"I Need Help With the Abortion, so I Won't Have to Ever See or Hear From Him Again": Relationship Barriers Faced by Abortion Fund Applicants in the Rocky Mountain West.

To explore the factors impacting abortion access for abortion fund clients, data from 816 applicants was analyzed using a summative content analysis approach. Nine relationship themes emerged for applicants who cited their partner as a significant factor in their abortion decision-making, including (a) power and control, (b) fear and safety concerns, (c) leaving the relationship, (d) barriers to accessing care, (e) sexual violence, (f) perpetration and victimization, (g) having an unsupportive partner, (h) being partnerless, and (i) having a supportive partner. Abortion funds are a potential resource for those experiencing intimate partner violence and can support survivors through confidential care and referrals.

"'You Just Want to Give me Some Medicine and be on my Way': Preferences, Beliefs, and Experiences Related to Western Medication among Members of a State-Recognized Tribe".

Background: Native American/American Indian (NA/AI) people have higher rates of chronic disease, including substance use and mental health disorders, compared to White Americans. Though pharmaceuticals can be helpful in addressing many chronic healthcare conditions, many people do not take medications as prescribed. NA/AI identity has been found to be associated with lower rates of medication adherence compared to White Americans. Purpose: The purpose of this study is to better understand NA/AI women's perceptions, beliefs, and experiences related to medication. Methods: Thirty-one semi-structured interviews were conducted with NA/AI women from a state-recognized tribe located in the Gulf South. Interviews were transcribed and analyzed using a qualitative description approach. Results: Eighteen women discussed their experiences using medications when asked about their healthcare experiences. Participants identified the following themes in their discussion of medication: (a) Cost of Medication as a Barrier; (b) Negative Side Effects of Western Medication; (c) Fear of Resistance and Dependence; (d) Preference for Traditional Medicine or None; and (e) Lack of Communication around Medications from Providers. Conclusion: Our findings support the growing call for cultural safety within medical settings and integrating NA/AI conceptualizations of health and well-being and traditional practices into western healthcare settings to better support NA/AI people.

'A profound effect on how I see myself and the world around me': what students found meaningful about taking an academic course intended to reduce campus sexual violence.

Sexual violence is common on US college campuses and can result in negative health and academic outcomes. Credit-bearing courses are a possible innovative intervention, but few have been studied, and little is known about enrolled students' experiences. Our institution, located in the Southern United States, developed a semester-long class as a curricular intervention after our institutional climate survey results showed high rates of sexual violence among undergraduate students. Students enrolled in the course wrote a final reflection paper on what they found meaningful about the class (N = 62). Qualitative conventional content analysis was used to examine what students found most salient. Three overarching categories emerged: course content, course delivery and course impact, each with multiple themes. For course content, students wrote about 22 different topics from the class. For course delivery, students discussed the open forum to discuss sexuality, the importance of taking the course in their first year of college and the course structure. For course impact, students discussed gaining new knowledge, questioning prior assumptions, experiencing personal transformation and feeling empowered to act. Results indicated that students had a powerful class experience and that this kind of educational intervention has the potential to positively impact enrolled students.

"'We'd Just Patch Ourselves up': Preference for Holistic Approaches to Healthcare and Traditional Medicine among Members of a State-Recognized Tribe".

Background:Health disparities between Native Americans and white Americans persist due to a variety of factors, including colonization, poverty, and racism. Racist interpersonal interactions between nurses and other healthcare providers and tribal members may also contribute to reluctance among Native Americans to engage with Western healthcare systems. Purpose: The purpose of this study was to better understand the healthcare experiences of members of a state-recognized Gulf Coast tribe. Methods: In partnership with a community advisory board, 31 semistructured interviews were conducted, transcribed, and analyzed utilizing a qualitative description approach. Results: All participants mentioned their preferences, views about, or experiences of using natural or traditional medicine approaches (referenced 65 times). Emergent themes include (a) preference for and use of traditional medicine; (b) resistance to western healthcare systems; (c) preference for holistic approaches to health; and (d) negative provider interpersonal interactions contributing to reluctance in seeking care. Conclusion: These findings suggest that integrating a holistic conceptualization of health and traditional medicine practices into Western healthcare settings would benefit Native Americans.

Developing the Weaving Healthy Families Program to Promote Wellness and Prevent Substance Abuse and Violence: Approach, Adaptation, and Implementation.

Family prevention programs that enhance mental health, wellness, and resilience-while simultaneously addressing violence and alcohol and other drug (AOD) abuse-among Indigenous families are scarce. This gap in culturally grounded and community-based programs creates a critical need to develop and evaluate the efficacy of such prevention programs. This article fills this gap, with the purpose of describing the structure and content of the Weaving Healthy Families (WHF) program, a culturally grounded and community-based program aimed at preventing violence and AOD use while promoting mental health, resilience, and wellness in Indigenous families. The focus then turns to how to approach this process of developing and implementing the program in a culturally grounded and community-based way.

"I Think [Western] Healthcare Fails Them": Qualitative Perspectives of State-recognized Women Tribal Members on Elders' Healthcare Access Experiences.

