Year of Award

2021

Document Type

Dissertation

Degree Type

Doctor of Philosophy (PhD)

Degree Name

Public Health

Department or School/College

School of Public and Community Health Sciences

Committee Chair

Kari Jo Harris

Commitee Members

Curtis Noonan, Blakely Brown, Keith Anderson, Jordan P. Lewis

Keywords

American Indian, Community-based participatory research, Exercise, Health Promotion, Native American, Physical activity

Abstract

Background: Physical activity (PA) promotion is acknowledged as a critical component to improve public health among the growing population of older adults in the U.S. American Indian and Alaska Native (AIAN) older adults experience disproportionately high rates of chronic disease and disability compared with non-Hispanic White peers, and demonstrate lower levels of PA, indicating a need for examination of unique factors influencing their PA behavior.

Purpose: This study revealed the current state of PA intervention research among AIAN older adults in the U.S. and utilized best practices to identify factors that can influence the development, adaptation, and implementation of PA interventions among this population.

Methods: In study one, a systematic approach was applied to examine the scientific literature on PA interventions among AIAN older adults. Studies two and three utilized a community-based participatory research approach, qualitative methods, and an appropriate theoretical approach to first identify barriers and facilitators to PA behavior among a sample of rural AI older adults; then characterize contextually-and culturally appropriate factors to inform the selection and adaptation of an evidence-based PA intervention.

Results: The systematic review process yielded three eligible PA interventions evaluated among AIAN older adults in the U.S., none of which described the use of best practices for research among AIAN populations. The sample for studies two and three included AI older adults (N=21) living on a rural AI reservation in the Northwestern region of the U.S. Themes relating to PA behavior were identified; selected themes included barriers of caregiving, lack of social support, and limited community options, and facilitators as personal connection to the land, multigenerational participation, and supportive tribal policies. Recommendations for intervention adaptations included in-person strategies for targeted engagement, preference for group format, and inclusiveness of programming.

Conclusion: This dissertation brings to light the present limited research to increase PA among AIAN older adults and indicates key characteristics of PA behavior and programmatic preferences among a rural AI older adult population. Findings establish a rationale for additional research in this area, and provide a foundation for strengths-based, contextually-and culturally relevant PA promotion strategies addressing unique needs.

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