The Development of a Measure of Alaska Native Community Resilience Factors through Knowledge Co-production

Abstract

Background:

The Alaska Native Community Resilience Study (ANCRS) is the central research project of the Alaska Native Collaborative Hub for Research on Resilience (ANCHRR), one of three American Indian and Alaska Native (AIAN) suicide prevention hubs funded by the National Institute of Mental Health.

Objective:

This paper describes the development of a structured interview to identify and measure community-level protective factors that may reduce suicide risk among youth in rural Alaska Native communities.

Methods:

Multilevel, iterative collaborative processes resulted in: a) expanded and refined constructs of community-level protection, b) clearer and broadly relevant item wording, c) respectful data collection procedures, and d) Alaska Native people from rural Alaska as primary knowledge-gathering interviewers.

Lessons Learned:

Moving beyond engagement to knowledge co-production in Alaska Native research requires flexibility, shared decision-making and commitment to diverse knowledge systems; this can result in culturally attuned methods, greater tool validity, new ways to understand complex issues and innovations that support community health.

The ANCRS is the central research project of the ANCHRR.¹ The first aim of ANCRS is to identify mutable community-level protective factors hypothesized to confer specific protections from suicide risk among Alaska Native youth and to test their relation with suicide and suicide related outcomes in the rural communities of the Yukon Kuskokwim, Northwest, and Bering Strait regions of Alaska. The project is supported and guided at multiple levels by Alaska Native community partnerships organized as part of ANCHRR’s longer-term goals. These goals include an objective to develop and sustain tribal capacity to conduct collaborative research and to use scientific tools to promote and increase Alaska Native youth and community wellbeing.

ANCRS is guided by a Research Steering Committee (RSC) and an Executive Advisory Committee (EAC). The RSC assists in directing the research project, meeting monthly to oversee and guide the study process. The RSC² (https://www.anchrr.org/copy-of-committees) is comprised of 12 long-term research partners from more than 20 years of collaborative suicide prevention work in Yukon Kuskokwim Delta (e.g., Rasmus and Allen)^3–5 and Northwest and Bering Strait (e.g., Wexler and Peter)^6–8 regions of Alaska along with additional tribal leaders, service providers, and researchers interested in using research to further Alaska Native youth wellness. The EAC provides executive level administrative oversight for the entire ANCHRR project, monitoring and informing the tribally engaged research process as well as the outreach activities of the hub statewide. The EAC meets annually, and is made up of Alaska Native directors of tribal health organizations and corporations, chairpersons of Tribal and InterTribal councils, and executives and leaders of nonprofits, service organizations, and advocacy organizations.

ANCHRR also holds statewide annual gatherings that more broadly engage service providers, community stakeholders, youth, and other researchers from all regions of the state. These gatherings typically involve about 100 Alaska Native participants and inform the research through structured dialogue about community resilience, storytelling and illustrative examples of strength and resilience from across Alaska. These gatherings provide a platform for sharing and interpreting evolving research outcomes.

This paper describes the ways in which the multilevel collaborative processes of the ANCRS shaped the development of the Alaska Native Community Protective Factors Scale (ANCPFS). The tool, ANCPFS, intends to assess community-level protective factors in rural Alaska Native communities as part of the first aim of the study. In this paper, we describe the strength-based approaches that pushed our project from community engagement to knowledge co-production. Knowledge co-production means bringing together multiple knowledge systems, including local, Indigenous and Western science.⁹

The central goal of the ANCRS study is to identify vital community assets associated with a reduction of youth suicide risk on a community level. Social determinants play a key role in health outcomes, including in the disproportionately high rates of Indigenous youth suicide.^10–13 In Alaska, from 1960 to 1995, the Alaska Native youth suicide rate increased approximately 500%.¹⁴ This period was one of forced assimilation that included imposed social, economic and political systems change,^15–17 Although diverse communities have different historical and contemporary experiences, this shared colonial legacy means that, in addition to important variations, Indigenous communities also share a broadly similar set of social determinants. However, when considered more specifically, community by community, the conditions and each community’s response to stressors can vary greatly. Likewise, suicide rates can differ dramatically when examined at the level of specific Indigenous tribes or communities.¹⁸ A study of 196 of Canada’s First Nation communities in British Columbia explored the association of “cultural continuity” factors to suicide rates.^19,20 These factors were measured through review of administrative data documenting efforts to secure Aboriginal land titles; self-governance related to education, law enforcement, healthcare; and other potentially protective factors like facilities dedicated to cultural activities. This study found a negative association, meaning that communities with more of these cultural continuity protective factors had lower rates of suicide.^19,20 This landmark study is cited extensively in Indigenous suicide prevention literature, and has been influential in the development of conceptions of community-level resilience factors in Indigenous settings.²¹ However, the study has yet to be replicated and little is known regarding how these factors shape daily life, and which community factors are most impactful for youth health outcomes.

