Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT05937087 |
| Other study ID # |
University of New Mexico |
| Secondary ID |
|
| Status |
Completed |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
March 17, 2018 |
| Est. completion date |
June 30, 2019 |
Study information
| Verified date |
May 2024 |
| Source |
University of New Mexico |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial 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
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?
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, the investigators found that Navajo 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 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. 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.
