Development of an Instrument for Assessment of Indigenous Historical Trauma as a Social Determinant of Health Among American Indian/Alaska Native Populations

点击翻译按钮获取中文摘要

ABSTRACT American Indian/Alaska Native (AI/AN) populations experience some of the most extensive health disparities in the U.S. for any demographic group. Increasing evidence shows that indigenous historical trauma (IHT) is a likely causal factor for AI/AN health disparities. However, recent research has only begun the process of defining and operationalizing IHT as a construct that could be measured and assessed as a health determinant, and the instruments now available focus primarily on historical loss experience and associated symptoms, though the experience and effects of IHT are likely to be more extensive. Progress is needed to develop validated assessment tools that capture broader and cross-generational aspects of the phenomenon. To address this specific gap in the literature and contribute to the reduction of health disparities among AI/ANs, we propose community-based research that brings together complementary strengths of the Department of Prevention and Community Health (DPCH) at the George Washington University Milken Institute School of Public Health (GWSPH), the Eastern Band of Cherokee Indians (EBCI), and Western Carolina University (WCU) in a partnership to: 1) Use systematic qualitative methods, cultural models theory, and a community participatory approach to elicit/validate characteristics and manifestations of an expanded IHT construct (to include those identified in previous research), followed by scale development procedures to develop and pre- test an expanded IHT instrument that integrates these broader factors; and 2) administer the newly developed IHT scale and health assessment instrument to a sample of 400 Tribal participants to test its internal consistency, reliability, and factor structure. We will additionally evaluate the associations between IHT and behavioral risks/outcomes and priority health conditions prioritized by EBCI, including substance abuse and related issues, violence and abuse, diabetes, stress and depression. Results will be disseminated to EBCI and to the field.