Indigenous Culture and Research: Measurement Approaches andConsideration of Consequences

Melissa Walls1 & Tina Handeland2

1University of Minnesota Medical School, Duluth campus2Zaasijiwan Early Head Start and Head Start Program, Lac du Flambeau

Zaasijiwan Head Start

●AIAN Federally Funded Program●98% Families-Tribal Affiliation●112 Children Enrolled●HS Center-Based/EHS Center-based and

Home-based●29 Staff- Nine (9) Tribal Affiliation

BIBOON

ZIIGWANDAGWAAGIN

NIIBIN

● Spring Spearfishing● Maple Sugar● Wild Leek● Berries ● Powwow● Wild Rice● Storytelling● Winter Spearfishing● Decoy Carving● Museum

Objectives

• Identify rationale for attempts to empirically assess the role(s) of Indigenous cultural factors for health

• Share stories and lessons learned in one (ongoing) journey of measurement development and implementation– Strategies– Implications and Consequences

• Successes, Faults, Foibles • Describe a model of measurement development

– Practical utility in CBPR/TBPR

What We Won’t Achieve Today• Psychometric evaluation principles• Survey design “best practices”• Exhaustive review of measurement approaches• Definitive answers (i.e., how? Should we even

try?)

Colleagues Like You!

More Rationale

• Culture as treatment/medicine/prevention• Indigenous and Decolonizing Approaches• Culture impacts perceptions, behaviors, and

values

What is Culture?

• Hundreds of definitions across literatures– Cumulative knowledge, experiences, beliefs,

attitudes, understanding, religions, roles, etc. acquired or possessed by a group, often across generations

– A way of life, cultivated behavior, “tradition,” collective norms, customs, etc.

• Special/unique/particular meaning in AIAN groups

American Indian and Alaska Native Culture: Measurement Think Tank Meeting Outcomes

May 26, 2015, Washington, DC

• No single, monolithic construct of “culture” to measure– We can potentially isolate specific dimensions of culture

• Humans are multicultural beings– “Ecological conundrum” intertwines AIAN culture with

historical, political and environmental factors– Contemporary meaning of a measure also depends on

these contexts• Ethical interplay

– Burden and Consequences• Tensions and Opportunities: Generalizability and

Specificity

Measurement Approaches: A Brief History of Healing Pathways

Culturally Rooted Protective Factors

Enculturation

Knowledge(e.g., Language Fluency)

Identity Practices (Traditional)

(Spiritual)

Enculturation:How engaged or embedded one is in their (Native) culture.

First Nations Voices

• Cultural Identity“I think there’s a loss of their identity. From being Native, we lost a lot of that. . .and once they’re growing up they wonder, “who am I?” They are lost, you know.” (Female Service Provider)

• Traditional Activities“When you go to see an elder the elder will say ‘how many thoughts do you have?’ What that elder is asking is what’s your dream, what’s your vision for life? Because your dream an vision give you purpose. These children don’t have purpose around here.” (Male Elder)

• Language“When you speak the language, you feel it, you understand. . . .We have to go back to our way of life. . . .We have to go back to these 7 teachings about the Creator.” (Male Elder)

Culturally Rooted Protective Factors

Enculturation

Knowledge(e.g., Language Fluency)

Identity Practices (Traditional)

(Spiritual)

Enculturation:How engaged or embedded one is in their (Native) culture.

Sense of Belonging& Purpose Multidimensional Mastery Values & Worldview Extended Kinship Networks

Potential Pathways of Resilience

• Direct Protective Effects/Associations• Risk/Stress Buffering or Mediating Effects• Interplay with Other Protective Factors

– Interactive (Modifying/Amplifying) or Mediating Effects

Youth Adults• Flourishing Mental

Health Status

• Apathy , QoL and Blood Glucose Control

• Alcohol CessationSupported in part by NIDA (DA039912, DA039912, DA13580), NIMH (MH67281, MH085852),

and NIDDK (DK091250)

Empirical Evidence Cultural Factors Linked to:

Traditional Culture Buffers Impact of Discrimination on Depressive Symptoms

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

0.4

0.45

0.5

-1 -0.5 0 0.5 1

Prob

abili

ty o

f CES

-D C

utof

f Sco

re

Traditional Participation

The Relationship between Traditional Participation and CES-D Depression at Three Levels of Perceived Discrimination

High Discrimination

Medium Discrimination

Low Discrimination

See also: High levels of racial identity actualization (positive self/racial group identity) buffer impact of discrimination on health (Chae & Walters, 2009)

Positive mental health & diabetes outcomes positively related to communal mastery

Associations between cultural identity, diabetes support & Diabetes Empowerment

13

13.5

14

14.5

15

15.5

16

16.5

17

17.5

�Low Diabetes Support �Med Diabetes Support �High Diabetes Support

Low Anishinaabe identity score

High Anishinaabe identity score

YOUR work!

