Table 3.

Cultural considerations and adaptations

Theme	Example Quote
Gifting	“When we get a gift from somebody it’s not necessarily the value of whatever, but the symbolic meaning of it, it means I care, or somebody cares…maybe there could be a package of something that has meaning. Cultural meaning.”
Elders	“Somebody or something that they respect in their family, identify an Elder or a family member, and they can do something. A token thing to remember…what they accomplished in their life and that’ll be like a motivator for them, ‘I want to be like this person.’”
Traditions	“Develop an honor song…have somebody to make that honor song, just for your people, who make that circle. That way when that songs sung, they’ll know it and they’ll remember it. Because that drum touches their heart. That drum touches their spirit.”
Language and symbolism	“I know that language…is a good connector…find words that are easier to pronounce in the Native language. Something…short…the word for “good.”
Importance of cultural reinforcers	“Anything that you can have that has a traditional meaning or a historical meaning, it might hit on, hit the heart a little more…it might remind them of a good feeling or a thought they had that they earned this and it’s also culturally significant as well. Because that’s so important, the cultural component to wellness.”