ANCRS aims to identify how these kinds of cultural continuity or protective factors at a community level translate to Alaska Native communities, and what factors may emerge that are specific to local Indigenous knowledge systems and ways of living. Through the structured interview measure, ANCPFS, we seek to identify community factors that may reduce risk for suicide. Our team science²² process involved combining local and cultural ideas together with published literature about social determinants^10–12 of Indigenous suicide to create a measure of community-level cultural practices, organizational relationships, programming, opportunities and governance structures that captures key ways that diverse rural Alaska Native villages may function for the wellbeing of their youth.

Development of the ANCPFS is a first step to identify and measure community-level factors that may reduce the risk of suicide. This is a difficult task, further complicated by the remote, frontier and diverse contexts of the participating villages. The 64 Alaska Native communities in the study are each a federally recognized tribe, and include considerable linguistic and cultural diversity spanning across Inupiaq, Yup’ik, Saint Laurence Island Yupik, Cup’ik, and Athabascan peoples. Communities also span a vast geographic and environmental diversity from coastal and island to riverine and inland communities, and range in population size from 100 to more than 1000. The ANCPFS tool, therefore, is intended to reflect broad and shared understandings of adults within each community, reflecting knowledge about the standard practices, opportunities, and systems that shape community life. To accomplish this goal, the research team embarked on a collaborative process that engaged multiple groups of community members to develop the content of the interview and knowledge gathering process.

METHODS

Starting with the kinds of cultural continuity and community-level factors described in previous research,^18–20 the iterative process of developing the ANCPFS involved monthly meetings with the RSC, annual feedback from the EAC, targeted sessions with diverse community stakeholders, and solicited feedback at the statewide ANCHRR Alaska Collaborative Hub annual gatherings. Table 1 summarizes our team process and timeline.

Table 1.

Collaborative Process Timeline to Develop the Alaska Native Community Resilience Structured Interview (ANCRSI)

Event Number	Date	Event	Description
1	January 2018	1st in-person RSC and EAC meeting	Region wide RSC travels to UAF; adds Spirituality subscale and expands item pool.
2	February–March 2018	Monthly Tele-Video RSC Meetings Subcommittee on Spirituality	Literature review for additional categories and items with RSC meetings to refine. Smaller subcommittee work on Spirituality items.
3	April 2018	1st Collaborative Hub Meeting with members of RSC and EAC included	Collaborative Hub Meeting at UAF with self-selected Collaborative Hub participant review and feedback from across Alaska.
4	April 2018	Pilot the subscales and questions as a survey with focus group after	Pilot survey and focus group discussion with Alaska Native students from rural communities in the 3 study regions
5	May 2018	Tele-Video RSC Meeting	Integrate pilot work feedback, develop response categories
6	May 2018	Stakeholder Consultation	Consulted with rural regional stakeholders to assess relevance and acceptability, and gaps.
7	June 2018	Preliminary psychometric work	Test pilot data internal consistency reliability; remove poor functioning items
8	July–September 2018	Monthly Tele-Video RSC Meetings Subcommittee on Spirituality and Religion	Spirituality and Religion work group identified items, discussed appropriate questions that could be asked, and identified four item parcels of “traditional spirituality,” “organized religion,” “ceremonies,” “engaging in spiritual practices.”
9	September 2018	In Person RSC Meeting	Reviews items and observed a structured interview process. Developed protocols to assist in data collection.
10	October 2018	Training with RHS/HUMS student research assistants	Developed training materials, ethics protocols, and observed practice interviewing conducted by RHS/HUMS student research interviewers.
11	November 2018	RHS/HUMS research assistants begin to conduct telephone interviews using the ANCPFS	Recruitment, consent processes, structured interview script, participant incentives, and research assistant support coordinated long-distance: Data collection using the ANCPFS began.

Note: RSC = Research Steering Committee, EAC = Executive Advisory Committee, UAF = University of Alaska Fairbanks, RHS/HUMS = Rural Human Services / Human Services degree program.

Established in January 2018, the RSC is comprised primarily of rural community members from the regions in which ANCRS focuses, many of whom partnered with the primary investigators on related projects or were recommended by these partners. The members include Alaska Native leaders and service providers from the three participating regions, and researchers from or working in the participating regions. The RSC met monthly by phone and video conference for nine months to discuss the meaning and content of the subscales, and to shape the ANCPFS as a tool to measure Alaska Native community-level protective and resilience factors. RSC members are significant contributors to the science of the research study. This is reflected in how many of these RSC members are co-authors of this paper.

