820/aian.3001.2023.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Family relationships are an important source of emotional and instrumental support. In American Indian (AI) communities, families often provide support for women during childbirth and childrearing. The present study sought to gain insight into the influence of family during the pregnancy, childbirth, and childrearing experiences of AI women from a Gulf Coast tribe. A qualitative descriptive research design was used, and 31 interviews were conducted with women from the tribe. The average age of participants was 51.17, and the majority of women had 2 to 3 children. Data was analyzed using a content analysis approach. Themes that emerged include: Influence of Childhood on Participant's Families and Parenting Styles, Significance of Family Emotional Closeness, Significance of Family Physical Closeness, Importance of Taking Care of Family Members, Importance of Family in Childbirth, and Generational Shifts in Caregiving. Results of the study may influence health interventions for this community, and results should encourage health care providers to consider positive implications of including family and community supports in care.
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Liddell JL. Birth control access experiences for members of an Indigenous tribe in the Gulf Coast. Women's Studies International Forum 2023. [DOI: 10.1016/j.wsif.2022.102667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
Indigenous women in the United States are among the most vulnerable to intimate partner violence (IPV), which has reached endemic levels. The purpose of this qualitative inquiry was to understand contextual factors and barriers to becoming liberated from violence. Reconstructive analysis of data from a critical ethnography with a sample of 231 women across two tribes who described IPV relationships identified the following themes: controlling relationships, losing sense of priorities, using children, socioeconomic stress, family pressures, and restricting relationships. Results revealed these tactics, which parallel those used in the patriarchal colonialism of historical oppression, impeded women's liberation from relationships.
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Liddell JL, Meyer S. Healthcare needs and infrastructure obstacles for a state-recognised Indigenous tribe in the United States. Health Soc Care Community 2022; 30:e5988-e5997. [PMID: 36134617 DOI: 10.1111/hsc.14031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/30/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state-recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community-based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life-course interviews with participants of a state-recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state-recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs.
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Affiliation(s)
| | - Sydney Meyer
- University of Montana School of Social Work, Missoula, Montana, USA
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Carlson TA, Liddell JL. The importance of community support for women in a Gulf Coast Indigenous tribe. IJHRH 2022. [DOI: 10.1108/ijhrh-06-2022-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose
Community support is an integral aspect of health and well-being for Indigenous peoples. The purpose of this paper is to demonstrate the valuable role of community support for Indigenous women specifically, who experience reproductive health disparities at alarming rates. This study helps fill an important gap in Indigenous scholarship by centering the resilience of women and Indigenous tribes and by using a framework that is consistent with Indigenous holistic views of health.
Design/methodology/approach
The data for this paper was collected as part of a larger study exploring the reproductive health experiences of a state-recognized Gulf Coast tribe. A total of 31 semi-structured interviews were conducted with individuals who identify as women and as members of this tribe using qualitative descriptive methodology. This method is recommended for research with Indigenous communities. A community advisory board with representatives from this tribe provided feedback throughout the project.
Findings
Themes expressed by participants included Community Closeness and Support; Community Support in Raising Children; Informal Adoption Common; and Community Values of Mutual Aid and Self-Sufficiency. The findings support current literature noting the value of generational and communal ties for Indigenous peoples. Implications of this research include the need to value and support community networks in programs serving tribes, in addition to meaningfully including Indigenous communities in developing interventions.
Originality/value
This paper centers Indigenous women’s resilience, approaches the health and well-being of Indigenous tribes holistically and helps to fill an important gap in literature describing informal adoption (outside the legal system) in state-recognized Indigenous communities.
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Lilly J, McKinley CE, Knipp H, Liddell JL. "When You Come Together and Do Everything, It'll be Better for Everybody": Exploring Gender Relations Among Two Southeastern Native American Tribes. J Fam Issues 2022; 43:2111-2133. [PMID: 35938087 PMCID: PMC9354704 DOI: 10.1177/0192513x211030059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Prior to the imposition of patriarchal colonial norms, Native American (NA) gender relations were characterized as complementary and egalitarian; however, little research has explored gender relations within NA communities today. This study used a community-based critical ethnography to explore contemporary NA gender relations with a purposive sample of 208 individuals from the "Coastal Tribe" and 228 participants from the "Inland Tribe." After participant observation, interviews, and focus groups were conducted, a collaborative approach to reconstructive analysis was used to identify themes in the data. Within these communities, gender relations tended to reflect egalitarian and cooperative but gendered norms, and participants provided examples of how tribal members are transcending patriarchal colonialism. Through the lens of the Framework of Historical Oppression, Resilience, and Transcendence, we theorize how these gender norms may protect families from risks associated with historical oppression and promote family resilience with implications for research, practice, and policy.
