Dissertation title: Exploring Culturally Responsive Indicators for Social Determinants of Health Impacting American Indian and Alaska Native Communities: A Systematized Review Using Publicly Available Data

Dissertation Chair: Dr. Kimberley Freire

Dissertation Abstract:  

Background: The Social Determinants of Health (SDOH) profoundly impact chronic disease outcomes but are not universal across all populations within the United States. SDOH factors affecting American Indian and Alaska Native (AI/AN) communities are distinct yet frequently do not appear in peer-reviewed literature, making it challenging to locate publicly available data for tracking, monitoring, and measuring the impacts of health interventions. These issues are further complicated by the significant impacts of racial misclassification that profoundly affect the undercounting and underreporting of AI/AN individuals in national data systems.

Purpose: The primary goal of this project is to develop a set of indicators and data tools that public health agencies and organizations can use to measure the impacts of SDOH in the AI/AN communities they serve. This knowledge can then be applied to improve program planning, evaluation, and prevention efforts while identifying and addressing gaps in national data sources, thereby enhancing the quality of public health data for AI/AN communities.

Methods & Results: This project used a modified version of the CDC’s Sexual Violence Indicator Framework to systematically review publicly available data sources for SDOH indicators. Five Tribal health experts participated in the project, ensuring it remained community-centered and that the findings could be quickly implemented in public health practice. Out of 59 data sources (e.g., surveillance systems, surveys, and administrative systems), 30 data sources comprising ~252 indicators were selected as indicators for measuring SDOH in AI/AN communities. However, notable gaps appeared across cultural constructs which are viewed as protective factors. Of note, one-third (or 30%) of data sources included in this study collapsed racial identities into ‘AI/AN’ race only or classified biracial AI/AN individuals as ‘Two or More Races,’ which further restricted the sample size, making it challenging to use public data within the context of Tribal health.

Implications for Public Health Practice: Based on the results of this project, recommendations to improve SDOH data quality and cultural relevance include: (1) Create partnerships with Tribes that focus on developing uniform AI/AN racial definitions and culturally responsive strategies to increase data collection across federal data sources; (2) Develop asset-based SDOH measures that can be used in the Tribal Public Health System to promote health equity, and (3) Incorporate qualitative evidence in AI/AN population health assessments which can enhance information and relevance despite small sample sizes and align well with Indigenous scientific methods.