Initially, the ANCPFS subscales were based in Chandler and Lalonde’s^18–20 influential work. The university-based research team developed a first draft based around four provisional subscales that included Effective Services (six items), Community Development (six items), Self-Determination/Local Control (six items), and Cultural Continuity (five items). Then, additional items were added, emphasizing the category of Effective Services to reflect more recent research focused on community resilience.^23–27

To begin to guide the instrument development, the RSC first discussed each subscale and then each question within it. In these discussions, RSC members offered additional concepts or changed (or rejected) questions based on their relevance to a rural Alaska Native context. This process expanded the original 23-item set to 40 items across six revised or new subscales that now included Cultural Health (8 items), Self-Determination/Local Control (10 items), Services (6 items), Livelihood and Recreation (8 items), Community Relationships (4 items), and Spirituality and Religion (4 items). The last scale was particularly noted as a significant oversight in previous research and was added due to its centrality to Alaska Native community life (see Table 2 for a listing of subscales and items at each stage of development).

Table 2.

Alaska Native Community Protective Factors Scale (ANCPFS) Subscale and Item Development

Initial Subscale/Items	RSC, EAC & CH Subscale/Items Preliminary Revisions and Additions	Pilot Subscales/Items (Self Report)	Final Subscale/Items (Structured Interview)
Cultural Continuity	Cultural Health	Cultural Health	Cultural Continuity
1. There are times/places set aside for cultural activities** 2. There are traditional rites of passage that most local youth participate in^^ 3. Local school have times scheduled for Indigenous learning** 4. Indigenous language is used/taught to younger generations^^ 5. There are regular opportunities for youth and Elders to get together^^	1. Does your community have space set aside that is just for cultural activities (song and dance, Elders gatherings, potlatches, etc.)? 2. Are there cultural celebrations your community does every year? Are there ways to make sure everyone can participate in cultural activities? 3. *Are there regular opportunities for youth and Elders to get together? 4. *Are there on-going cultural activities that are open to all? 5. *Do young people speak their Native language? 6. Do most village organizations honor Indigenous practices and values in their policies (e.g. allow parents to bring babies to work, subsistence leave, leave for cultural events)? 7. Are cultural songs/dances being practiced? 8. Are cultural teachings being observed in the community around healthy birth? (pregnancy rules, etc.) 9. Are cultural teachings about growing up observed in the community? (Example: sharing first catch, etc.) 10. *Does the village have enough subsistence food for its celebrations and gatherings? 11. *Are there active and involved Elders who are a part of community decision-making through the tribe, city, school, church?	1. Our community has a place to hold cultural activities (for example ceremonies, Elders gatherings, potlatches). 2. We have opportunities for most all our youth to get together with Elders at least once a week. 3. Our young people can speak our Native language. 4. We have community wide celebrations every year that most all people in the community attend. 5. We teach our traditional songs/dances to many young people in our community. 6. We have enough traditional food to share with everyone at our celebrations and gatherings. 7. We make sure all young people have opportunity to get out on the land to participate in subsistence activities (hunting, fishing, berry picking). 8. We practice traditional healing (gather medicines from the land; take sweats for healing).	1. Do you have a place where people can go to participate in cultural activities like ceremonies, Elders gatherings, and potlatches? 2. If a young person is interested, does your community have opportunities to get together with Elders at least once a week—like through organized service like shoveling snow, time together at sporting events, or through teachings or storytelling? 3. Do most young people learn to speak their Native language [Yup’ik/Cup’ik/Inupiaq]? 4. Do you have community celebrations every year that most people attend? 5. Do traditional songs/dances get taught to most young people? 6. Do you have traditional food at most community celebrations and gatherings? 7. Do most young people have an opportunity to get out on the land to do subsistence activities like hunting, fishing, and berry picking.
Self-determination/Local Control	Self-determination/Local Control	Self-determination/Local Control	Self-determination/Local Control
1. Is there an Elder’s Council in the village that has taken action within the last [how many] years? 2. Schools work with community members and leaders to support their children’s education** 3. There is a tribal court in the community 4. Village governing bodies (tribes, cities, regional organizations) regularly come together to solve problems** 5. Local/tribal option laws are enforced (example: curfew, alcohol restrictions)** 6. Village tribal leaders took action within the past year to address a community problem^^	1. Does the Village Council make decisions and follow through for the good of the community? [governance] 2. *Are local/Tribal option laws enforced? 3. Does your community limit the distribution and sale of alcohol through local/Tribal option laws? 4. Is there an Elder Council? Does the Elder Council make decisions and follow through for the good of the community? 