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Affiliation(s)
- Jenn Lilly
- Graduate School of Social Service, Fordham University, New York, NY, USA
| | | | - Hannah Knipp
- School of Social Work, Tulane University, New Orleans, LA, USA
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Liddell JL, Lilly JM. Healthcare experiences of uninsured and under-insured American Indian women in the United States. Glob Health Res Policy 2022; 7:5. [PMID: 35148788 PMCID: PMC8832673 DOI: 10.1186/s41256-022-00236-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Extensive health disparities exist for American Indian groups throughout the United States. Although insurance status is linked to important healthcare outcomes, this topic has infrequently been explored for American Indian tribes. For state-recognized tribes, who do not receive healthcare services through the Indian Health Service, this topic has yet to be explored. The purpose of this study is to explore how having limited access to health insurance (being uninsured or under-insured) impact American Indian women's healthcare experiences?. Methods In partnership with a community advisory board, this study used a qualitative description approach to conduct thirty-one semi-structured life-course interviews with American Indian women who are members of a state-recognized tribe in the Gulf Coast (United States) to explore their Western healthcare experiences. Interview were conducted at community centers, participant homes, and other locations identified by participants. Interviews were transcribed verbatim and findings were analyzed in NVivo using conventional content analysis. Findings were presented at tribal council meetings and to participants for member checking. Results Themes identified by participants included: (a) lack of insurance as a barrier to healthcare; (b) pre-paying for childbirth when uninsured; and (c) access to public health insurance coverage. Twenty-four women mentioned the role or importance of insurance in discussing their healthcare experiences, which was referenced a total of 59 times. Conclusion These findings begin to fill an important gap in the literature about the health insurance experiences of American Indian tribal members. Not having insurance was an important concern for participants, particularly for elderly and pregnant tribal members. Not having insurance also kept tribal members from seeking healthcare services, and from getting needed prescriptions. In addition to promoting knowledge about, and expanding insurance options and enrollment, increased sovereignty and resources for state-recognized tribes is needed to address the health disparities experienced by American Indian groups.
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Affiliation(s)
- Jessica L Liddell
- University of Montana School of Social Work, Jeannette Rankin Hall 004, 32 Campus Dr, Missoula, MT, 59812, USA.
| | - Jenn M Lilly
- Fordham University Graduate School of Social Service, New York, NY, USA
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McKinley CE, Lilly J, Liddell JL, Knipp H. "I Have to Watch Them Closely": Native American Parenting Practice and Philosophies. J Child Fam Stud 2021; 30:2952-2965. [PMID: 34966218 PMCID: PMC8714024 DOI: 10.1007/s10826-021-02116-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 06/14/2023]
Abstract
One of many ways that Native American (NA) families demonstrate resilience is by parenting children in some of the most adverse contexts in U.S. society. We use the framework of historical oppression, resilience, and transcendence (FHORT) in a critical ethnography to qualitatively explore the parenting philosophies and practices that NAs use to protect children from the risks of an oppressive context. Data were drawn from 436 members of two Southeastern NA tribes. A team-based critical ethnographic data analysis approach was used to analyze these findings, revealing the following themes: (a) "Your Kids Come First": Prioritizing Children's Needs; (b) "They Should Enjoy their Childhood": Sheltering Children from Family Stressors; (c) "I Have to Watch Them Closely": Closely Monitoring Children; and, (d) "There's No Drinking at My House": Preventing Children's Exposure to Substance Abuse. Results indicate that NA parents adopt child-centric mindsets and use a number of positive practices to protect their children from the potentially harmful environments created through historical oppression.
