Ethnic minorities are expected to experience a greater demand for family caregiving than non-Latino Whites due to their projected population growth. Although the consensus of researchers on caregiving and culture finds that the caregiving experience differs significantly among cultural/ethnic groups, the question remains as to how cultural values and norms influence the caregiver experiences. We conducted an interpretative, phenomenological qualitative analysis of focus group transcripts from four groups (African American, Asian American, Hispanic American, and European American) for cultural influences on caregiving. Data were collected in Nevada between December 7, 2009, and August 20, 2010. Thirty-five caregivers participated in this study. We found commonalities among all of the cultural/ethnic groups in their experiences of the difficulties of caregiving. However, there were some significant differences in the cultural values and norms that shaped the caregiving experience. We categorized these differences as: (a) cultural embeddedness of caregiving, (b) cultural determinants of caregiving responsibilities or taxonomy of caregiving, and (c) cultural values and norms underlying the decision to provide care. The significance of this study is that it highlights the culturally perceived mandate to provide care in the African, Asian, and Hispanic American cultures.
Rare in Indian country just sixty years ago, type 2 diabetes mellitus is now woven into the fabric of losses in tribal communities across North America. Westernized lifestyles, with coincident obesity and physical inactivity, are powerful risk factors for this relatively new "disease of civilization." The web of causation is thicker and wider than obesity and physical activity alone, intertwined by historical, economic, environmental, and sociological roots. As diabetes-related morbidity, disability, and mortality continue to increase in communities around the globe, many tribal elders recall when diabetes was almost unknown. They remember being taught how to stay healthy, lessons that were part of their "traditional ecological knowledge," a symbolic and informational knowledge that is grounded in cultural values and practices, and refined through generations of observation, experimentation, and adaptation. In these conversations, the elders' traditional ecological knowledge richly illustrates the cultural capital that supported their survival and helped maintain the health of their communities even when they had to face challenging times. The purpose of this article is to describe a number of dynamic, tribally driven efforts that draw on traditional ecological knowledge to address the problem of diabetes in American Indian and Alaska Native communities.
Purpose and Objectives
We aimed to determine why the Eagle Books, an illustrated series for American Indian and Alaska Native (AIAN) children to address type 2 diabetes, remain viable long after their release. We sought to answer 2 questions: Why did the books maintain popularity? What factors have sustained them?
Intervention Approach
Type 2 diabetes burgeoned in the US after World War II, compounding a long legacy of injustices for AIAN peoples. By the 1980s, their rates soared above those of White people. Concerned for future generations, Tribal Leaders suggested that the Centers for Disease Control and Prevention and Indian Health Service use traditional storytelling to teach children about staying healthy. Public health interventions are most effective when culture and history are integrated into health education, particularly stories to address a relatively new disease for AIAN peoples.
Evaluation Methods
From 2008 through 2013, we conducted a case study among 8 tribal communities to evaluate the uptake of the Eagle Books across Indian Country. To understand the Eagle Books’ sustained appeal, in 2022 we reanalyzed the original case study themes and analyzed for the first time themes that emerged from evaluation results in the Eagle Books’ program literature. These were programs that had independently evaluated their use of the Eagle Books and published their findings.
Results
Outcomes demonstrated continuous application of the Eagle Books in diverse community interventions, influencing children's healthy choices. Community implementers described sustainability components, such as the books’ versatility, flexibility of use, and availability online and in print.
Implications for Public Health
Historical, social, economic, and environmental health determinants intersect with biological and behavioral factors to weave a complex web of causation for type 2 diabetes, beginning early in life. Compelling, colorful stories reflecting traditional wisdom and respect for Western and Indigenous science — through the eyes of a wise eagle, a clever rabbit, a tricky coyote, and kids in T-shirts and sneakers — can positively influence community health.
The COVID-19 pandemic compounds stressors of daily life among American Indian/Alaska Natives. This study investigated the impact of COVID-19 among American Indian/Alaska Natives and non-Hispanic whites by examining depressive symptoms, overall stress, resilience, and coping, utilizing the Transactional Model of Stress and Coping. Of the 207 individuals participating in this study, 109 identified as American Indian/Alaska Native and 98 as non-Hispanic white. Despite demographic similarities, American Indian/Alaska Natives exhibited more stressors related to COVID-19 as well as higher depressive symptom scores compared to non-Hispanic whites. Furthermore, COVID-19 stressors were more positively correlated with depressive symptoms for American Indian/Alaska Natives than non-Hispanic whites. For American Indian/Alaska Natives, the predominant coping processes identified were planful problem solving, escape-avoidance, and self-controlling. This study provides data to support programs and policies centered on improving the psychosocial health for American Indians/Alaska Natives and decreasing COVID-19-related health disparities.
In Brief
Preventing and reducing the onset of type 2 diabetes among American Indian/Alaska Native youth requires educational strategies to affect knowledge, attitudes, and cognitive decision-making skills. In an unparalleled effort to address the growing epidemic of type 2 diabetes in tribal communities, eight tribal colleges and three federal agencies collaborated to develop and implement a kindergarten-through-twelfth-grade (K–12) Diabetes Education in Tribal Schools curriculum. This article outlines the scientific and cultural development of a comprehensive K–12 science curriculum as a targeted health prevention strategy.
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