5. *Does your community play a role in the management of land, water and animals? [SLI Walrus Ordinance] 6. Does your community have control over the research done in it? *Does your community have a way to review research done in the community? 7. Is there an active Youth Council? 8. *Is there an active Tribal Court? 9. Does your community have representation on federal/state level boards that make policy?	1. Our IRA or Tribal Council makes decisions and follows through on them. 2. We enforce our local/Tribal option laws. 3. Elders are involved in community decision making. 4. We manage our land, water, and animals [Walrus Ordinance-will make specific to different communities]. 5. Youth are involved in community decision making. 6. We have an active Tribal Court. 7. Our community applied for grants to support our priorities this past year. 8. We have opportunities for youth to work with our community leaders. 9. Our IRA or Tribal Council meetings are well attended by community members. 10. We take responsibility for our own community members when they need help.	1. Does the Tribal Council (or IRA) follow through on policies they make? 2. Does the tribe and/or community enforce its curfew? 3. Are Elders involved in community decision-making? 4. Does your community take actions to manage your natural resources (like land and water)? 5. Does your community take actions to manage fish and game resources? 6. Are youth involved in community decisions that affect them? 7. Do you have an active Tribal Court or other ways Elders and other leaders are part of criminal justice? 8. Has the tribe, city, or some other organization applied for grants to support community priorities this year? 9. Are there opportunities for youth to work with community leaders in paid or volunteer work? 10. Are Tribal Council meetings well attended? 11. Do most people know when the Tribal Council makes important decisions? 12. Does the community have sure ways to help each other when needed?
Effective Services	Services and Infrastructure	Services	Culturally-Responsive Services
1. There is local law enforcement in the village most of the time in the past 5 years a. VPOs and VPSOs are (village law enforcement is) fair and active** 2. Search and rescue, fire-fighting, emergency heat services are available, when needed** 3. Health care meets the needs of community members** 4. The community has ways to ensure all community members have enough food^^ 5. The community has ways to make sure children are safe** 6. There is a consistent way that community members orient new professionals to their community (health providers, law enforcement, school staff, church …)	Education 1. Does your school give credit to students who miss class for subsistence activities? 2. *Does your community ensure that the people providing education to your children receive appropriate professional development training in the culture, community history, and community expectations? 3. *Do the school and other organizations work around subsistence calendars? 4. *Does your local school teach Indigenous (Alaska Native) history? 5. Are community members a part of teaching school children? 6. *Are Elders present in the school during the school day? 7. Is the local Indigenous language taught to children or youth in school? Is the time to teach the local language enough? Infrastructure 1. Is there good enough housing for all? 2. Is gasoline subsidized in your community? 3. Does everyone have running water? Is the water drinkable? Do most people still use honey buckets? Is there a sewer system? Other services 1. Does your village have ways to make sure everyone has food? 2. Has your community (city or tribe) received any ‘soft monies’ grants to support community priorities? 3. *Does your community ensure that the people providing social services receive appropriate professional development training in the culture, community history, and community expectations? Law enforcement 1. *Does your community ensure that the people enforcing the law receive appropriate professional development training in the culture, community history, and community expectations? 2. Was there a VPO/VPSO present in your community for most of the last 5 years? In your opinion, have the VPO/VPSO services been fair and available most of the time? Healthcare 1. Is good health care available in your village? 2. Are mental health services available? 3. Does your community have a PA, NP or other mid-level medical provider? (may be a function of size) 4. Does your community ensure that healthcare and mental health providers receive training in the (or have exposure to) culture, community history, and community expectations 5. Does anyone practice or have knowledge of traditional healing in your community (does anyone gather medicines from the land?; take sweats for healing, etc)	1. Our school and other organizations work around subsistence calendars. 2. Our local school teaches about our [Alaska Native] culture and history. 3. Our Native language is taught in school daily. 4. Our school is open and accepting of community members and community activities. 5. People coming into our community (teachers, service providers, law enforcement) receive training in our culture, community history, and community expectations. 6. Our community has enough programs and services to meet the needs of all of our members	1. Does the school calendar include or allow for local subsistence activities? 2. Do most community organizations allow for local subsistence activities? 3. Does the school teach Alaska Native culture and history? 4. Is the Native language [Yup’ik/Cup’ik/Inupiaq] taught in school daily? 5. Is the school open to having Elders or community members in the classrooms? 6. Do new teachers get training in culture, community history, and community values? 7. Do new service providers receive training in culture, community history, and community values? 8. Do new law enforcement personnel receive training in culture, community history, and community values? 9. Do community programs and services meet the needs of most people? 10. Is the school available for the community to use for large events?
