Concepts and Models of Resilient Health in a Southwestern American Indian Tribe

Purposes/Aims:American Indians (AI) have significant physical and mental health disparity challenges. The purpose of this study was to highlight concepts in American Indian (AI) culture to determine their relationships with two health assessments among members of a Southwest AI Tribe. The specific aims were: (1) to determine agreement and content validity between concepts and items selected from a pre-established database that reflected six concepts, (2) to discover the factor structure of the resulting items, (3) to determine if a relationship existed between the factors and outcomes of psychological distress, (4) to determine if a relationship existed between the factors and outcomes of health related quality of life.

Background:There are significant health disparities experienced by AIs. Health interventions available to AI populations have demonstrated limitations in addressing the AI health disparities as evidenced by ongoing reports of high rates of physical, mental, social, and environmental challenges including: diabetes, obesity, mental illness, trauma, suicide, substance abuse, and obesity.

Methods:This secondary analysis of data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) study (Beals, Manson, Mitchell, Spicer, and the AI-SUPERPFP Team, 2003) explored the factor structure of six cultural concepts (spirituality, respect, reciprocity, relationship, thinking, discipline) in a Southwestern AI Tribe. Structural equation modeling using exploratory factor analysis, confirmatory factor analysis, and path analysis was conducted on the original sample of 1446 Southwestern AI subjects. The health related quality of life measure included both the physical component summary (PCS) and the mental component summary (MCS). The psychological distress measure was the Kessler Distress (K6).

Results: A 3-factor structure provided the best model fit. The latent variables were labeled Harmony, Spirituality, and Respect.  Significant relationships were discovered between Respect and MCS (β=0.382), Respect and PCS (β=0.310), Respect and K6 (β=-0.392), Spirituality and PCS (β=-0.09). No significant relationships were found between Harmony and MCS, PCS, or K6. The study findings contributed to the development of a culturally congruent model of AI resilience while establishing the foundation for the development of culturally informed wellness and resilience measures.

Implications:Future research on AI cultural concepts is warranted to support the development of culturally relevant measures, wellness models, and health promotion interventions for AI populations.