American Indian/Alaska Natives (AI/AN) are a culturally diverse community with more than 4 million people from more than 560 federally recognized nations living on more than 300 reservations across 35 states and urban areas. Each nation and reservation has individual cultural beliefs, religions, languages, and customs, and the traditional values vary widely. The health beliefs are a blend of traditional culture and western medical influences and there is great distrust for outsiders. American Indian/Alaska Natives have well-documented protective factors such as strong family networks and cultural practices that reinforce the value of family-centered healing and prevention. In addition, AI/ANs have some of the most concerning health care needs in the United States today including limited health care access, tuberculosis, diabetes, alcoholism, obesity, family violence, and poverty.
Research among AI/ANs has been limited because of the distrust of the community for outsiders who historically came into the community; completed their research; and then left without forming a partnership, a trust relationship, or community partners to build on strengths and change the community. Today, that historical type of research can no longer happen. Outsiders must build a bridge of trust and partner with the community or tribe to help the community develop strengths necessary to reclaim their heritage, culture, and traditions.
Each article in this issue demonstrates the success of building trust and a community partnership to change the health disparities for AI/ANs. The articles showcase the strength of working together with the communities and supporting the cultural values; spirituality; and the harmony of mind, body, and spirit, which are essential to facilitate building on the strengths inherent in the AI/AN culture to bring about successful health care interventions. This issue supports the need for inclusive, holistic, and culturally appropriate programs in all health care settings.
For AI/AN women, there exist major prenatal health care disparities in care access, utilization, and outcomes. American Indian/Alaska Native women had the highest rate of late or no prenatal care in the United States during 2002, and during the 2004 to 2006 time frame and AI/ANs had the second highest infant mortality. Barriers to prenatal care have centered in 3 main areas including policies, sociodemographic concerns, and communication. Arnold, Aragon, Shephard, and VanSell share a case study on working cross culturally to develop a prenatal education tool. The Coming of the Blessing has been named by the Indian Health Service as a promising practice and has won 2 national awards. This case study describes how an organization can work with the community, build on strengths, and value culture.
Type 2 diabetes has been described as epidemic among AI/ANs as well as obesity. This fact has been attributed to limited access to health care as well as healthy foods, environmental factors, lifestyle, socioeconomic status, and a shift from the traditional low-fat diet to the high-fat and sugar diet of today.
Fleischhacker, Vu, Ries, and McPhail take the oral storytelling tradition of AI/AN people to develop talking circles to help build partnerships with health care providers, academia, and the community. The objective was to gain knowledge on how environment and policies influence access to healthy foods, develop strategies to improve access, and help the community learn about healthy eating in a traditional manner. The case study by Mohammed explores the impact of socioeconomic status on diabetes for AI/ANs including the inability to access health care and low funding for Indian Health Services. She looks at some potential solutions such as increasing governmental assistance programs to support the ability to buy healthy foods and giving the community culturally appropriate health education that supports and values their traditions and protective factors.
Eni and Rowe use a qualitative approach to look at the importance of interpersonal support and relationships, socioeconomic factors, and community initiatives to support young families through childbearing and early parenting. They state that complex historical events (including boarding schools) have compromised families in AI/AN communities. Their qualitative study supports the need for culturally appropriate prenatal education and the support of AI/AN culture, tradition, and language to make a difference for young AI/AN parents.
One of the major protective factors for AI/AN people is the family; yet, domestic violence has become a serious problem in AI/AN communities. Two separate articles approach this concern in very different methods. Begay writes a case study on building a woman's shelter in a rural American Indian community and the lessons learned. Gottlieb and Outten explore the development and implementation of a culturally relevant model to address the physical, emotional, and spiritual wellness needs of adult survivors of abuse in Alaska. Both articles demonstrate that working together, families and communities can reduce stress and move toward the harmony of wellness.
American Indians/Alaska Natives have a higher risk of alcohol abuse than the general population in the United States. Alcohol abuse during pregnancy places the fetus at risk for premature birth, low birth weight, and fetal alcohol spectrum disorders. Fetal alcohol spectrum disorders are the most common preventable cause for mental retardation as a result of prenatal alcohol abuse. Becket describes in her case study the success of health care providers, the community, and tribal partners to impact the health and wellbeing of AI/AN infants and children.
Tribal permission and partnership is required for outsiders to conduct research on reservations. The research must support culturally relevant interventions that support the community. Christopher et al offer a case study on community-based participatory research among AI/AN people to reduce health disparities. Building trust relationships and sharing power prove to be the foundation for outsiders to conduct research within American Indian communities to help make the difference between health care interventions that are accepted by the community or not.
Iwasaki, Byrd, and Onda sum this issue in their review of promoting mental health identities and reclamation of the indigenous heritage of AI/AN people. Their article supports the need for promoting a positive "native" identity and health care interventions that are holistic and culturally appropriate to support the cultural identity of each AI/AN individual.
To assist AI/AN teens in smoking cessation, Ubinas, Van Sell, Woods and Arnold review culturally appropriate interventions for application by healthcare providers with evidence-based best practices supporting the diagram, Nurse Practitioner Culturally Specific American Indian and Alaskan Native Youth Decision Tree for Smoking Cessation.
Woven throughout this issue is the need for health care providers, researchers, organizations, and communities to work together building trust relationships and honoring the traditions, values, and culture of American Indian and Alaska Natives. Only then can anyone hope to change the disparities that exist today.
-Sharon L. Van Sell, EdD, RN, PAHM
Professor T. Boone Pickens Institute of Health Science-Dallas Center
The Houston J. and Florence A. Doswell College of Nursing
Texas Woman's University
Dallas, TX 75235
[email protected]
-Carol M. Arnold, PhD, RN
Associate Professor
T. Boone Pickens Institute of Health
Science-Dallas Center
The Houston J. and Florence A. Doswell College of Nursing
Texas Woman's University
Dallas, TX 75235
[email protected]