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Affiliation(s)
| | - Jennifer Lilly
- Fordham University Graduate School of Social Service, New York, NY, USA
| | | | - Hannah Knipp
- Tulane University School of Social Work, New Orleans, LA, USA
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McKinley CE, Lilly JM, Knipp H, Liddell JL. "A Dad Can Get the Money and the Mom Stays at Home": Patriarchal Gender Role Attitudes, Intimate Partner Violence, Historical Oppression, and Resilience Among Indigenous Peoples. Sex Roles 2021; 85:499-514. [PMID: 34955587 PMCID: PMC8693633 DOI: 10.1007/s11199-021-01232-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
Research has shown that gender role attitudes influence a number of health-related outcomes, including intimate partner violence (IPV). Yet the gender role attitudes of Indigenous peoples - a population that experiences persistent health and violence disparities - have received scant scholarly attention. Using the Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this mixed methodology was to qualitatively explore U.S. Indigenous peoples' gender role attitudes and quantitatively examine how key social determinants of health, including IPV perpetration, historical oppression, and resilience, relate to gender role attitudes. This research integrates qualitative and quantitative data from two Southeastern tribes with a total of 563 unique data sources. Regression analysis revealed male sex and IPV victimization were associated with higher patriarchal gender role attitudes, while historical oppression and resilience were associated with lower patriarchal gender role attitudes. Resilience was also associated with lower "victim blaming." Ethnographic team-based data analysis methods revealed qualitative themes of patriarchal gender role attitudes and gendered socialization processes. This work highlights how key aspects of the FHORT might explain Indigenous peoples' patriarchal gender role attitudes, suggesting the need to redress historical oppression and patriarchal roles through decolonization.
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Affiliation(s)
| | - Jenn M. Lilly
- Fordham University Graduate School of Social Services, New York, NY
| | - Hannah Knipp
- Tulane University School of Social Work, New Orleans, LA
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Liddell JL, McKinley CE, Knipp H, Scarnato JM. "She's the Center of My Life, the One That Keeps My Heart Open": Roles and Expectations of Native American Women. Affilia 2021; 36:357-375. [PMID: 34267418 PMCID: PMC8276874 DOI: 10.1177/0886109920954409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Historically, Native American (NA) mothers have proven essential to the survival of their families and communities, yet scant research has examined their roles today. Current gender roles in NA communities are influenced by historical oppression (both historic and contemporary forms) that acted to reverse matrilineal gender norms in favor of patriarchy. The present study sought to explore norms and expectations for women among two NA tribes located in the southeastern region of the United States. The framework of Historical Oppression, Resilience and Transcendence (FHORT), Hill-Collins's concept of "motherwork," and a framework of reproductive justice were used to frame the study and interpret findings. This critical ethnography included data from field notes, semistructured interviews, and focus groups. Reconstructive analysis, a specific type of thematic qualitative analysis for critical ethnographies, was used to interpret data. Participants from both tribes described themes related to the expectations and roles of mothers. These expectations included themes of (a) mothers as caretakers, (b) mothers as the centers of family and role models, (c) women to prioritize family over economic and educational aspirations, and (d) decolonizing norms for mothers. While historical oppression and patriarchal norms have constrained and regulated expectations for motherhood and the domestic roles of NA women, these findings also highlight how women decolonize these norms and find ways to reclaim their power through their roles as mothers.
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Affiliation(s)
| | | | - Hannah Knipp
- Tulane University School of Social Work, New Orleans, LA, USA
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Liddell JL, Kington SG. "Something Was Attacking Them and Their Reproductive Organs": Environmental Reproductive Justice in an Indigenous Tribe in the United States Gulf Coast. Int J Environ Res Public Health 2021; 18:E666. [PMID: 33466865 PMCID: PMC7830890 DOI: 10.3390/ijerph18020666] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/27/2022]
Abstract
Environmental reproductive justice is increasingly being utilized as a framework for exploring how environmental exploitation and pollution contribute to reproductive health and reproductive injustices. However, little research explores how settler colonialism and historical oppression contribute to the physical transformation of land, and how this undermines tribal members' health. Even less research explores the intersection of environmental justice and reproductive justice among Indigenous groups, especially in the Gulf South, who are especially vulnerable to environmental justice issues due to climate change, land loss, and oil company exploitation, and for tribes that are non-federally recognized. A qualitative description research methodology was used to conduct 31 life-history interviews with women from a Gulf Coast Indigenous tribe. Findings of this study reveal that central components of reproductive justice, including the ability to have children and the ability to raise children in safe and healthy environments, are undermined by environmental justice issues in the community. Among concerns raised by women were high rates of chronic healthcare issues among community members, and issues with infertility. Recognizing Indigenous sovereignty is central to addressing these environmental reproductive justice issues. This research is unique in exploring the topic of environmental reproductive justice among a state-recognized Gulf Coast tribe.
