Native Americans In Healthcare Settings: Identifying Culturally Relevant Spiritual Assessment Approaches

Background and Purpose: The Joint Commission—the nation's largest healthcare accrediting body—requires the administration of spiritual assessments in hospitals, agencies providing addiction services, and other organizations providing services to Native Americans. Although spirituality is linked to health and wellness in many tribal communities, little research has been conducted to ensure that such assessments are administered in a culturally relevant manner. This raises the possibility that helping relationships may be compromised as assessment approaches or tools are used that are incongruent with common Native values. Many conceptually distinct approaches to spiritual assessment have appeared in the literature. If healthcare professionals are required to conduct spiritual assessments with Native clients, it is critical that research be conducted to identify assessment tools that are congruent with common Native American cultural values. Drawing from the concept of social validity (Wolf, 1978), this mixed-method study determined which spirituality assessment approaches—at a conceptual level—are most congruent with Native American values.

Methods: In keeping with Pace et al.'s (2006) recommendations for assessing social validity, a hybrid purposive/snowball sampling strategy was used to identify individuals (N=50, 75% response rate) with specialized knowledge of Native American culture. The mean age of the sample was approximately 50, close to two-thirds were female, and the respondents reported a diverse array of tribal, geographic, and spiritual affiliations. The survey instrument described six conceptually unique approaches to spiritual assessment. Quantitative items asked respondents to rank the degree of cultural consistency of each approach on a 0 (no consistency) to 10 scale (complete consistency). Qualitative items explored the strengths and weakness of each approach. After pilot testing, the survey instrument was mailed to potential respondents. For the quantitative data, means, standard deviations, and modes were computed and reported. For the qualitative data, an inductively oriented constant comparative methodology was used to analyze the data (Padgett, 2008). Using this approach, data were examined across cases for similarities, patterns, and common concepts. In a recursive process, these commonalities were continually compared to similar phenomena across cases to identify, classify, and refine the emerging themes.

Results: The quantitative findings indicated that the process of taking a spiritual history represented the approach that was perceived to be most congruent with common Native values (M=7.06). Conversely, genograms—although widely used with general European American population—were perceived to be the least congruent with Native values (M=5.40). The qualitative responses helped illuminate these findings (e.g., genograms provide a poor cultural fit with the complex non-nuclear, family relationships common in many tribal communities).

Conclusions and Implications: Although spirituality is a key variable in health and wellness for many Native clients, certain spiritual assessment approaches were perceived to be more congruent than others with common Native values. These results have distinct implications for practitioners required to administer spiritual assessments. Namely, assessments are likely to be perceived to be more culturally valid by Native clients if clinically salient information is gathered using a spiritual history.