Yappalli: Walking Slowly and Softly to Address Choctaw Health

Background: Health disparities in American Indian/Alaska Native (AIAN) communities are well documented, particularly the effects of colonization and historical trauma. In spite of highly resourced tribal health services in Choctaw Nation, over 70% of the tribe is obese or seriously overweight and an estimated 1 of 3 children will be diagnosed with Type II diabetes by 2050. Many AIAN health promotion efforts do not originate from within the community or reflect Native values and experiences in spite of evidence that best practices are rooted in Native culture. This research examines tribal conceptualizations of health, mechanisms for change in health practices, and implications for intervention design and health promotion.

Method: Using a community-based participatory research model, this research developed through a partnership between Choctaw Nation and a university research institute after tribal members called for an intervention rooted in Choctaw understandings of health by retracing the Trail of Tears. Participants travelled 254 miles over nine days, camping and walking 8-10 miles per day. Analysis drew on two sources of qualitative data from Choctaw tribal members: 14 semi-structured interviews and two focus groups (N=9). Transcripts were analyzed using an inductive thematic approach to identify conceptualizations of health and features of the intervention that facilitated mechanisms of change in reclaiming health practices. To provide cultural validity, findings were reviewed with tribal members as they were developed.

Results: The challenge of walking, living outdoors, being away from homes and the legacy of historical trauma from the Trail combined to force participants “out of their comfort zones”. The unique spatial location and intense immersion facilitated changes in the ways individuals integrated values around health into understanding their own health behaviors. Relationships with other tribal members, stronger tribal identities and understanding “what it means to be Choctaw” emerged as key components in descriptions of health. With relationships came responsibility, another important feature of tribal health values. The physical challenge of the walk resulted in better understandings of and relationships to their own bodies, facilitating an understanding that caring for their own health was a relational responsibility to family and tribe. Balance and holistic views integrating mental, physical, and spiritual aspects of health were highlighted. And the importance of cultural traditions and the need to reclaim traditions and ceremonies within tribal health practices was articulated.

Implications: Culturally-specific understandings of health must inform health promotion and health services. Findings support research suggesting that intervention design must be rooted in cultural values and belief systems. This project incorporated an Indigenous perspective of knowledge acquisition that includes experiential learning and earned knowledges, suggesting the integration of these components in future interventions. It also aligned with Indigenous epistemological issues of spatiality – space and place being important to learning and health and wellness. Interventions that include these components may be particularly successful in AIAN health disparities research, or similar communities, that aim to articulate culturally-specific health promotion models and explore mechanisms of change in health practices