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Affiliation(s)
| | - Sarah G. Kington
- Department of Sociology, School of Liberal Arts, Tulane University, New Orleans, LA 70118, USA;
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Johnson KM, Lederer AM, Liddell JL, Sheffield S, McCraw A. Teaching to Impact Sexual Violence? The Evaluation of a Curricular Intervention for First-Year College Students. Am J Health Promot 2020; 35:438-441. [PMID: 33084379 DOI: 10.1177/0890117120967604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate whether a semester-long course for first-year undergraduates influenced knowledge, attitudes, and behavioral intentions about gender, sexuality, and sexual violence. DESIGN Quasi-experimental survey design. SETTING A private university in the Southeastern US. PARTICIPANTS Undergraduates enrolled in an intervention (n = 49) or comparison (n = 60) course in Fall 2018. MEASURES Sociosexual Orientation Inventory, Sexual Conservatism, Heteronormative Attitudes and Beliefs, Illinois Rape Myth Acceptance Scale, Bystander Efficacy Scale, Consent Myths, Sexual Misconduct Apathy, Campus Resource Awareness Index. ANALYSIS A 2-way mixed-factorial ANOVA. RESULTS Relative to the comparison group, students in the intervention course had significantly greater rates of change in reducing heteronormative views, decreasing sexual misconduct apathy, and increasing awareness of campus resources for sexual violence. CONCLUSION A semester-long course targeting first-year undergraduates can potentially influence knowledge, attitudes, and behavioral intentions regarding sexual violence and create a more positive campus climate.
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Affiliation(s)
| | - Alyssa M Lederer
- School of Public Health and Tropical Medicine, 5783Tulane University, New Orleans, LA, USA
| | - Jessica L Liddell
- City, Culture, and Community Program, 5783Tulane University, New Orleans, LA, USA
| | - Sydney Sheffield
- School of Public Health and Tropical Medicine, 5783Tulane University, New Orleans, LA, USA
| | - Alicia McCraw
- City, Culture, and Community Program, 5783Tulane University, New Orleans, LA, USA
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McKinley CE, Figley CR, Woodward SM, Liddell JL, Billiot S, Comby N, Sanders S. Community-Engaged and Culturally Relevant Research to Develop Behavioral Health Interventions with American Indians and Alaska Natives. Am Indian Alsk Native Ment Health Res 2019; 26:79-103. [PMID: 31743416 PMCID: PMC7063680 DOI: 10.5820/aian.2603.2019.79] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
American Indians and Alaska Natives experience pervasive mental, behavioral, and physical health disparities, yet access to culturally relevant and evidenced-based programs (EBPs) are severely limited. The purpose of this research is to describe the process of conducting a rigorous and culturally sensitive research approach, which was used to inform the development of a family-based substance abuse and violence prevention program that promotes resilience. The focus of this article is on the process of this development, rather than the intervention itself. We utilize a convergent mixed-methods design with distinct tribes in the Southeast that included 436 research participants across individual, family, and focus group interviews, field notes and existing data, and a quantitative survey (n = 127). This community-engaged, culturally sensitive, and rigorous research methodology provides a road-map for developing culturally relevant interventions.
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Abstract
Although American Indian (AI) women continue to experience cancer at higher rates and have not seen the same decline in cancer prevalence as the general U.S. population, little research examines how interactions with health care providers may influence and exacerbate these health disparities. The purpose of the study was to understand the experiences of AI women who receive cancer treatment, which is integral for eradication of AI cancer disparities among women. A qualitative descriptive methodology was used with a sample of 43 AI women with breast, cervical, colon, and other types of cancer from the Northern Plains region of South Dakota. Interviews were conducted from June 2014 to February 2015. Qualitative content analysis revealed that women experienced: (a) health concerns being ignored or overlooked; (b) lack of consistent and qualified providers; (c) inadequate healthcare infrastructure; (d) sub-optimal patient-healthcare provider relationships; (e) positive experiences with healthcare providers; and (f) pressure and misinformation about treatment. Results indicate the types of support AI women may need when accessing healthcare. Culturally informed trainings for healthcare professionals may be needed to provide high-quality and sensitive care for AI women who have cancer, and to support those providers already providing proper care.
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Affiliation(s)
- Jessica L. Liddell
- City, Community and Culture PhD Program, School of Social Work, Tulane University, New Orleans, LA, USA
| | | | - Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, SD, USA
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, CA, USA
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