Developing Community Partnerships Through Research to Define Community Well-Being With Three (Diné) Navajo Communities
Condition: Behavior, Health; Mental Health Wellness 1; Community
Study type: Observational

Summary: 
      This community engaged research pilot project begins a process of engaging Navajo community
      members from the communities of Counselor, Ojo Encino, and Torreon chapters in northwest New
      Mexico in critical dialogue and praxis to address longstanding health disparities. The
      research design is based on a Tribal Crit theoretical framework that aims to explore the
      perspectives of community members' understandings of wellbeing from a Diné centered paradigm
      using a community based participatory research approach integrated with a Diné-centered
      scientific research methodology. The proposed aims include using the Diné conceptualization
      of K'é (kinship) to define community wellbeing with future plans to build upon this knowledge
      by developing a community profile survey for obtaining baseline community health information
      that can be used to inform future research studies. A long-term goal of this mixed-method,
      community-based participatory research (CBPR) study is to create a community-university
      research partnership in an Indigenous context by establishing a multi-dimensional,
      Diné-centered research infrastructure with the capacity to improve mental/behavioral health
      outcomes and reduce health disparities. The creation of this infrastructure is a critical
      first step that will make it possible to use health research to positively transform the
      health landscape in Indigenous communities
    

Detailed description: 
      Specific Aims. Indigenous communities experience alarmingly high rates of depression, drug
      and alcohol dependency, school dropout, and suicide. For example, Indigenous youth suicide
      rates are at crisis levels. Unfortunately, research methods used to address these critical
      issues have often failed to provide sufficient understanding of the complex dynamics
      underpinning these challenges in Indigenous contexts. As a result, mental/behavioral health
      interventions have been largely unsuccessful, Indigenous health disparities have actually
      increased, and complex culture-based relationships that influence health outcomes are under
      conceptualized. Solutions to this health disparity dilemma require a new research paradigm.
      Past preliminary work in Indigenous communities in New Mexico (NM) has been illuminating in
      this respect which showed that a lack of wellbeing at individual, family, and community
      levels is associated with traumatic past experiences, a decline in Indigenous cultural
      practices, and decreasing use of the Indigenous language. And, in communities where the
      investigators worked, they were told that researchers have failed to involve community
      members or include community perspectives in the design or implementation of research and
      health interventions. Further, this preliminary work found that Indigenous community members
      associated the rise of 'fracking' activities on their lands by energy companies to negative
      behavioral/mental health outcomes that has implications for defining wellbeing from a
      Diné-centered perspective using a community driven research approach. This proposed
      mixed-method, community-based participatory research (CBPR) study builds on our previous work
      to develop a Diné-Centered Scientific Research (DCSR) methodology in three Navajo (Diné)
      communities in northwestern NM. The goal of this study is to create a community-university
      research partnership in an Indigenous context by establishing a multi-dimensional,
      Diné-centered research infrastructure with the capacity to improve mental/behavioral health
      outcomes and reduce disparities. The creation of this infrastructure is a critical first step
      that will make it possible to use health research to positively transform the health
      landscape in Indigenous communities.

      Aim # 1. To create a community-driven understanding of the concept of research, research
      methods, and research protocols using CBPR and DCSR to develop a unique Diné multi-level
      behavioral health framework. Hypothesis: Creating a community-driven understanding of the
      concept of research, including purpose, ownership of data, methods, protocols, and research
      design will increase the ability of community members to understand what research means to
      them personally and as a community, decrease mistrust that often characterizes attempts to
      conduct research in such contexts, and to be clear on the implications of participating in
      research. Questions: a) What is the community-based concept of research that is articulated?
      b) How does existing community capacity enhance reflection on desired partnership values and
      strategies and how does this change in the process? c) How did creation of the partnership
      impact community trust? d) Did creation of the partnership decrease anxiety regarding
      community research? e). What collaboration factors are achieved/not achieved? Aim # 2. To
      enable the Diné culture-based concept of k'é (relationships) to evoke wellbeing that will be
      enacted as a culturally relevant framework for multilevel mental and behavioral health
      interventions. Hypothesis: Integrating a CBPR framework with a DCSR methodology will enable
      the Diné concept of K'é to empower our community partners to develop culturally based
      interventions to address community-identified health priorities. Questions: a) In what ways
      are the core cultural values of the community mobilized to address health disparities? b)
      What is the community-defined understanding of wellbeing? c) How can K'é, as a cultural
      strengths model, be used to facilitate community dialogue and praxis for transformative
      healing? d) How does K'é influence the way that local elders, traditional practitioners,
      and/or other community members are involved in the design and outcomes of behavioral and
      mental health interventions? Expected Outcomes. This proposed project will demonstrate that a
      research model integrating CBPR with DCSR can improve health outcomes in Indigenous contexts
      through community partnerships focused on critical dialogue and praxis to enable culturally
      relevant interventions driven by the local community. Generalizability. While this research
      is specifically intended to be unique to three Diné communities, the research process has
      implications for doing effective work in other Indigenous communities. Future Research. The
      investigators will apply for an R21 award to build on and validate research concepts and
      knowledge gained from this community partnership research process to generate baseline
      community health information and test community-designed interventions that can be utilized
      for future community revitalization initiatives.

