Rhetorical Ruptures: Disconnects Among Indigenous Peoples in Conventional Health and Social Services

Background and Purpose.  Research shows severe health and social disparities among particular groups in the United States (U.S.).  Foremost among these are Indigenous American Indian and Alaska Native (AI/AN) peoples. Significantly, the U.S. Department of Health and Human Services has identified AI/AN peoples as a “priority population” in the National Health Care Disparities Report 2012.  These disparities are typically addressed through conventional health and social service organizations in Native North America. Because these organizations in Native North America are culturally pluralistic and will continue to be so in the future, this study investigates the culture-communication nexus among Indigenous peoples, particularly older adults, and conventional community-based health and social service organizations. Conducted in Alaska, this study aims to improve the well-being among Indigenous peoples by identifying culture-communication hindrances and solutions in conventional health and social service delivery practices in Native North America.

Methods. This research study is a multi-sited, qualitative study resulting from 12 non-consecutive months of ethnographic fieldwork throughout the state of Alaska.  Data collection took place in urban, rural hub, and remote village sites and at micro-(individual), mezzo-(community), and macro-(social, legislative policy) levels.  Among data collected were 22 semi-structured interviews with Indigenous Elders followed by member-checking, field notes and documents from community-based public venues.  Through posted flyers and word-of-mouth at a local community church, senior center and an annual Indigenous cultural event in the state’s largest city, a purposive sampling approach was employed to recruit interview participants.  Following purposive recruitment, a snowball sampling approach was employed for recruiting interview participants.  All major Indigenous cultural groups were represented among interview participants, including the Inupiaq, Athabascan, Yup’ik and Cup’ik, Aleut and Alutiiq, and  Tlingit, Haida, and Tsimshian.  This study incorporates older adult participatory action, community engaged, and relational research principles with Indigenous Elders.  All interviews were transcribed verbatim and randomly selected interviews were coded using ATLAS.ti qualitative software.  Coding of interview transcripts comprised iterative cycles of open and “in vivo” coding followed by focused coding.  Further qualitative analysis included the development of themes as a result of analytic memo-writing and conceptual mapping that incorporated field notes and documents.      

Findings.  Findings indicate a cultural disjuncture exists among Indigenous peoples, particularly older adults, in the service delivery context of conventional health and social service organizations in Alaska.  This cultural disjuncture results from rhetorical ruptures—gaps or discontinuities between the rhetoric of care associated with these conventional health and social service organizations and Indigenous cultural ideologies.  Rhetorical rupturesare repeatedly evident across multiple levels in the service delivery context.          

Conclusion and Implications.  Findings highlight the importance of collective accountability and responsibility in order to achieve health equity among Indigenous peoples. By connecting AI/AN colonial histories to contemporary healing and cultural ideologies to communication codes, social workers can help to identify rhetorical ruptures in service delivery practices.  In doing so, social workers can help to repair these rhetorical rupturesin order to provide culturally relevant services to Indigenous peoples, particularly older adults, in conventional health and social services.