Urban American Indian/Alaska Native Views of the Utilization of Traditional Services

Background and Purpose: Urban American Indian and Alaska Native (AI/AN) populations generally lack access to physical and mental health services due to limited IHS funds, insufficient insurance, no insurance or the lack of culturally sensitive services at non-Indian health centers. The purpose of this study was to conduct an in-depth examination of AIs/ANs who receive services at a behavioral and physical health center that provides culturally sensitive services at American Indian Health and Family Services (AIHFS) in Michigan. We also compared the characteristics of the users of services at AIHFS with those who seek care elsewhere as well as their views on the use of traditional services/traditional medicine.

Methods: This cross-sectional survey used a sample of 389 AIs/ANs age 18 and older living in 8 counties in Southeast Michigan. Participants were recruited from AIHFS client lists, newspapers, flyers, community events, and word of mouth. In person interviews were conducted March-October 2008 and lasted approximately 45 minutes. Questions related to six major themes: 1) health education and health promotion; 2) healthcare and health program funding; 3) systems and regulations; 4) healthcare access-general; 5) healthcare quality and 6) social issues that impact health. Data were analyzed with STATA SE 10.

Results: A higher percent of AIHFS users (60.48%) compared to non-users (33.33%) felt it was very important to receive health care from a facility specifically for AI/AN peoples (p<0.0001) and a higher percent of users (66.67%) were interested in using traditional services/medicine to treat alcohol/drug problems compared to non-users (33.33%) (p<0.0001). Additionally, a higher percent of users (79.38%) reported interest in using traditional services/medicine as a learning experience compared to non-users (43.94%) (p<0.0001). Younger individuals were more likely to be AIFHS users (OR= .84, p<0.05). However, there were no differences between users and non-users and interest in 1) using traditional services/medicine to treat general physical health problems and specific diseases/illnesses and 2) interest in participating in traditional cultural ceremonies such as traditional health, spiritual purification and sweats. Results of multiple logistic regression analyses indicate that the above findings remained statistically significant even after controlling for sex, age, marital status, and socioeconomic status.

Conclusions and Implications: This study found that users of this urban Indian health center want to receive care from an AI/AN health center, want to receive traditional services/medicine to treat substance use problems, want to learn about traditional services/medicine and that no differences exist between users and non-users in terms of levels of interest in participating in traditional services/medicine, and cultural ceremonies for physical health problems. Social workers who conduct research, impact policies and practice need to be aware of these findings as too often the over emphasis on evidence based practice precludes the study of, the funding of and the practice of utilizing more traditional types of services/medicine that have existed for centuries among AIs/ANs.

This research was supported in part by SAMHSA grant # (1HS5 SM05 8836-01). Thank you to the Urban Indian Health Institute/Seattle Indian Health Board and to the AI/AN peoples who shared their stories.