Community Development	Community Relationships	Community Relationships	Community Relationships
1. There are programs in place to make a positive, shared future for the community^^ 2. There are different kinds of activities available for young people 3. There are regular and accessible opportunities to contribute to the community^^ 4. At least # (maybe a % of population) are involved in creating positive community activities 5. There are regular events that bring the community together for celebration/community building 6. There is an active youth council in the village 7. In the past 3 years, did community members in this village have the opportunity to be trained in suicide prevention, ACES prevention, wellness, decolonization or other?	1. *Do community leaders have open meetings with the public? Are they well-attended? 2. Does your community have a long-range plan (a strategic plan)? 3. *Do the organizations in your village get together regularly to plan and coordinate? Are there regularly scheduled joint meetings between the key institutions within your village (tribe, city, school, for-profit, head start, church …)? 4. *Are there regularly-scheduled activities for youth: After school? In the summer? 5. Do the agencies in your community (such as the Tribe, Corp., City) work on projects together? Have there been any projects within the past 5 years that involve 2+ community institutions? (need examples)	1. Our community leaders have open meetings with the public when making big decisions. 2. Our community organizations meet together at least monthly to plan and coordinate (tribe, city, school, for-profit, head start, church). 3. Our community has regularly-scheduled activities for youth in the summer. 4. Our community organizations work together to deliver programs and hold activities.	1. Do community leaders seriously consider public input when they make big decisions? 2. Do organizations like the Tribe, city, school, and corporations meet together at least monthly to coordinate? 3. Do you have activities for youth in the summer like culture camp or basketball camp? 4. Do community organizations work together on activities like a prevention program, anti-bullying program, or parenting classes? 5. Do the leaders of the different community organizations work well together?
		Livelihood and Recreation 1. We have job training opportunities in our community. 2. We have local businesses and/or a community development cooperative (YDFDA, CVRF, etc). 3. We have an active community group working on wellness. 4. We have a place with public internet available to everyone. 5. We have at least one playground. 6. We have a place people can gather together for meetings and activities. 7. We have safe public places for young people. 8. There is transportation available for young people to go out on the land and participate in activities.	Community Opportunities and Support 1. Does your community have job training opportunities? 2. Does your community have jobs for most youth in the summer? 3. Do you have a community development association to help people go into business, like an office of the Yukon Delta Fisheries Development Association, Coastal Villages Region Fund, Bering Sea Fisherman’s Association? 4. Do you have an active community group working on wellness? 5. Do you have a place with public internet available to everyone? 6. Do you have safe public places for young people? 7. Do you have a place people can gather together for meetings and activities? 8. Do you have organized activities for young people to go out on the land?
	Spirituality 1. Do the Churches in your village work with each other? Like to put on events or coordinate schedules of youth programs? (Skip if only 1 church) 2. Do religious/spiritual spaces have both youth and Elder events? 3. Are there scheduled religious/spiritual services in your community? 4. Does your community regularly practice cultural ceremonies and rituals?	Spirituality and Religion 1. Churches in our village work with each other for the benefit of our people. (e.g. coordinate schedules of youth programs). (Skip if only 1 church) 2. Church teachings and traditional teachings are both supported. 3. Church services are well attended in our community. 4. Our community practices our traditional ceremonies.	Spirituality & Religion 1. Does your community have many spiritual leaders? 2. Are most youth taught about traditional spirituality? 3. Do many people practice traditional ceremonies (like specific dances)? 4. Do many people engage in traditional/spiritual practices (like Inupiaq or Yupik naming)? 5. Do many youth go through a traditional rite of passage when they become a man or woman (like having a first catch or first dance)? 6. Do people practice traditional healing like gathering medicines from the land, or taking sweats for healing? 7. Are church teachings and traditional teachings both supported? 8. Do churches work with each other, like to coordinate schedules of youth programs? (Skip if only 1 church) 9. Does the church support your community’s traditional beliefs? 10. Does the church support your community’s traditional spiritual practices (like Inupiaq/Yupik dance)? 11. Are church services well attended? 12. Do many people do Christian spiritual practices?
Response options: Yes, No	Response options: Yes, Not Recently [in the last 5 years]	Response options: Strongly Agree, Mostly Agree, Mostly Disagree, Strongly Disagree, Don’t Know Focus Group Discussion Questions++	Response options: Yes, Sort of, Not yet or No

