Ethnographic Approaches to Alaska Native Health Disparities Research

Principal Investigator: Carol Z. Jolles

Ethnographic Approaches to Alaska Native Health Disparities Research is a culturally informed project that combines investigation of difficulties tied to previous dental health disparities research in Alaska Native communities with preparation of a culturally sensitive, collaborative model with greater potential for positive community receptivity, collaboration and response. The project focuses specifically on the Caries Transmission Prevention in Alaska Native Infants study [or CTP Study]; its research dealt with 11 primarily mainland Yup'ik [Eskimo/Alaska Native] communities in the Yukon-Kuskokwim [Y-K] Delta region of Alaska and was intended to address serious caries conditions that affect Yup’ik infants and children. The CTP Study was a response to widespread dental disease problems among Alaska Native children. The study encountered significant problems, however, and never achieved its objectives.

The premise of the current project is that cultural context and related life history experiences in local communities bear directly on the outcome of research and intervention efforts. The specific objectives are: 1) to conduct in-depth ethnographic research with all stakeholders involved in the CTP Study in order to understand its problems; and 2) to use the resulting ethnographic data to construct a culturally sound model having substantial local-community/research-community collaboration potential for use in Alaska Native communities such as the Yukon-Kuskokwim Delta villages and in other indigenous communities with histories of significant dental health disparities. The research hypothesizes that models relevant to northern indigenous community interests must take into account both traditional holistic Native perspectives of the world and ways of knowing and Western perspectives and social scientific principles in order to succeed.

The study is organized into two phases and addresses three aims.

1.1) In the first phase we will analyze the experience of the Caries Transmission Prevention in Alaska Native Infants project [CTP Study] through investigation of its underlying strengths and weaknesses. Accomplishment will require researchers to conduct in-depth ethnographic investigation and documentation of stakeholder groups involved in the CTP Study. The stakeholders include University of Washington investigators from the Department of Dental Public Health Sciences who conducted the CTP Study; regional health and human services personnel associated with the Yukon-Kuskokwim Regional Health Corporation who were involved in the study; and, members of the 5 Yup’ik communities [the regional hub town of Bethel and four rural villages: Hooper Bay, Kwethluk, Mountain Village and Pilot Station] having the highest levels of participation in the CTP Study. The objective is to achieve a more thorough understanding of the problems encountered by the communities and organizations brought together under the umbrella of the CTP Study and to document the cultural backgrounds of the five participant communities so as to develop baseline ethnographies to serve as a foundation for developing a culturally sound alternative model. Aim 1 will involve qualitative data collection procedures and analyses.

1.2) In the second aim of the first phase we will use the assembled body of ethnographic data from research with all participating entities to develop a model for future use that is considered culturally appropriate by the communities themselves and incorporates greater “ownership” characteristics, that is, a model whose characteristics provide for greater collaboration and cooperation among the various stakeholders and that addresses specific issues of cultural context relative to Y-K Delta Native communities.

2.1) In phase II, we will obtain community-level endorsement for a new study that would serve as a test case for the model with one or more of the Y-K Delta communities as yet to be determined as partners in a collaborative and more culturally sensitive project following completion of Aims 1 and 2.