Understanding the Resilience of Children Living on an American Indian Reservation: A Mixed Methods Participatory-Social Justice Investigation

Abstract

Background: American Indian and Alaska Native (AI/AN) children living on reservations have critical mental health inequities compared to national samples of White peers due to complex social determinants of health. Resilience is an evidence-based concept that frames the inherent coping abilities of children and their environments and can inform the development of health prevention strategies. Purpose: To explore risk and protective factors of resilience in AI and White children who attend an elementary school on an Indian Reservation. Methods: A theory-driven convergent mixed methods study was conducted, using a community-based participatory research approach, and guided by the Social Ecological Resilience of Indigenous Adolescents (SERIA) situation-specific nursing theory. Embracing cultural humility and respect for Indigenous Knowledge, this study corroborated multiple sources of data. Results: A total of 47 child/caregiver dyads enrolled in the study. Children were on average 9.8 years old (age range=6-13 years), and the majority were Native American (77%, n=36). Each child completed a 24-item Child Youth Resilience Measure (CYRM-R) survey, and their caregiver completed a 24-item Person Most Knowledgeable (PMK) version of the CYRM-R. Relational/caregiver related resilience was significantly higher than personal resilience in this group of children, suggesting they have a supportive ecosystem. Caregivers on average scored their children higher in resilience than children scored themselves. A subset of 20 children participated in a 15-minute semi-structured interview. Six themes of resilience emerged, 1) Families are extensive and supportive, 2) Loss and grief are common challenges to resilience, 3) Talking and mindfulness help children deal with strong feelings, 4) The school contributes to children’s physical and mental health, 5) Spirituality is important in this community, and 6) Children embrace values of respect, compassion, and hard work. Integration of the qualitative findings and the quantitative findings provided a rich description of resilience of these children. The mixed methods approach allowed for qualitative expansion and corroboration on most survey items. Conclusion: Findings from this study substantiated the conceptual relationships of the SERIA theory. The participatory research approach was a strength of the study and created partnerships for the development of future intervention studies. Replication of this study in other AI/AN youth populations has promise to discover knowledge that will advance the fields of suicide and substance use prevention. Findings have implications for nursing practice, research, and policy to improve mental health outcomes for AI/AN children living on this reservation.