Note: RSC = Research Steering Committee, EAC = Executive Advisory Committee, CH = Alaska Native Collaborative Hub for Research on Resilience (ANCHRR) Alaska State-wide Collaborative Hub Meeting.

^*Modification made to reflect Alaska Native communities

^**Item developed out of review of previous research

^{^^}RSC identified this as an additional important area of content

⁺⁺

Focus Group Questions: After each section, Alaska Native participants from rural communities who filled out the survey were asked:

• Which of these questions was easy to answer?
• Do you think most people in your community would answer the way that you did? Why or why not.
• What did you think about when you read it?
• What made it tricky to answer?
• How would you say this question in your own words?
• What do you think would make this question easier for community members to answer?
• If the question was made clearer, do you think most people in the community would answer it the same way? Why or why not?

After the whole survey was completed, researchers said to pilot participants:

• Thank you! We appreciate your guidance in helping us capture key ways that communities are working toward cultural health, self-determination, responsive services, healthy community relationships, livelihood and recreation, religion and spirituality. We are hoping the survey covers factors that all communities can answer. We also want to questions to be as ‘objective’ as possible, meaning that most people in the community could easily agree on the answer (such as: “Is there a playground?).

What are other questions we should ask?

To get a wider perspective on the relevance of the community-level protective factors, community members, researchers, and Indigenous leaders were invited to participate in a session focused on researching community-level resilience during the first statewide annual Collaborative Hub Gathering in April 2018.²⁸ At the event, university researchers and RSC members conducted a modified “World Café.” ²⁹ Participants moved around to different tables for each subscale to offer and document their perspectives about the acceptability of the questions, their relevance, possible concerns or confounders, and suggestions for improving the clarity or relevance. This input facilitated further modifications.

To expand our exposure to critical perspectives about the relevance and acceptability of the subscales and specific items within the tool for rural community members, we then hosted three focus group sessions, recruiting from the main University of Alaska Fairbanks (UAF) campus and the rural UAF Kuskokwim campus, which serves all three key regions of the ANCRS study. A total of 50 Alaska Native, predominantly “nontraditional” or older, university students from the three participating regions, completed the draft survey individually in a self-report format. After doing so, members of the research team facilitated a cognitive interviewing process with these students about each subscale, the clarity of each item within it, and the relevance of the question to the students’ home communities. For each item, students were asked to suggest improvements to increase clarity and relevance, and their answers were used to adapt the survey (see Table 2 for the items and focus group questions).

As an additional step, the RSC participated in an exercise whereby a mock structured interview with a member of the RSC was conducted while the rest of the RSC and research team observed and commented on both flow and content. The process offered the team the opportunity to assess the overall interview process, and to modify the consent procedures, the interview introduction, instructions and response categories to be clearer, more respectful of communities, and non-stigmatizing.

OUTCOMES

The outcomes in this section capture the collaborative development of the ANCPFS and captures the ways that co-production of knowledge can work. RSC and Alaska Native community stakeholders expanded and refined the original construct of community-level protection by revising item wording, making the resulting measure more holistic, practical and responsive through pilot testing and Indigenizing data collection to multiple meaning systems.

Cultural Auditing of a Measure of Community Protective Factors and Processes

The first phase of cultural attunement began with initial input from the RSC and EAC; the four original dimensions of community resilience (Cultural Continuity, Self-Determination/Local Control, Effective Services, and Community Development)^18–20 were revised and expanded (see Table 2, for details on this and subsequent phases of revision through the cultural process). The Services subscale was revised to include infrastructure, the variety of services available (e.g., food assistance), and an acknowledge that effective services may not always be culturally respectful. Community Development was reconceptualized to prioritize Community Relationships, and Cultural Continuity was renamed Cultural Health. Through several work sessions, the RSC developed a significant Spirituality (and later Spirituality and Religion) subscale because of the central importance of spirituality in Alaska Native communities. These meetings focused on how to best capture the historically complex but often impactful contemporary relationships between Western religious institutions and traditional Alaska Native spiritual practices. Additionally, this new subscale aims to capture how traditional spirituality may continue alongside formal religious practice, and to acknowledge newly formed traditions.

The entire process of cultural auditing then involved iterative discussions with the RSC, Collaborative Hub participants, and other Alaska Native stakeholders. The original four subscales were ultimately expanded to include two additional subscales and all subscales included more nuanced and locally relevant components. The RSC member-checked items by confirming and prioritizing aspects of community life viewed as most impactful for youth, and most likely to be shared across communities.

Pilot Testing of the ANCPFS Item Pool

In the next phase, the item pool was piloted with rural Alaska Native university students (n = 50), with focus groups debriefings on clarity and cultural/ecological appropriateness. Items were retained that resulted in subscale coefficient alpha of more than 0.70. Items with high levels of endorsement (> 80% endorsement as yes) or that did not contribute to Cronbach alpha internal consistency on their subscale were identified and revised, or abandoned.

