Stakeholder Informed Recommendations for Culturally Relevant OT Interventions for Native Americans in the United States

PURPOSE: Many health disparities exist among Native American (NA) communities in the United States due to separation from cultural routines, rituals, roles, and environments, through forced relocation, trauma, and assimilation policies. Provider mistrust, racism, microaggressions, and lack of cultural humility training further exacerbate disparities. The purpose of this study was to identify educational and rapport-building strategies for occupational therapists (OTs) working with the native community.

DESIGN AND METHOD: This study examines secondary interview notes (N = 7) from stakeholders in the NA community to understand necessary aspects of culturally-appropriate occupational therapy intervention. Inductive coding methods were used to create nine codes using a ‘Know, Do, Promote’ framework.

RESULTS: Three themes emerged: Know, Do, and Promote. OTs should Know about historical trauma, generational differences between tribes, and cultural variability. OTs should emphasize client-centered practice through the ‘Know, Do, Promote’ framework, use rapport-building strategies, and ask about personal preferences and culture during treatment. OTs should Promote colleague education regarding trauma, cultural humility strategies, and universal principles of ‘good customer service’ for optimal healthcare services.

CONCLUSION: Findings from the study emphasize the strengths and core pillars of occupational therapy that include holistic, client-centered, and occupation-based care. However, NA cultural, psychosocial, and environmental factors must be considered before providing care to this population. Given the variability of native culture, providers should make optimal use of the occupational profile template to identify NA healthcare preferences.

IMPACT STATEMENT: Addressing health disparities is important to improve NA health outcomes. Using the ‘Know, Do, Promote’ framework enhances occupational therapy intervention and NA health.

References

Guadagnolo, B. A., Cina, K., Helbig, P., Molloy, K., Reiner, M., Cook, E. F., & Petereit, D. G. (2009). Medical mistrust and less satisfaction with health care among native americans presenting for cancer treatment. Journal of Health Care for the Poor Underserved, 20(1), 210–226. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2665798/

Walls, M. L., Gonzalez, J., Gladney, T., & Onello, E. (2015). Unconscious biases: Racial microaggressions in american indian health care. Journal of the American Board of Family Medicine, 28(2), 231–239. http://www.jabfm.org/cgi/doi/10.3122/jabfm.2015.02.140194