Understanding Resilience and Mental Wellbeing in Southwest Indigenous Nations* and the Impact of COVID-19: Protocol for a Mixed-Methods Study (Preprint)

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BACKGROUND Despite experiencing many adversities, American Indians/Alaska Natives (AI/ANs) have demonstrated tremendous resilience during the COVID-19 pandemic, drawing upon Indigenous determinants of health (IDOH) and Indigenous Nation-Building. OBJECTIVE Our multidisciplinary team undertook this study to achieve two aims: 1) to determine the role of IDOH in tribal government policy and action that support Indigenous mental health and wellbeing, and in turn, resilience during the COVID-19 crisis; and 2) to document the impact of IDOH on Indigenous mental health, wellbeing, and resilience of four specific community groups, including first responders, educators, traditional knowledge holders and practitioners, and the substance abuse recovery community, living and/or working in or near three Native nations in Arizona. METHODS To guide this study, we developed a conceptual framework based upon IDOH, Indigenous Nation-Building, and concepts of Indigenous Mental Wellbeing and Resilience. The research process was guided by the CARE Principles for Indigenous Data Governance to honor tribal and data sovereignty. Data were collected through a mixed methods research design - including interviews, talking circles, asset mapping, and coding of executive orders - that documented the contextual factors that contribute to mental health and wellbeing among Native nations. Special attention was placed on the assets and culturally, socially, and geographically distinct features of each Native nation and the communities within them. Our study was unique in that our research team consisted of predominantly Indigenous scholars and community researchers representing at least eight tribes and nations in the United States. The members of the team, regardless of whether they identified as Indigenous or non-Indigenous, have many collective years of experience working with Indigenous peoples and are committed to the health and wellbeing of tribal communities. RESULTS The number of participants enrolled in this study was 105 adults, with a total of 92 individuals interviewed and 13 individuals engaged in four talking circles. Due to time constraints, the team elected to host talking circles with only one nation, with participants ranging from 2-6 in each group. Currently, we are in the process of conducting a qualitative analysis of the transcribed narratives from the interviews, talking circles, and executive orders. These processes and outcomes will be described in future manuscripts. CONCLUSIONS This community-engaged study lays the groundwork for future studies addressing Indigenous mental health, wellbeing, and resilience. Findings from this study will be shared through presentations and publications to larger Indigenous and non-Indigenous audiences; local recovery groups, treatment centers, and individuals in recovery; K-12 and higher education educators and administrators; directors of first responder agencies; traditional medicine practitioners; and elected community leaders. The findings will also be used to produce wellbeing and resilience education materials, such as print and digital toolkits, in-service training sessions, and future recommendations for stakeholder organizations. CLINICALTRIAL N/A

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