Final Phase Revisions of a Structured Interview to Assess Community-level Resilience

In the final phase, efforts resulted in six subscales that included Cultural Continuity, Self-Determination/Local Control, Culturally Responsive Services, Community Opportunities and Support, Community Relationships, Spirituality and Religion. The response option format for the structured interview was adapted from “strongly agree,” “mostly agree,” “mostly disagree,” “strongly disagree” to instead read “yes,” “sort of,” “not yet,” or “no” in efforts to maintain a strengths-based focus in the protocol that weaves in hope for positive change. A final open-ended section was added to capture other potentially valuable feedback beyond the structured response categories. Expanded instructions were developed to engage participants more fully in assessing their community’s strengths. This collaborative process of knowledge co-production meaningfully expanded our shared understanding of community resilience and adjusted item wording to be more culturally appropriate, linguistically accurate, and locally relevant.

Indigenizing the Data Collection Process

The original plan for data collection proposed university graduate students as primary data collectors. These students would conduct structured interviews by telephone with up to five key local expert community members in each of 64 rural communities across the three regions. The EAC and the RSC both suggested an alternative approach whereby the research team would train and support Alaska Native people from the regions where the study was to be conducted to do the structured interviews. In response, the research team revised procedures to recruit, train, and support Alaska Native students in the Rural Human Services Certificate Program, the Human Services Associate of Arts degree program, and the Bachelors of Social Work degree programs at the UAF Kuskokwim campus. This campus is located in the Yukon Kuskokwim Delta region and draws students from all three regions involved in the study. These rural students reside in their home communities and receive instruction via distance technologies along with one week per month of face-to-face contact in a cohort model. Students recruited to conduct the ANCPFS data collection did so through a paid research practicum, and participated in a multi-day face-to-face research training seminar during their Fall semester (2018). This seminar provided training in research ethics, methods, interviewing skills, study procedures, and prepared them to recruit study participants and conduct phone interviews from their home communities under supervision of practicum supervisors coordinated by a Kuskokwim campus faculty person who is also a RSC member. This key change to the research design contributed to local research capacity building efforts. It also enhanced trust and minimized the possibility of misunderstandings associated with “outsiders” doing research in rural Alaska Native communities. Importantly, these changes further Indigenized the knowledge gathering process, and transformed the research agenda from information gathering to co-production of knowledge. This approach combines interviewer and interviewee local knowledges and increases the potential value of the research to the Alaska Native communities of concern.

The RSC developed and reviewed interview protocols that outlined how the local student “knowledge advocates” (as coined by an EAC member) would administer the structured interview. The resulting protocol includes new regional examples of community resilience factors, a descriptive introduction to each subscale section and specific contextual instructions to help participants interpret their answers based on the targeted construct. For instance, the interview script states, “this first section asks about traditions, language and culture,” and “these next questions ask about local control and self-determination.” These introductions provide the interviewees with ideas about the questions they are focusing on so they are better able to answer. Another element of the process suggested by the RSC, was to invite participants to give additional insights after answering the questions. Participants were told, “please go ahead and give your answer first, and we can talk about your answers after if you want.” Interviewers recorded these comments to assess interviewee perceptions and areas to investigate further. In this way, the collaborative process further developed procedures for selecting people to collect the data and conduct structured telephone interviews, ultimately leading to increased Indigenization³⁰ of the original research design.

The collaborative and multi-layered process of cultural auditing and community member-checking of the categories, questions, and data collection procedures resulted in knowledge gathering that conformed to Indigenous ways of knowing, understanding, and communicating about their world. These outcomes will aid the team in better exploring the mechanisms of community protection in the next phases of research.

LESSONS LEARNED

Inviting guidance from multiple groups of stakeholders represents a process of knowledge co-production on a broader scale than typically done in community-based participatory research. Often in community-based participatory research, researchers partner with one community or community sector. To develop a measure of community resilience that would work across 64 diverse Alaska Native rural communities required ANCRS to involve a broad spectrum of Alaska Native community stakeholder perspectives. The effort was necessary for rigor, in order to attain insight into the multiple and at times conflicting priorities, relationships, and practices that define Alaska Native community resilience. The many levels of engagement—from the RSC, the EAC, to statewide and more grassroots community stakeholder input from the Collaborative Hub gatherings—aided this translational process. Each new audience offered new ways to conceptualize community resilience and new approaches to gather insights and information. This collaborative process provides a fuller perspective on what might constitute effective strategies for building strengths and reducing risk for suicide in young Alaska Native people.

