American Indians/Alaska Natives/Native Hawaiians (AI/AN/NHs) disproportionately experience higher rates of various health conditions. Developing culturally centered interventions targeting health conditions is a strategy to decrease the burden of health conditions among this population. This study analyzes characteristics from 21 studies currently funded under the Interventions for Health Promotion and Disease Prevention in Native American (NA) Populations program among investigators currently funded under this grant mechanism. Four broad challenges were revealed as critical to address when scientifically establishing culturally centered interventions for Native populations. These challenges were (a) their ability to harness culture-centered knowledge and perspectives from communities; (b) their utilization of Indigenous-based theories and knowledge systems with Western-based intervention paradigms and theories; (c) their use of Western-based methodologies; and (d) their cultural adaptation, if based on an evidence-based treatment. Findings revealed that qualitative methodologies and community-based participatory research (CBPR) approaches were very commonly used to finalize the development of interventions. Various Indigenous-based theories and knowledge systems and Western-based theories were used in the methodologies employed. Cultural adaptations were made that often used formative mixed qualitative and quantitative methods. Illustrative examples of strategies used and suggestions for future research are provided. Findings underscored the importance of CBPR methods to improve the efficacy of interventions for AI/AN/NH communities by integrating Indigenous-based theories and knowledge systems with Western science approaches to improve health.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Allen, J., Ching, C., Fok, T., Henry, D., Skewes, M., & People Awakening Team. (2012). Umyuangcaryaraq “reflecting”: Multidimensional assessment of reflective processes on the consequences of alcohol use among rural Yup’ik Alaska Native youth. The American Journal of Drug and Alcohol Abuse, 38, 468–475. https://doi.org/10.3109/00952990.2012.702169.
Baldwin, J. A., Johnson, J. L., & Benally, C. C. (2009). Building partnerships between indigenous communities and universities: Lessons learned in HIV/AIDS and substance abuse prevention research. American Journal of Public Health, 99, S77–S82. https://doi.org/10.2105/AJPH.2008.134585.
Bandura, A. (1986). Social foundations in thought and action. Englewood Cliffs: Prentice Hall.
Barnes, P. M., Adams, P. F., & Powell-Griner, E. (2010). Health characteristics of the American Indian or Alaska Native adult population: United States, 2004–2008. Natl Health Stat Report, 20, 1-22
Barrera, M., & Castro, F. G. (2006). A heuristic framework for the cultural adaptation of interventions. Clinical Psychology: Science and Practice, 13, 311–316. https://doi.org/10.1111/j.1468-2850.2006.00043.x.
Beals, J., Belcourt-Dittloff, A., Garroutte, E. M., Croy, C., Jervis, L. L., Whitesell, N. R., et al. (2013). Trauma and conditional risk of posttraumatic stress disorder in two American Indian reservation communities. Social Psychiatry and Psychiatric Epidemiology, 48, 895–905. https://doi.org/10.1007/s00127-012-0615-5.
Belone, L., Tosa, J., Shendo, K., Toya, A., Straits, K., Tafoya, G., ... Wallerstein, N. (2016). Community-based participatory research co-creating interventions with Native communities: A partnership between the University of New Mexico and the Pueblo of Jemez. In N. Zane, F. Leong & G. Bernal (Eds.), Evidence-based Psychological Practice with Ethnic Minorities: Culturally Informed Research and Clinical Strategies, 199-220.
Belone, L., Orosco, A., Damon, E., Smith-McNeal, W., Rae, R., Sherpa, M. L., et al. (2017). The piloting of a culturally centered American Indian family prevention program: A CBPR partnership between Mescalero Apache and the University of New Mexico. Public Health Reviews, 38, 13. https://doi.org/10.1186/s40985-017-0076-1.
Benish, S. Q., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis. Journal of Counseling Psychology, 58, 279–289. https://doi.org/10.1037/a0023626.
Bowlby, J. (1969). Attachment and loss. New York: Basic Books.
Bronfenbrenner, U. (1986). Ecology of the family as a context for human development: Research perspectives. Developmental Psychology, 22, 723–742.
Cajete, G. (1994). Look to the mountain: An ecology of indigenous education (1st ed.). Durango: Kivaki Press.
