Developing a Public Health Course to Train Undergraduate Student Health Messengers to Address Vaccine Hesitancy in an American Indian Community.

The purpose of the Diné Teachings and Public Health Students Informing Peers and Relatives about Vaccine Education (RAVE) project was to develop strategies for health communication that addressed COVID-19 vaccine safety for residents of the Navajo Nation. The RAVE project developed a 16-week course using the Diné Educational Philosophy as a framework to train Diné College (DC) public health undergraduate students (n = 16) as health messengers to share COVID-19 vaccine safety information with unvaccinated peers and relatives. An online community survey (n = 50) was used to assess DC community vaccination perceptions to guide course development. The two primary reasons survey participants got vaccinated were to protect the health of others [82% (n = 41)] and to protect their own health [76% (n = 38)]. A pretest/post-test and a retrospective pretest (n = 13) were implemented to determine course effectiveness. A finding approaching significance was related to student confidence in being health messengers (9.1% increase). RAVE offers the first example in the published literature of successfully training American Indian undergraduate students in the context of a public health course to contribute to the response workforce during a public health crisis.

Diné (Navajo) Traditional Knowledge Holders' Perspective of COVID-19.

From the start of the COVID-19 pandemic on the Navajo Nation, Diné (Navajo) traditional knowledge holders (TKHs), such as medicine men and women and traditional practitioners, contributed their services and healing practices. Although TKHs are not always fully acknowledged in the western health care system, they have an established role to protect and promote the health of Diné people. To date, their roles in mitigating the COVID-19 pandemic have not been fully explored. The purpose of this research was to understand the social and cultural contexts of the COVID-19 pandemic and vaccines based on the roles and perspectives of Diné TKHs. A multi-investigator consensus analysis was conducted by six American Indian researchers using interviews with TKHs collected between December 2021-January 2022. The Hózhó Resilience Model was used as a framework to analyze the data using four parent themes: COVID-19, harmony and relationships, spirituality, and respect for self and discipline. These parent themes were further organized into promoters and/or barriers for 12 sub-themes that emerged from the data, such as traditional knowledge, Diné identity, and vaccine. Overall, the analysis showed key factors that could be applied in pandemic planning and public health mitigation efforts based on the cultural perspective of TKHs.

Teacher and Caregiver Perspectives on Water Is K'é: An Early Child Education Program to Promote Healthy Beverages among Navajo Children.

The Water is K'é program was developed to increase water consumption and decrease consumption of sugar-sweetened beverages for young children and caregivers. The pilot program was successfully delivered by three Family and Child Education (FACE) programs on the Navajo Nation using a culturally centered curriculum between 2020 to 2022. The purpose of this research was to understand teacher and caregiver perspectives of program feasibility, acceptability, impact, and other factors influencing beverage behaviors due to the pilot program. Nine caregivers and teachers were interviewed between June 2022 and December 2022, and a study team of four, including three who self-identified as Navajo, analyzed the data using inductive thematic analysis and consensus building to agree on codes. Five themes emerged, including feasibility, acceptability, impact, suggestions for future use of the program, and external factors that influenced water consumption. The analysis showed stakeholders' strong approval for continuing the program based on impact and acceptability, and identified factors that promote the program and barriers that can be addressed to make the program sustainable. Overall, the Water is K'é program and staff overcame many challenges during the COVID-19 pandemic to support healthy behavior change that had a rippled influence among children, caregivers, teachers, and many others.

Engaging Native American High School Students in Public Health Career Preparation Through the Indigenous Summer Enhancement Program.

Native American populations are systematically marginalized in the healthcare and public health workforce. One effective approach to reduce health disparities and improve health care delivery among Indigenous populations is to train more Native American health professionals who integrate academic and cultural knowledge to understand and influence health behaviors and perspectives. Diné College partnered with Northern Arizona University to develop the Navajo Native American Research Center for Health (NARCH) Partnership, funded by the National Institutes of Health. The high school component of the Navajo NARCH Partnership created the Indigenous Summer Enhancement Program (ISEP), a 1-week summer training program providing exposure to health careers and mentorship in pursuing public health careers for Native American high school students. ISEP utilizes the Diné Educational Philosophy (DEP), a Navajo conceptual framework to serve as the foundation of the program. In 2020-2021, due to COVID-19 restrictions, the DEP model had to be incorporated in the Navajo NARCH high school virtual program activities. ISEP used 2018 and 2019 past program evaluation data to inform the virtual programming. Students' perception of the program was collected using an online Qualtrics evaluation questionnaire. Students stated appreciation for program staff, fellow students, peer mentors and culturally relevant learning experiences in both virtual and in-person environments. Recommendations included: expanding the length of ISEP and continuing the hands-on activities and Public Health Leadership series.

Adapting Summer Education Programs for Navajo Students: Resilient Teamwork.

In May 2020, the Navajo Native American Research Center for Health Partnership (Navajo NARCH) was scheduled to launch two summer programs: a 10 weeks-long Summer Research Enhancement Program (SREP) for undergraduate students to learn and practice health research methods and participate in a practicum experience, and a week-long Indigenous Summer Enhancement Program (ISEP) for high school students that introduces a range of health professions and develops leadership qualities. Students accepted into the programs are predominantly Navajo and live within Navajo Nation (NN) during the summer. Due to NN restrictions and CDC guidelines for physically distancing in response to the coronavirus (COVID-19) pandemic, the Navajo NARCH team organized to offer both programs entirely online via Zoom™. This paper explores the instructional teams' adaptation process to maintain a commitment to preserve the programs' supportive environment for exploring and developing strong multicultural approaches in public health and health research. In preparation for online instruction, the team developed and offered workshops for staff and instructors to address anticipated challenges. The team identified the following challenges: technological difficulties, social disconnectedness, consistent student engagement, and facilitation of a practicum research experience. Results showed that program adaptations were successful as the team applied collaborative and holistic approaches, and established social connections remotely with students to offer meaningful research and practicum experiences.

Shaping a Stories of Resilience Model from urban American Indian elders' narratives of historical trauma and resilience.

American Indians (AIs) have experienced traumatizing events but practice remarkable resilience to large-scale and long-term adversities. Qualitative, community-based participatory research served to collect urban AI elders' life narratives on historical trauma and resilience strategies. A consensus group of 15 elders helped finalize open-ended questions that guided 13 elders in telling their stories. Elders shared multifaceted personal stories that revealed the interconnectedness between historical trauma and resilience, and between traditional perceptions connecting past and present, and individuals, families, and communities. Based on the elders' narratives, and supported by the literature, an explanatory Stories of Resilience Model was developed.

American Indian Elders' resilience: Sources of strength for building a healthy future for youth.

This study examined American Indian (AI) elders' resilience to support an intervention to build resilience among AI urban youth. A literature review of peer-reviewed articles that address resilience in AI and other Indigenous elders yielded six studies that focused on intergenerational relationships, culture, and self-identity. In addition, a qualitative research project collected narratives with urban AI elders to document perceptions of resilience and resilience strategies. The combined outcomes of the literature search and research project revealed how resilience is exemplified in elders' lives and how resilience strategies are linked to cultural teachings and values, youth activities, and education.