BackgroundPublic insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.MethodsThis community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.DiscussionThe information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.Trial registrationThis protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404. Registered June 6, 2018.

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After initial instruction in written and spoken Tiwa, young adult participants in the summer language program at San Antonio Pueblo began authoring their own pedagogical materials as a learning activity. Charged with writing pedagogical dialogues to aid in language learning, the students created "the first Native soap opera," as the students described it, which they named As the Rez Turns. In this paper, I analyze the processes of entextualization surrounding the creation of this text, its generic features, and its content, which provides a glimpse into the contemporary lived experience of community members in this community that emphasizes strict control of textual circulation and limiting access to local knowledge. I utilize Philip Deloria's (2004) analysis of Native Americans' engagement with popular cultural forms, and linguistic anthropological work on intertextuality and genre to analyze this example of representation, outlining the extra-and intracommunity generic and ideological "expectations" conditioning the creation of this dialogue to show how the students utilize associated "anomalies" as discursive resources to construct veiled political commentaries and assert the right to author indigenous language materials. By including stylistic and thematic elements outside of and in dialogue with the standard forms of pedagogical language dialogues and contemporary soap operas among other genres, the final text is an example of the ways that indigenous people continue to "creat[e] modernity in dialogue with others" (Deloria 2004:238). Pueblo language ideologies privileging indirection are honored in the creation of this covert political commentary supposedly created as a neutral language learning tool. Thus, As the Rez Turns is an example of a comedy of manners, highlighting membership issues, gender, and indigenous identity in this community.

Indigenous language literacy in Pueblo contexts is both highly controversial and a new site for the enactment of processes of perfectibility, refinement, and control. This essay examines the creation, content, and circulation of an indigenous language pedagogical text at San Antonio Pueblo and the ways that writing is used in prototypically Pueblo ways. This allows for the expansion of understandings of secrecy, literacies, and the importance of examining language in material form. I argue that by considering practices of perfectibility, a critique of the formation of publics arises centering on literacy as a technology of refinement and control rather than anonymous circulation. Indigenous‐language literacy practices at San Antonio Pueblo reflect different understandings of citizenship and political participation that rely on known but indirectly addressed individuals, rather than unknown publics, for their realization.

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