COVID-19 Vaccine Confidence | Rapid Community Assessment Guide 1

Addendum

Considerations for Conducting 

Rapid Community Assessment 

in Tribal Communities

November 2021

U.S. Department of

Health and Human Services

Centers for Disease

Control and Prevention
COVID-19 Vaccine Confidence | Rapid Community Assessment Guide 2

Purpose

This document outlines considerations and guidelines for working with Tribal Communities as part of a Rapid 

Community Assessment (RCA). A full RCA guide with detailed steps and adaptable tools is available on the CDC website.

RCA Step 1: Identifying Objectives & Communities of Focus

Identify Your Objective(s)

American Indian/Alaska Native (AI/AN) community leaders and key community partners should be consulted to 

ensure the assessment objectives align with the Tribal Communities’ needs and perspectives. Examples of objectives 

for engaging in a Tribal RCA may include: 

1. Learning about the communities’ background, values, social norms, and beliefs as they relate to vaccination.

2. Identifying and understanding unique barriers, facilitators, and recommended strategies for vaccination in specific

Tribal Communities.

3. Engaging Tribal Leaders in developing strategies to build vaccine confidence and support uptake.

Identify Your Community(ies) of Focus

When conducting an RCA with Tribal Communities, be sure to properly identify the community to avoid 

misclassification. Here are some common identities that can be used to identify your community(ies) of focus:

1. AI/AN

2. Urban or rural community

3. On or off reservation

4. Ethnicity (Latino/Hispanic)

5. Tribal Affiliation/Tribal Citizenship

Note: If you are unsure of identification, simply ask. Refrain from generalizing terminology such as “mixed-race or other.” 
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Review Existing Data

When reviewing existing data, keep in mind that some data sources may generalize AI/AN communities (e.g., U.S. 

census uses the term American Indians broadly). In preparation for the RCA, consider using Tribal Epidemiology 

Centers (TECs) as a resource. 

TECs:

• Are recognized Public Health Authorities that work in partnership with their local Tribes to improve health

outcomes.

• Can provide epidemiological data and analyses of COVID-19 surveillance data by different socio-demographic

variables to better understand COVID-19 impact on various sub-populations.

• May be able to provide granular analysis of vaccine uptake data for the Tribal Communities they serve.

Note: The capacity of each TEC may vary. Tribes may also have varying relationships with their TECs; some may have a 

strong relationship or, in some cases, a fraught relationship with the TEC for their region. It is advisable to consider the 

Tribes’ relationship with Tribal Partners in their respective areas.

Human Subjects Clearance

If your organization or agency has Institutional Review Board requirements, submit your RCA plan for research 

determination. Whether it is determined to be research or not, rights of participants should be respected and 

prioritized. The following Human Subjects Protections are recommended when working with Tribal Communities:

1. Tribal Government approval: Secure permission and approval of Tribal Government Authorities (e.g., at Tribal

Council meetings).

2. Obtain Data Use Agreement: This agreement grants permission for data collection and release of data from the

Tribes. Obtain this agreement from the appropriate Tribe(s) that grant release.

3. Informed consent: Obtain participants' verbal or written agreement to participate in the assessment. Work with

Tribal Partners to determine appropriate approach to consent (e.g., verbal, written) to ensure acceptability.

4. Vulnerable populations: Take additional steps to protect vulnerable adults, including pregnant people, prisoners,

individuals with cognitive disabilities, and individuals living under violent conditions (e.g., domestic abuse,

political conflict).

5. Confidentiality: Unless quoting a public figure posting in a public forum (e.g., a politician, an influencer), the rule

of thumb is to protect confidentiality of the poster's identity (even in public forums).

6. Recognition of community-level harms and benefits: Potential harms and benefits should be outlined for

participants.
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RCA Step 2: Planning for the Assessment

Identify Community Partners

Identify the key community partners and key decision makers in the Tribe(s) that are empowered to work with you, 

including: 

• Tribal Leader(s)

• Operating authorities

• Governing bodies

Note: AI/AN Tribes are sovereign nations that have a government-to-government relationship with the United States. 

Remain cognizant of this when working with Tribal Nations, and remember to address their leadership appropriately 

(e.g., Councilwoman, Chairman, Governor).

Obtain Support

When engaging community partners and other Tribal Leaders, consider the following:

1. Reach out personally to representatives (e.g., emails, letters).

» Emphasize the benefits of this work to the community.

» Confirm if a Letter of Invitation is needed or required from Tribal Leadership.

2. Avoid the following common mistakes.

» Failing to recognize the cultural diversity that exists among Tribes.

» Not engaging Tribal Leadership from the onset of the project.

» Not providing team members with cultural awareness training.

