[Re]-Connecting: Experiential Learning in an Indigenous Health Intervention

Background: American Indian/Alaska Natives have one of the highest rates of obesity and related health issues worldwide. Overweight and obesity are associated with increased risk of diabetes, cardiovascular disease, hypertension, pulmonary stress, and orthopedic problems as well as alcohol and other drug-related diseases. This research examines the role of hardship in an intervention designed to address obesity-related health disparities in a tribal community based on principles of wilderness experience programming (WEP). What distinguishes this research from the WEP literature are the cultural aspects of program design, including Indigenous values related to history and place, and culturally-specific understandings of the role of hardship in this type of health program. Additionally, this adds to the literature on WEP by examining in more detail how these challenges promote or produce behavioral change.

Method: Using a community-based participatory research approach, tribal members and supporters re-walked a portion of the Trail of Tears after community members called for a culture-centered intervention to reduce obesity-related health problems. (This tribe was the first to be removed from traditional homelands under the Indian Removal Act of 1830. This forced migration is known as the Trail of Tears.) Analysis drew on qualitative data from tribal members who participated in the Walk: 14 semi-structured interviews (pre- and post-) and two focus groups (N=9). Transcripts were analyzed using an inductive thematic approach to identify experiential aspects of participant experiences and related changes in health attitudes and behaviors. To provide cultural validity, findings were reviewed with tribal members as they were developed.

Results: This project emphasized experiential learning, personal challenges, and engagement with place to explore changes in participants’ health behaviors related to obesity and connected chronic diseases within the Tribe. The unique setting of this project, drawing not only on the historical significance of the Trail, but the demands of walking and camping challenged participants mentally, physically, and spiritually. From the data emerged the narrative of a journey, facilitated by engaging with an unfamiliar place. In the course of the journey, tribal members were forced to examine, embrace and push through hardship. This resulted in new or renewed relationships to their bodies and visions of health. Three themes emerged: (a) [re]connecting to the body, (b) out of the head and into the body, and (c) reflecting and [re]-connecting. Sub-themes of [re]connecting to the body include: (a) health in unfamiliar places, (b) discomfort, disequilibrium, and doubt; (c) breaking down; and (d) breaking through.

Implications: This analysis suggests that engagement with place and experiential learning facilitated changes in health beliefs, attitudes, and potentially behaviors that may not successfully occur in a traditional, brief therapy session. Deep engagement outside of traditional health service settings should be considered in intervention design and current health services and may be particularly effective in promoting positive health behaviors in Native communities. Wilderness experience programming-informed interventions should consider (1) the ability of hardship to facilitate changes in personal health behaviors and (2) integrating cultural understandings of the role of hardship in knowledge acquisition.