Healthy Native Community Fellowship: An Indigenous Leadership Program to Enhance Community Wellness

Abstract

The Healthy Native Communities Fellowship (HNCF) is a grassroots evidence-based mentorship and leadership program that develops the skills and community-building capacities of leaders and community teams to improve health status through several intermediate social and cultural mechanisms: (a) strengthening social participation (also known as social capital or cohesion); (b) strengthening cultural connectedness and revitalization of cultural identity; and (c) advocating for health-enhancing policies, practices, and programs that strengthen systems of prevention and care, as well as address the structural social determinants of health. This leadership program uses a community-based participatory research (CBPR) approach and participatory evaluation to investigate how the work of local American Indian and Alaska Native leaders (fellows) and their community coalitions contributes to individual, family, and community level health outcomes.

Engage for Equity: Development of Community-Based Participatory Research Tools

“…The CBPR conceptual model (Figure 1) served as the overarching orienting framework for tool development and testing. Thus, we were able to draw from (a) our own evidence of promising partnering practice benchmarks that could serve as motivational comparisons with partners’ own project-level assessments (Duran et al, 2019; Oetzel et al, 2018), (b) our recognition of the collective reflection power-sharing approach from the seven case studies (Wallerstein, Muhammad, et al, 2019), also rooted in previous experience with Paulo Freire–based liberatory education methodologies (Freire, 1970; Rae et al, 2016), and (c) our analysis of the importance of culture-centered community knowledge systems, including community theories about health problem etiologies and the role of cultural epistemologies for solutions (Wallerstein, Oetzel, et al, 2019). We then added implementation science practices to evaluate testing of our tools of their best fit and acceptability by partnerships for adoption and adaptation (Brownson et al, 2017).…”

Shared Participatory Research Principles and Methodologies: Perspectives from the USA and Brazil—45 Years after Paulo Freire’s “Pedagogy of the Oppressed”

“…Tribal communities have faced some of the worst health inequities in the U.S., with high rates of poverty and unemployment, though they also have demonstrable protective factors of culture, social cohesion, and language. In 2005, the Indian Health Service Preventive Task Force established and funded a Native leadership program, using a strengths-based approach with beliefs of community wisdom, cultural knowledge, social justice, and community empowerment to build “Fellow” teams of change agents among American Indian/Alaska Native (AI/AN) tribal nations and urban Native communities [ 40 , 41 ].…”

“…The University of New Mexico Center for Participatory Research continues to work with the non-profit Healthy Native Communities Partnership, which took over the management from Indian Health Service, to capture these empowerment processes and outcomes to support communities to document their successes. Evaluation results have included community change actions, increased collaborations, policy testimonies, changes in individual knowledge and behaviors, programs based on language and cultural strengths, healthier policies, and reduced disparities [ 41 ]. The challenges to HNCF are many, including the far-flung distances of fellowship teams across the nation, the variability of local tribal resources to address concerns identified by the fellows, and the inconsistent funding for the fellowship itself.…”