Centers for Disease Control and Prevention (2015). Evidence-based practices. Retrived from https://www.cdc.gov/stltpublichealth/program/resources/evidence.html.
Centers for Disease Control and Prevention (2017). Summary Health Statistics: National Health Interview Survey: 2015. Table A-15. Retrieved from https://www.cdc.gov/nchs/nhis/shs/tables.htm.
Crump, A. D., Etz, K., Arroyo, J. A., Hemberger, N., & Srinivasan, S. (2017). Accelerating and strengthening Native American health research through a collaborative NIH initiative. Prevention Science. https://doi.org/10.1007/s11121-017-0854-5. [Epub ahead of print]
Denzin, N. K., Lincoln, Y. S., & Smith, L. T. (Eds.). (2008). Handbook of critical and indigenous methodologies. Thousand Oaks: Sage.
Dickerson, D. L., Johnson, C. L., Castro, C., Naswood, E., & Leon, J.M.P. (2012). CommUNITY voices: Integrating traditional healing services for urban American Indians/Alaska Natives in Los Angeles County. Learning Collaborative Summary Report. Los Angeles: Los Angeles County Department of Mental Health.
Dutta, M. J. (2007). Communicating about culture and health: Theorizing culture-centered and cultural sensitivity approaches. Communication Theory, 17, 304–328. https://doi.org/10.1111/j.1468-2885.2007.00297.x.
Evans-Campbell, T. (2008). Multilevel framework for exploring impacts on individuals, families, and communities historical trauma in American Indian/Native Alaska communities: A multilevel framework for exploring impacts on individuals, families, and communities. Journal of Interpersonal Violence, 23, 316–338. https://doi.org/10.1177/0886260507312290.
Frieden, T. R. (2017). Evidence for health decision making—Beyond randomized, controlled trials. New England Journal of Medicine, 377, 465–475. https://doi.org/10.1056/NEJMra1614394.
Gone, J. P. (2016). Alternative knowledges and the future of community psychology: Provocations from an American Indian healing tradition. American Journal of Community Psychology, 58, 314–321. https://doi.org/10.1002/ajcp.12046.
Grandinetti, A., Kaholokula, J. K., Theriault, A. G., Mor, J. M., Chang, H. K., & Waslien, C. (2007). Prevalence of diabetes and glucose intolerance in an ethnically diverse rural community of Hawai‘i. Ethnicity & Disease, 17, 245–250.
Health Impact Partners (n.d.). New to HIA? Retrieved from: http://www.humanimpact.org/new-to-hia/ on September 17, 2017.
Herne, M. A., Bartholomew, M. L., & Weahkee, R. L. (2014). Suicide mortality among American Indians and Alaska Natives, 1999–2009. American Journal of Public Health, 104, S336–S342. https://doi.org/10.2105/AJPH.2014.301929.
Institute of Medicine. (2012). An integrated framework for assessing the value of community-based prevention. Washington, DC: The National Academies Press.
Institute of Medicine. (2013). Leveraging culture to address health inequalities: Examples from native communities: Workshop summary. Washington, DC: The National Academies Press.
Johnson, D. B., Oyama, N., LeMarchand, L., & Wilkens, L. (2004). Native Hawaiians mortality, morbidity, and lifestyle: Comparing data from 1982, 1990, and 2000. Pacific Health Dialogue, 11, 120–130.
Kagawa-Singer, M. (2012). Applying the concept of culture to reduce health disparities through health behavior research. Preventive Medicine, 55, 356–361. https://doi.org/10.1016/j.ypmed.2012.02.011.
Kagawa-Singer, M., Dressler, W. W., George, S. M., & Elwood, W. N. (2015). The cultural framework for health: An integrative approach for research and program design and evaluation. Bethesda, MD: Retrieved from https://obssr.od.nih.gov/sites/default/files/cultural_framework_for_health%201.pdf.
Kaholokula, J. K., Braun, K. L., Kana'iaupuni, S., Grandinetti, A., & Chang, H. K. (2006). Ethnic-by-gender differences in cigarette smoking among Asian and Pacific Islanders. Nicotine & Tobacco Research, 8, 275–286. https://doi.org/10.1080/14622200500484600.