The (Mixed?) State of the Literature

• Null Findings: Identity and Mental Health (Whitesell, et al., 2014; Whitesell, Mitchell, & Spice, 2009; Bates, Beauvais, & Trimble, 1997; Paradies & Cunningham)

• One dimension of identity (centrality) linked to depressive symptoms; another (positive affect) linked to fewer symptoms (Matheson & Anisman, 2011)

• Native American Spirituality Scale (NASS) dual factor structure, only one dimension associated with lower substance use; neither factor related to mental health (Greenfield, et al., 2015)

Explaining Mixed Findings: Speculations

• Postcolonial predicament– Historical Assaults + ongoing legacy of colonization– Community Example: Spirituality and Hunting

• Diversity of opinions on what culture is and is not (back to the ecological conundrum)

“The way of the pipe respect.” simultaneously met with: “What I believe is the (our) people came from a thing called Turtle Island,

that’s where our roots are. Christianity came from; I don’t know where it came from, that’s where their roots are. This is why I think when one of our people says they’re Christians, you know it’s like a tree or a plant without roots.” (Male Service Provider)

And“I’m proud, 6 or 7 years after I got my life straight, I became a Christian, and

then that’s when they all come, ‘you’ve gone the wrong way.’ But to me, I found a way. It worked for me. . . . not until the day I became a Christian, I found love.” (Female Service Provider)

• Cultural strengths & culturally unique experiences with adversity: Two sides to explore and operationalize

– Socially determined risk factors (e.g., poverty, discrimination); Historical Trauma

Ethics, Consequences and Soul Searching

FRAMEWORK FOR GUIDING MEASUREMENT WITH AIAN POPULATIONS

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Melissa Walls | Nancy Whitesell Allison Barlow | Michelle Sarche

Common

Tailored for AIAN Population

Tailored for AIAN

Tribe/Cultural Group

Tailored for Specific AIAN

Community

Conceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

Wheel of AIAN Specificity

Walls, M.L., Whitesell, N.R., Barlow, A. and Sarche, M. (2017). Research withAmerican Indian and Alaska Native Populations: Measurement Matters.Journal of Ethnicity and Substance Abuse. Published online 4/25/17. DOI: 10.1080/15332640.2017.1310640

This framework has a lot of moving parts

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Measurement Development Cycle

Measurement Development CycleConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

34

Measurement Development CycleConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n Common

Tailored for AIAN Population

Tailored for AIAN

Tribe/Cultural Group

Tailored for Specific AIAN

Community

Wheel of AIAN Specificity

35

Common

Wheel of AIAN SpecificityConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

36

Tailored for AIAN Population

Wheel of AIAN SpecificityConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

37

Tailored for AIAN

Tribe/Cultural Group

Wheel of AIAN SpecificityConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

38

Tailored for Specific AIAN

Community

Wheel of AIAN SpecificityConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

39

Common

Tailored for AIAN Population

Tailored for AIAN

Tribe/Cultural Group

Tailored for Specific AIAN

Community

Conceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

Wheel of AIAN Specificity

Measurement Development Cycle

40

Measurement Development CycleConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

41

Measurement Development CycleConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

42

Measurement Development CycleConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

43

Measurement Development CycleConceptualization

Operationalization

Implementation

Inte

rpre

tatio

n

44

This is all a little overwhelming.

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Moving Forward

• Pragmatism: baby steps of science• Mixed-methods and qualitative approaches• Cross-Cultural Measurement Innovation• Interdisciplinary Teams• Is it worth trying?

– recognizing limitations when we do

American Indian and Alaska Native Culture: Measurement Think Tank Meeting Outcomes

May 26, 2015, Washington, DC

• No single, monolithic construct of “culture” to measure– We can potentially isolate specific dimensions of culture

• Humans are multicultural beings– “Ecological conundrum” intertwines AIAN culture with

historical, political and environmental factors– Meaning of a measure also depends on these contexts

• Ethical interplay– Burden and Consequences

• Tensions and Opportunities: Generalizability and Specificity

“I try to put that in perspective and then try understand you know what it was like pre-contact of the European when he landed here in our homeland and when I genetically remember you know, from our ancestors, is that our people were living a very beautiful life. There was an abundance of riches of the land and spirit. Our people were a spiritual people and we are a spiritual people and they will always be a spiritual people.” (Male Elder)