Table 3. Qualitative Themes Identified During Focus Groups and Interviews With Older American Indians Discussing Health, Arthritis, and Physical Activity Programs, Oregon, 2013.

Domain	Sample Quotations
Domain 1: Meaning of Health
The meaning of health is informed by cultural teachings passed down from elders and family	• “We had traditional meals (when we were raised) like. . . Indian roots. . . . That’s what (my grandparents) taught you, was to eat healthy foods and not . . . the stuff they have now.” (Female, I1)   • “I was raised . . . with my uncles. They were there to give you good advice. . . . Always some way to take care of your body.” (Male participant, FG1)
Health is holistic	• “(Health is) taking care of your body physically, spiritually, emotionally, honoring your food.” (Female participant, I7)
Living a healthy lifestyle is central to health	• “(Health) means if I want to live or die, I’ve got to stick to my diet and do my exercise because . . . being healthy is going to keep me alive.” (Male participant, I15)
Health is the ability to move, to be active, and to take care of self and others	• “(Health is) where you can be more active at cooking . . . taking care of yourself. And take care of children and able to work.” (Female participant, I5)   • “(Health is) to be able to get up every day, get out of bed, feed myself, and dress myself.” (Female participant, I11)
Health is freedom from pain and illness	• “(Health is) getting up without having to take . . . the 8 pills I take and not wait the hour for it to kick in.” (Male participant, I12)
The ability to live a healthy lifestyle has changed over time and affects the community	• “We lived off the land. . . . My grandparents cooked. They canned. They had cellars. I’m talking the old lifestyle that we lived.” (Male participant, I15)   • “We have youth that aren’t well and they could be if they have things to look forward to like knowing more about health. . . . Some kids don’t have that. They don’t have the guidance and they need somebody to show them that there are better things for your body.” (Female participant, I1)
Domain 2: Living with arthritis
Description of arthritis pain ranges from minimal to severe	• “It doesn’t really bother me much . . . it’ll come and go.” (Female participant, I1)   • “Literally, some days . . . I wake up crying because it hurts so badly, and I just don’t want to do nothing.” (Female participant, I6)
Arthritis impacts ability to complete activities of daily living, to engage with family, and to do leisure activities	• “I can’t wash my own clothes” (Female participant, I2)   • “It’s becoming less of a joy to go out and feed the horses.” (Male participant, I13)   • “You don’t even want to hold a baby. You might drop it.” (Female participant, FG2)   • “I was bead working before, making moccasins. I can’t do that now.” (Female participant, I3)
Confusion about what arthritis is and where it comes from	• “I don’t know if I have arthritis or osteoarthritis . . . . I don’t know the meaning of either one.” (Female participant, FG5)
Coping strategies
Use of medication	• “With medication (my arthritis is) really good now” (Female participant, I2),   • “(Medicine) didn’t really relieve my pain. It just took the edge off.” (Female participant, I3)
Culturally based strategies	• “What really helped me was going to a sweat lodge.” (Female participant, I6)   • “We have medicinal, Native American plants that we use for arthritis.” (Female participant, FG4)
Distraction	• “(I) try to get (the pain) out of my head.” (Female participant, I5)   • “It’s mind over matter.” (Male participant, I14)
Movement	• “Sometimes (moving) will hurt, but I notice it feels good afterwards. I won’t be stiff and I’ll get around better.” (Female participant, I1)
Access to medical care is challenging because of lack of local doctors, and the perception that Western doctors are not responsive	• “We just don’t have an arthritis doctor for us here on the reservation.” (Female participant, FG6)   • “(Clinicians) don’t really take it to hear that you’re suffering. . . . That’s part of the reason why people don’t go to the clinic. . . . I think it’s natural for Native Americans to go back to old ways without any doctors and attention or somebody to help you out.” (Male participant, FG1)
Domain 3: Barriers and facilitators to physical activity
Barriers
Arthritis or other health conditions	• “It seems like after I had my surgery, I had a harder time walking.” (Female participant, I9)   • “I can only do so much walking and then my stomach and back gets weak. . . . It was several years ago I had a hernia.” (Female participant, I3)
Lack of safe and accessible locations	• “Where you gonna walk without running into all these dogs along (the road)?” (Male participant, I16)   • “Our native buildings should have our own gym.” (Female participant, I11)
Lack motivation or confidence that physical activity will help	• “I guess I just don’t want to be really active.” (Female participant, I4)   • “Physical exertion and stretches. . . . I told myself they’re not helping. I feel like they’re making it worse.” (Male participant, I13)
Facilitators
Focus on family	• “Someday there’s going to be grandkids and I have to be chasing . . . them. So I need to love myself now.” (Female participant, I5)
Fear of getting worse	• “I just don’t wanna get real bad like my friend. . . . She could hardly get around.” (Female participant, I7)
Wanting to be healthy	• “I try to stay on top of it because you know in the long run it is gonna affect me and nobody else.” (Female participant, I8)
Domain 4: Preferences for program design
Interest in learning about arthritis	• “I am very interested in learning . . . pain management through exercise, nutrition and proper care versus the medication side of it.” (Female participant, FG4)
Preferences for group or solitary physical activity	• “I’d rather do it on my own.” (Female participant, I1)   • “I've been looking into going to something like that with more of a structured thing instead of just showing up and hoping someone comes.” (Female participant, I11)
Schedule group classes around other community activities; provide transportation	• “If you could (offer a program) at breakfast (at the senior center), right after it or before it, then you could do that all in one.” (Female participant, I5)   • “My main (barrier to participating) is transportation because I don’t drive.” (Male participant, I12)
Recruit by encouraging community members, engaging youth, and by showcasing successful community members	• “The main thing is to encourage them. I know a lot of people that . . . need that ‘come on let’s be a partner,’ somebody to let them know ‘I’ll go with you.’” (Female participant, I1)   • “(Try) to get youth involvement and family activities they can all do together. It’d be fun. Might get more participation. That seemed to work (on another occasion).” (Male participant, I6)   • “(If you) get people out on the floor and they’re all looking like, ‘Oh, them are Indian guys. They are Indian women. If they can do it, I can do it, too.’” (Male participant, I15)

Abbreviation: I, interview; FG, focus group.