      SIGNIFICANCE Devastating Mental and Behavioral Health Disparities in Indigenous Communities.
      Indigenous communities experience alarmingly high rates of depression, drug and alcohol
      dependency, and suicide. Indigenous youth suicide rates are at crisis levels . In a
      preliminary study, we found that Navajo (Diné) community members associated the rise of
      'fracking' activities on their lands by energy companies to negative behavioral and mental
      health outcomes . However, mental/behavioral health interventions that have been designed for
      implementation in tribal settings using Western models have been largely unsuccessful,
      complex relationships that influence health outcomes are under conceptualized, and Indigenous
      health disparities have actually increased. Solutions to this health disparity dilemma
      require a new research paradigm as well as future prospects for drawing upon Indigenous
      communities' cultural strengths. In preliminary research, community members report that
      'fracking' activities have had a profound negative impact on their entire way of life. To
      heal historical trauma and counter these negative dynamics, there must be an acknowledgement
      and understanding of these "colonially generated cultural disruptions. " By understanding the
      ways in which these external and internal processes occurred and continue to operate, some
      Indigenous communities are beginning to further understand historical trauma and its
      consequences as well as identifying their own cultural strengths to overcome or transcend
      them through community-engaged research approaches . Decolonizing methodologies that use
      Indigenous-centered approaches can help to engage a community in transformative action .

      Culture: An Under-Appreciated Indigenous Asset. Culture is often ignored, devalued, or
      under-conceptualized in health interventions. However, in Indigenous communities, collective
      cultural knowledge and community cultural wealth continues to inform and sustain contemporary
      ways of life . Yet, much of this system of Indigenous knowledge has been marginalized,
      largely underutilized and eroded, and this is particularly true in relation to health
      research. Movement away from Indigenous cultural practices and decreasing usage of Indigenous
      language has made indigenous conceptualization of wellbeing at individual, family, and
      community levels difficult. Increasingly, however, Indigenous communities are working to
      recover, reclaim, revitalize, and restore their cultural knowledge about wellbeing, including
      language, traditional economies, and traditional ecological knowledge. They are recognizing
      to draw on cultural strengths to maintain relationships and partnerships that will be
      sustainable for future generations. They are using Indigenous-centered approaches and
      traditional cultural understandings to guide and inform community-based research projects and
      initiatives. Indigenous communities and researchers are re-centering Indigenous cultural
      knowledge to structure research with Indigenous communities by finding new ways to transcend
      the impacts of historical trauma, cultural genocide, environmental degradation, and
      internalized oppression. Community based participatory research by Indigenous scholars
      working with Indigenous communities can examine these critical issues while considering
      strategic ways in planning for and implementing effective transformational changes to address
      behavioral and mental health disparities that have not been responsive to more traditional
      approaches.

