Applying Indigenous Research Methodologies to Inform the Development of an American Indian Mother Daughter Preconception Health Intervention

Abstract

BACKGROUND: American Indian and Alaska Native (AIAN) youth experience disproportionately high rates of health inequities in multiple areas, including: suicide, unintentional injuries, obesity, sexually transmitted infections, substance abuse, teenage pregnancy, and sexual violence. Despite the increasing support for integrating cultural protective factors (“cultural assets”) to address these health inequities, literature on formative processes for identifying and incorporating such factors is sparse. OBJECTIVES: This dissertation study addresses the gap in literature by applying mixed method and Indigenous research methodologies to identify cultural assets and foundational elements critical for developing a culturally grounded mother daughter intervention that aims to reduce substance abuse, prevent teenage pregnancy, and promote reproductive health among pre-pubescent (age 9 – 11 years) Diné (Navajo) girls. METHODS: Cultural assets and foundational elements were identified through the following aims: 1) a systematic review of strengths-based intergenerational interventions in North American Indigenous (NAI) communities; 2) a cross-sectional, community-based survey of 200 adult Diné women; and 3) focus group and in-depth interview/storytelling sessions with Diné women age 8 years and older. RESULTS: For the systematic review, 115 articles were initially identified and 7 met the review inclusion criteria. Major themes of promising methods were: 1) community-based participatory research or participatory action (CBPR/PAR) approaches; 2) qualitative methods; 3) storytelling as data collection; 4) bridging historical trauma to healing; 5) mothers as a source of support; 6) collectivist cultural values; and 7) strengthening interventions with cultural teachings. For aim 2, the survey revealed that 66% women admired their mother/grandmother most during puberty; 29% of women were 10-11 years old when someone first spoke to them about menses; and 86% felt their culture was a source of strength. Seventy percent (70%) would have liked to learn more about reproductive health when they were a teenager; 67% felt Diné mothers are able to provide reproductive health education; 51% reported having a rite of passage event, with younger age groups desiring a rite of passage event significantly more than older age groups. In 2-choice responses, 37% of women chose father as a someone they admired most. Several women wrote-in male relatives under multiple questions. Survey responses also alluded to a disruption of cultural practices due to historically traumatic events. For aim 3, key cultural asset themes were: 1) preserving the Diné way of life; 2) cultural assets related to being a strong and healthy Diné woman; 3) matrilineal networks and female kin as a source of strength and pride; 4) historical trauma as a source of strength and resilience; 5) male influences as protective health factors; 6) “western” education as a measure of success; and 7) navigating conflicting beliefs. CONCLUSION: Findings supported the integration of cultural assets, engagement of male sources of support, application of CBPR/PAR approaches to culturally ground interventions, application of Indigenous research methodologies to identify cultural assets, framing of historical trauma from an asset- and resilience-based perspective, consideration of multiple family support persons, and provision of health communication tools. Area of for further research include: Indigenous father-child and father-daughter interventions, mother daughter randomized controlled trial in Indigenous communities, asset-based Indigenous health research, application of Indigenous research methodologies, and tribal titleholders/ambassadors as cultural knowledge resources and role models.