The complex, multilevel, collaborative and strength-based research relationship that guides both ANCHRR and the ANCRS study is also creating an infrastructure for research capacity building in Alaska. This approach moves research beyond community engagement and participation toward co-creation, and agency over research design. Working within the ANCHRR collaborative infrastructure, this first phase of ANCRS provides a case study in moving from engagement to leadership, participation to agency, and data collection to knowledge co-production, in an evolution toward the co-creation of new research findings and knowledge. This movement, as in any other process of change, is not without accompanying tensions and negotiation, challenges and points of reconciliation. But these experiences offer important lessons.

The community-guided processes and outcomes described here provide examples of what collaborative and co-produced research could offer scientific investigations that seek to develop valid and relevant measures. Lessons learned from the inclusive development and design of the ANCPF Interview and data collection process followed a series of steps and missteps. Over time, these steps resulted in an unanticipated implementation outcome with strong potential to increase the construct validity of the ANCPFS, including its ecological and consequential validity as an assessment tool. These steps included the following.

Creating “Community” from Communities

Composing the RSC, EAC, and Collaborative Hub all required an intentional process of selection and gathering of key representatives from: a) the three study regions (RSC); b) Alaska Native statewide leaders (EAC); c) statewide community, service and research stakeholders (Collaborative Hub). The selection of who represents Alaska Native communities, regions and statewide organizations and who should be included as community advisors on a research oversight board or committee are complex questions often fraught with tension and unclear answers. Our team was reminded of the importance of the relational network and its workings at multiple levels in Alaska in this process. The research team also relied on Alaska Native co-investigators and built administrative oversight (the EAC) into the ANCHRR administrative core to inform these early decisions, and then also stayed open to adding new members as the project evolved. A challenge we continue to face, due to the vast geography and diversity of Alaska, is overlooking or unintentionally leaving key stakeholders out of the process. We reconcile this challenge by continuing to push along the edges of our social networks and intentionally creating spaces at our annual collaborative hub gatherings and throughout our process for more voices to emerge, be heard, and invited into more formal roles.

Culturally Auditing the Researchers

The university researcher openness to allow themselves, as researchers, to be audited was essential, and such review became a critical function of the RSC. This cultural review can bring forth discomfort for university researchers, particularly for those who hold a narrow perspective of Western science, who may feel their ideas and notions are being assessed with an unfamiliar metric that may include different priorities and values. Fortunately, this essential cultural review was familiar to the university researchers on the ANCRS project because of previous work, and was one of the intended purposes in forming the RSC. Although it was intentional, it nonetheless posed challenges for the university researchers, particularly as scales, subscales, and items moved wholly away from original concepts, and became more Indigenized to community and cultural contexts. At times, new constructs emerged that had not appeared in the literature, such as the attempt to measure spirituality on a community level, or to explore areas of ongoing community tensions, such as co-existence and collaboration between traditional and western spiritual traditions. Missteps can occur in collaborative processes with Indigenous communities, particularly when university researchers object to community guidance, or are reluctant to reflect on their own practices and deploy scientifically rigorous methods in ways that respond to cultural and community driven priorities. Deploying the values and worldview of diverse knowledge systems can synthesize the strengths of each.

Negotiating Ways of Knowing

Reflecting collaborative partnerships between university researchers and AIAN communities that span decades,^3–8 ANCRS provides an example of ways the field is progressing, as it moves further along a continuum, from engagement and participation, to leadership and agency and from collaborations with one community to research that responds to many. Implicit in this work is an understanding of existing and potential tensions, a commitment to the centrality of negotiation and power sharing, and respect for alternative views. It is an exciting time to witness the increasing leadership of AIAN people who are doing collaborative research to harness Indigenous strengths and utilize Indigenous knowledge systems to understand and support communities’ health. A new perhaps fortunate challenge can be for university researchers to increasingly negotiate co-production of knowledge and practice; recognizing that the perspectives and methods they offer may not be perceived as greater or even of equal value to knowledge held by Indigenous Elders and community members. In this role, university researchers act as advisors, offering information that may be taken up and integrated, or alternatively, could well be rejected, deemed irrelevant, or unproven within an Indigenous knowledge system. A key strategy for navigating the inevitable tensions that can arise in such projects is paying continual attention to relationship building and mutual acknowledgement of the value added by all the invested members.

Becoming Co-Producers of Knowledge

Developing the ANCPFS has involved multiple negotiations that have, at times, tested power dynamics and patience between the drivers and agents of the research agenda. Reconciling scientific demands and community needs, values, and priorities requires a shared recognition that each team member has something of unique importance to offer, and is critically important to the work. All are co-producers and all should receive credit and acknowledgement for their contributions, variously as knowledge advocates, cultural advisors, community co-researchers, Indigenous methodologists, science ambassadors, and, as one of our Alaska Native RSC colleagues describes some of the university researchers in Yup’ik, cugyun or “measuring sticks.”