      Theoretical Frameworks and Decolonizing Methodologies for Tribal Health Research. Community
      Based Participatory Research (CBPR): Research with Indigenous communities has increasingly
      turned to CBPR approaches to reduce disparities and strengthen wellness . CBPR is not a
      research method per se, but is an orientation that challenges the traditional roles of
      researcher and researched to examine their roles of power, participation (who is included and
      who excluded) and who is leading the knowledge creation agenda; and as such, directly,
      address the aims of this study by reducing mistrust between the academy and the communities.
      Tribal Critical Theory: Brayboy's Tribal Critical (Crit) Theory emphasizes how "concepts of
      culture, knowledge, and power take on new meaning when examined through an Indigenous lens"
      and the way "tribal philosophies, beliefs, customs, traditions, and visions for the future
      are central to understanding the lived realities of Indigenous people" significant
      implications for change at the individual, family, and community level. For example, when
      research is used as an intervention as embedded within the goals of a research project, the
      research process allows for community engagement and partnerships to grow in a way that is
      essential to creating safe spaces for critical community dialogue and praxis with a focus on
      moving towards healing. Diné-Centered Scientific Research (DCSR) Methodology: DCSR is based
      on the Hózhóogo Na'aadá evaluation process . The Hózhóogo Naa'adá model was developed by the
      late Dr. Larry Emerson and Dr. Herbert Benally through a UNM P20 grant titled Our Journey
      Together. This research methodology allows for the utilization of a Diné-centered research
      lens to identify, evaluate, and assess life on the Navajo Nation and praxis to resolve these
      issues using culturally appropriate principles and values like K'é. K'é is the Diné (Navajo)
      kinship system that honors and recognizes relationships with family, relatives, and others
      based on the core values of love, respect, reciprocity, and responsibility.

      APPROACH. Overview: The proposed study will create a university-community research
      partnership and increase community member capacity for research in 3 Indigenous communities
      in New Mexico (NM) using a culture-based lens. The Navajo communities of Counselor, Ojo
      Encino, and Torreon/StarLake are located in northwestern New Mexico in the easternmost part
      of the Navajo reservation lands. The overall population of the communities is relatively a
      younger population with the average household income of under $20,000 and an unemployment
      average of about 20%. Moreover, these communities much like other Indigenous are experiencing
      many health disparities. All of these communities experienced a decline in population since
      the 1990s due to undercounting and/or community members leaving to seek employment in border
      towns like Farmington. Each community's local governing body or chapter house is part of the
      Navajo Nation's Eastern agency chapter government system. They have partnered to create a
      Tri-Chapter alliance to create an equitable system of revenue sharing to address local issues
      like oil and gas operations and road improvement as well as public safety, education, and
      community development. All of these communities are located in the Eastern checkerboard area
      of the Navajo nation consisting primarily Bureau of Land Management (BLM) lands, individual
      land allotments, Navajo trust lands, and private lands owned by non-Navajos. Many families
      living in these communities live on allotments that are currently being impacted by oil and
      gas drilling operations. In January 2018, a grassroots movement focused on the explosive
      growth of oil and gas activity in the northwest region of the state particularly on the
      Navajo Nation combined their resources to propose a health study focused on a Health Impact
      Assessment (HIA) of the three Navajo chapters. The proposed project will begin this process
      to collect self-reported data to report potential exposure related to shale gas drilling
      activities from Navajo residents living in a five mile radius of oil wells and other oil
      field infrastructure in the Tri-Chapter area of the Navajo Nation in New Mexico. Therefore,
      the investigators will engage community members in critical dialogue about recovering
      Indigenous knowledge and regenerating Indigeneity, our hypothesis and research design are
      based on a Tribal Crit theoretical framework that aims to explore the perspectives of
      community members' understandings of well-being from a Diné centered paradigm using a CBPR
      approach integrated with a DCSR methodology. The proposed project will develop a Dine
      conceptualization of well-being with plans to build upon this knowledge through future
      studies to develop a community profile survey in the hopes of obtaining baseline community
      health information that can be monitored as oil and gas activities are expected to increase
      over the next decade. The PI will submit and obtain both UNM and Navajo IRB approvals and all
      participants will provide signed informed consent. Inclusion Criteria..
    

Intervention name(s): Community engaged research
Intervention type(s): Other
Intervention description(s): The university is working with Navajo communities to conduct an intervention study integrating community based participatory research using an Indigenous research paradigm. The innovative proposed project uses two approaches to build a research partnership to create capacity in the community for community-engaged multilevel behavioral and mental health research. Members from the three Navajo communities have never previously been involved in health research focused on wellbeing. Integrating CBPR with DCSR methodology becomes a powerful innovative intervention as the: 1) the community is driving the research to identify culture-based solutions for health related disparities; 2) the community is provided opportunities through research to center their perspectives and understandings about behavioral and mental health interventions; and 3) the community draws upon their collective community Indigenous knowledge.
Observational model: Ecologic or Community
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The main requirement for participation in this study is self-identifying as a Navajo
        community member (adult or elder over the age of 18) from one of the three Navajo
        communities. Also emphasized in this study are community tribal and (possibly) non-tribal
        members who are service providers and/or tribal employees who work with the local community
        schools, behavioral health or social service organizations..