Kaholokula, J. K., Look, M., Mabellos, T., Zhang, G., de Silva, M., Yoshimura, S., et al. (2017). Cultural dance program improves hypertension management for Native Hawaiians and Pacific Islanders: A pilot randomized trial. Journal of Racial and Ethnic Health Disparities, 4, 35–46. https://doi.org/10.1007/s40615-015-0198-4.
Kaufman, C. E., Black, K., Keane, E. M., Big Crow, C. K., Shangreau, C., Arthur-Asmah, R., et al. (2014). Planning for a group-randomized trial with American Indian youth. Journal of Adolescent Health, 54(3), S59–S63. https://doi.org/10.1016/j.jadohealth.2013.12.028.
Kirmayer, L. J., Sehdev, M., Whitely, R., Dandeneau, S. E., & Issac, C. (2009). Community resilience: Models, metaphors and measures. Journal of Aboriginal Health, 5, 62–117.
Kirmayer, L. J., Dandeneau, S., Marshall, E., Phillips, M. K., & Williamson, K. J. (2011). Rethinking resilience from indigenous perspectives. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 56, 84–91.
Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88, 251–258.
Lau, A. S. (2006). Making a case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology: Science and Practice, 13, 295–310. https://doi.org/10.1111/j.1468-2850.2006.00042.x.
Lowe, J., Riggs, C., Henson, J., & Liehr, P. (2009). Cherokee self-reliance and word-use in stories of stress. Journal of Cultural Diversity, 16, 5–9.
Lowe, J., Liang, H., & Henson, J. (2016). Preventing substance use among Native American early adolescents. Journal of Community Psychology, 44, 997–1010. https://doi.org/10.1002/jcop.21823.
Manson, S. M., Beals, J., Klein, S., Croy, C. D., & the AI-SUPERPFP Team. (2005). The social epidemiology of trauma in two American Indian reservation populations. American Journal of Public Health, 95, 851–859. https://doi.org/10.2105/AJPH.2004.054171.
Martell, B. N., Garrett, B. E., & Caraballo, R. S. (2016). Disparities in adult cigarette smoking—United States, 2002–2005 and 2010–2013. Morbidity and Mortality Weekly Report, 65, 753–758. https://doi.org/10.15585/mmwr.mm6530a1.
Mohatt, N. V., Fok, C. C., Burket, R., Henry, D., & Allen, J. (2011). Assessment of awareness of connectedness as a culturally-based protective factor for Alaska native youth. Cultural Diversity and Ethnic Minority Psychology, 17, 444–455. https://doi.org/10.1037/a0025456.
Nakagawa, K., Koenig, M. A., Asai, S. N., Chang, C. W., & Seto, T. B. (2013). Disparities among Asians and native Hawaiians and Pacific Islanders with ischemic stroke. Neurology, 80, 839–843. https://doi.org/10.1212/WNL.0b013e3182840797.
Nakagawa, K., MacDonald, P. R., & Asai, S. M. (2015). Stroke disparities: Disaggregating Native Hawaiians from other Pacific Islanders. Ethnicity & Disease, 25, 157–161.
Native American Health Center. (2012). Native vision: A focus on improving behavioral health wellness for California Native Americans-California Reducing Disparities Project Native American population report. Oakland: Native American Health Center.
Okamoto, S. K., Kulis, S., Marsiglia, F. F., Steiker, L. K., & Dustman, P. A. (2014). Continuum of approaches toward developing culturally focused prevention interventions: From adaptation to grounding. Journal of Primary Prevention, 35, 103–112. https://doi.org/10.1007/s10935-013-0334-z.
Pankratz, M. M., Jackson-Newsom, J., Giles, S. M., Ringwalt, C. L., Bliss, K., & Bell, M. L. (2006). Implementation fidelity in a teacher-led alcohol use prevention curriculum. Journal of Drug Education, 36, 317–333. https://doi.org/10.2190/H210-2N47-5X5T-21U4.
Philip, J., Ford, T., Henry, D., Rasmus, S., & Allen, J. (2016). Relationship of social network as protective factors in suicide and alcohol use disorder intervention for rural Yup’ik Alaska Native youth. Psychosocial Intervention, 25, 45–54. https://doi.org/10.1016/j.psi.2015.08.002.