3. Establish long-term, meaningful relationships.

» Working with Tribal Nations is a long-term engagement. Be transparent and plan to establish long-term

meaningful relationships within the community.

» Examples of community partners that may have established long-term trusted relationships with Tribal

Communities include:

• Partnerships with Native Americans

• The Center for Native Health Partnerships

• The Center for Native Health
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4. Observe, listen, and support the Tribe.

» Be aware and respectful of the Tribe and their culture at all times. Remember you are an invited guest there to

support the Tribe and assist/offer guidance.

» Model the behavior you observe being practiced (e.g., greetings), as some behaviors may be subtle.

5. Do not make promises that you will not be able to fulfill, especially if you are representing a government

agency.

Identify Resources

When planning an RCA, it is critical to identify key resources and partners within the community and how they can be 

involved in the RCA. Organizations to consider include (but are not limited to): 

1. Tribal Public Health Authorities

2. Tribal Chairman

3. Tribally Operated Health Centers (638s) (Title 1 and Title 5)

4. Urban Indian Organizations

5. Indian Health Service

Partners and representatives from these organizations could participate in the RCA in various ways, including: 

• Joining the assessment team to assist with data collection

• Supporting logistics for meetings, focus groups, and surveys

• Facilitating communications and introductions of assessment team members in the community

• Serving as respondents for community interviews

Note: Be mindful that Tribes may have varying relationships with the Indian Health Service division in their region. It 

would be advisable to consider the Tribes' relationships with Tribal Partners in their respected areas. 

Choose Assessment Methods

When choosing assessment methods, think through available budget, time, staff, existing tools, timelines, and 

partnerships. When working with Tribal Communities, also consider traditional norms and cultural significance of 

Tribal and social practices within the community.
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Form the Assessment Team

Ideally, RCA team members should have experience working with Tribal Communities, have a standing relationship 

working within the community, or be from the community. When identifying members for your team, also consider:

1. Working with Tribal Leadership to identify community members to ensure RCA engagements are culturally

appropriate and meet the needs of the community. Tribal Members may defer to elders and veterans in their

community.

2. Including a professional trained in Mental Health First Aid to ensure appropriate supports are provided for

community members during RCA interactions if needed.

Recruit Participants 

When conducting an RCA with Tribal Communities, form relations with Tribal Government and key leaders: 

1. Request permission to attend a Tribal Council Meeting or Tribal Gatherings to discuss the project and what it will

intend to accomplish.

2. Share how the data will be used so they are aware of the benefit of their participation.

3. Seek Tribal Leadership to understand how best to promote RCA participant recruitment within their community.

For example, some communities have less stable internet connections and may suggest other methods than social

media or electronic questionnaires.

RCA Step 3: Collecting and Analyzing Data

Data Collection Tools 

The RCA toolkit offers a variety of data collection tools that can be adapted to Tribal Communities, including 

community interviews, listening sessions, observations, surveys, and social listening. 

When selecting and adapting data collection tools, consider the cultural context, available resources, and preferences 

of the Tribal Community and population of focus. For example, talking circles, similar to listening sessions, are a less 

formal and culturally relevant approach that is a familiar concept in Tribal Communities.

Data Analysis

When analyzing the data you have collected, be sure to include:

• Key findings

• Barriers

• Enablers

• Proposed solutions
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RCA Step 4: Reporting Findings and Identifying Solutions

Report Findings

When developing and presenting findings, consider the following:

1. Include the following report sections: Background, objectives, methods, key findings (disaggregated by

subgroups), and recommended solutions. 

» Work with Tribal Leadership and Tribal Organizations to obtain recommendations on when and how the

data should be shared, including whether a report out to the community and/or assessment participants is

appropriate and desired.

» Findings should be carefully discussed with leaders to ensure that they adequately reflect the community.

2. Maintain Tribal Privacy:

» As a reminder, the Data Use Agreement that grants permission for release of data from the Tribe should be

obtained prior to starting data collection. The data belongs to the Tribe.

» The release of Tribal-specific data without permission is a direct violation of the Tribe’s sovereignty, which

grants them authority to govern release of data. The team must have permission from the Tribal Council

prior to disseminating any assessment reports or results.

3. Avoid terms like “multi-racial” and “other” for racial/ethnic classification.

4. Credit the community for their participation and involvement with the work.

Identify Solutions

When identifying solutions to implement, examine their impact, feasibility, scalability, and sustainability. Proposed 

solutions should also involve key community leaders, Tribal Leaders, and activist groups connected to the community.

RCA Step 5: Evaluating Efforts

After the RCA has been concluded, revisit the objectives to determine if there is enough information about the Tribal 

Community(ies) of focus to make actionable recommendations to increase confidence in and uptake of COVID-19 

vaccines.