Resnicow, K., Soler, R., Braithwaite, R. L., Ahluwalia, J. S., & Butler, J. (2000). Cultural sensitivity in substance use prevention. Journal of Community Psychology, 28(3), 271–290. https://doi.org/10.1002/(SICI)1520-6629(200005)28:3<271::AID-JCOP4>3.0.CO;2-I.
Rogers, R. W. (1975). A protection motivation theory of fear appeals and attitude change. Journal of Psychology, 91, 93–114.
Rosenstock, I. (1974). Historical origins of the health belief model. Health Education Monographs, 2:328-335.
Singer, M., & Baer, H. (1995). Critical medical anthropology. Amityville: Bayswood Publishing.
Smith, T. B., Rodriguez, M. D., & Bernal, G. (2011). Culture. Journal of Clinical Psychology, 67, 166–175. https://doi.org/10.1002/jclp.20757.
Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies. (2010). The NSDUH report: Substance use among American Indian or Alaska Native Adults. Rockville: SAMHSA.
United States Department of Health and Human Services (2016). Intervention research to improve Native American health (IRINAH). Retrieved from http:www.cancercontrol.cancer.gov/nativeamericanintervention/ .
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. J. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76, 72–83. https://doi.org/10.1037/0022-006X.76.1.72.
Van Orden, K. A., Cukrowicz, K. C., Witte, T. K., & Joiner, T. E. J. (2012). Thwarted belongingness and perceived burdensomeness: Construct validity and psychometric properties of the Interpersonal Needs Questionnaire. Psychological Assessment, 24, 197–215. https://doi.org/10.1037/a0025358.
Victoroff, J. (2005). Introduction to the oppression questionnaire (OQ).Retrieved from: http://www.humiliationstudies.org/documents/VictoroffOppressionQuestionnaire.pdf.
Wallerstein, N., Duran, B., Oetzel, J., & Minkler, M. (Eds.). (2018). Community-based participatory research for health: Advancing social and health equity (3rd ed.). San Francisco: Jossey-Bass.
Walsh, M. L. (2014). Substance abuse prevention in American Indian and Alaska Native communities: Exploration of guiding theoretical underpinnings and theoretical fit in practice. Graduate Theses and Dissertations. http://scholarcommons.usf.edu/etd/5398.
Walters, K. L., Johnson-Jennings, M., Stroud, S., Rasmus, S., Charles, B., Simeon, J., et al. (2018). Growing from our roots: Strategies for developing culturally grounded health promotion interventions in American Indian, Alaska Native, and Native Hawaiian communities. Prevention Science Manuscript submitted for publication.
Whitbeck, L. B., Adams, G. W., Hoyt, D. T., & Chen, X. (2004). Conceptualizing and measuring historical trauma among American Indian people. AmericaJournal of Community Psychology, 33, 119–130. https://doi.org/10.1023/B:AJCP.0000027000.77357.31.
Wolsko, C., Lardon, C., Hopkins, S., & Ruppert, E. (2006). Conceptions of wellness among the Yup'ik of the Yukon–Kuskokwim Delta: The vitality of social and natural connection. Ethnicity & Health, 11, 345–363. https://doi.org/10.1080/13557850600824005.
Yuen, N. Y., Nahulu, L. B., Hishinuma, E. S., & Miyamoto, R. H. (2000). Cultural identification and attempted suicide in Native Hawaiian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 360–367. https://doi.org/10.1097/00004583-200003000-00019.
Funding for this work was provided by R01 AA022066-04 from NIAAA, 1R01ES022583-01A1 from NIEHS and OBSSR, R01 CA164533 from NCI, 1R01HL126577 from NHLBI, and 1R01DA037174 from NIDA.
Conflict of Interest
The authors declare that we have no conflicts of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Because this article is a review of research projects, informed consent is not applicable.
Electronic supplementary material
About this article
Cite this article
Dickerson, D., Baldwin, J.A., Belcourt, A. et al. Encompassing Cultural Contexts Within Scientific Research Methodologies in the Development of Health Promotion Interventions. Prev Sci 21, 33–42 (2020). https://doi.org/10.1007/s11121-018-0926-1
- American Indians
- Alaska Natives
- Native Americans
- Native Hawaiians