Elder tribal members are important cultural and spiritual leaders and experts among many American Indian and Alaska Native (AI/AN) cultures. AI/AN Elders play a key role in the maintenance and transmission of traditional cultural knowledge and practices and are highly valued members of AI/AN communities. AI/AN populations face disparities in healthcare outcomes, and the healthcare needs of AI/AN Elders remain an understudied area of research, particularly among tribes in the South and for tribes who do not have federal recognition. Qualitative data was collected through semi-structured interviews among 31 women, all of whom are members of a state-recognized Tribe in the Southern United States. While the interview questions were specific to their own reproductive healthcare experiences, repeated concerns were voiced by the women regarding the health of the Elders in their community. Key findings captured several concerns/barriers regarding Elders' healthcare experiences including: (a) Language and communication barriers between Elders and healthcare workers; (b) Prior negative experiences with Western medicine; (c) Lasting impacts of educational discrimination; (d) Concerns over self-invalidation; (e) Transportation barriers; and (f) Need for community programs. Issues related to these barriers have resulted in a concern that Elders are not receiving the full benefit of and access to Western healthcare systems. The purpose of this analysis was to highlight the concerns voiced by women tribal members on the health and wellbeing of Elders in their community. Opportunities related to the importance of prioritizing and improving AI/AN Elders' healthcare experiences and access are also described.

"When you hear the noise, you know it's love": Family Support in American Indian Communities.

Family relationships are an important source of emotional and instrumental support. In American Indian (AI) communities, families often provide support for women during childbirth and childrearing. The present study sought to gain insight into the influence of family during the pregnancy, childbirth, and childrearing experiences of AI women from a Gulf Coast tribe. A qualitative descriptive research design was used, and 31 interviews were conducted with women from the tribe. The average age of participants was 51.17, and the majority of women had 2 to 3 children. Data was analyzed using a content analysis approach. Themes that emerged include: Influence of Childhood on Participant's Families and Parenting Styles, Significance of Family Emotional Closeness, Significance of Family Physical Closeness, Importance of Taking Care of Family Members, Importance of Family in Childbirth, and Generational Shifts in Caregiving. Results of the study may influence health interventions for this community, and results should encourage health care providers to consider positive implications of including family and community supports in care.

The Multimethod Evaluation of a Curricular Intervention Intended to Reduce Sexual Violence on a College Campus: A Synthesis of Findings and Lessons Learned.

Sexual violence is a major problem on college campuses, and innovative solutions are needed. Our university created a semester-long, credit-bearing, academic course as a curricular intervention intended to reduce sexual violence on campus. In this article, we describe the multiple methods used to evaluate the course, including a pre-post online survey with a quasi-experimental design, a qualitative content analysis of student reflection papers, and semistructured interviews with previously enrolled students conducted by a peer interviewer 3 months after course completion. The synthesis of evaluation findings indicated that an academic course has the potential to positively affect campus climate around sexual violence. Furthermore, using multiple methods enabled us to create a theory of change that illustrates how key course components shaped students' knowledge, attitudes, and behaviors about sexual violence, thereby ideally generating campus change. Results have been used by various stakeholders for both practice-based and scholarly purposes. We provide lessons learned and implications for practice that are transferable to other multimethod curricular intervention evaluations regardless of topical focus, including the many ways in which using multiple methods added value to the study; the considerable investment of time and resources needed when using multiple methods; the challenges that can arise when integrating findings across methods; the major benefits of having a multidisciplinary research team consisting of faculty and students; and the need to engage in critical reflexivity.

"Treat Me like Your Family": Positive Factors that Influence Patient-Provider Relationships for Native American Women.

Although extensive documentation of the health disparities experienced by Native American peoples exists, little research explores experiences of members of non-federally recognized tribes who receive health care outside of the Indian Health Services (IHS) system. Additionally, positive factors that influence relationships between health care providers and tribal members are understudied and are needed to promote health care access. A qualitative descriptive methodologic approach was used to conduct semi structured life history interviews with 31 women who identified as members of a state-recognized, Gulf South Native American tribe. Results identified the following important themes: Do Participants Have a Regular Provider, Personal Relationship With Provider, Feel Provider Cares, Provider Addresses Concern, and Respect for Traditional or Holistic Medicine. These findings suggest health care providers play an important role in impacting the health care experiences of Native American tribal members. Implications for trainings for health care providers are discussed.

The importance of community support for women in a Gulf Coast Indigenous tribe.

Purpose ­: Community support is an integral aspect of health and well-being for Indigenous peoples. The purpose of this paper is to demonstrate the valuable role of community support for Indigenous women specifically, who experience reproductive health disparities at alarming rates. This study helps fill an important gap in Indigenous scholarship by centering the resilience of women and Indigenous tribes and by using a framework that is consistent with Indigenous holistic views of health. Design/methodology/approach ­: The data for this paper was collected as part of a larger study exploring the reproductive health experiences of a state-recognized Gulf Coast tribe. A total of 31 semi-structured interviews were conducted with individuals who identify as women and as members of this tribe using qualitative descriptive methodology. This method is recommended for research with Indigenous communities. A community advisory board with representatives from this tribe provided feedback throughout the project. Findings ­: Themes expressed by participants included Community Closeness and Support; Community Support in Raising Children; Informal Adoption Common; and Community Values of Mutual Aid and Self-Sufficiency. The findings support current literature noting the value of generational and communal ties for Indigenous peoples. Implications of this research include the need to value and support community networks in programs serving tribes, in addition to meaningfully including Indigenous communities in developing interventions. Originality/value ­: This paper centers Indigenous women's resilience, approaches the health and well-being of Indigenous tribes holistically and helps to fill an important gap in literature describing informal adoption (outside the legal system) in state-recognized Indigenous communities.

College Student Perceptions of the Root Causes of Sexual Violence Before and After a Curricular Intervention.

Campus sexual violence is prevalent and consequential. After a climate survey at our university revealed high rates of sexual violence, a semester-long academic course was designed as a curricular intervention for first-year students. This study examines an assignment completed at the beginning and end of the course. Students were asked: "What are the root causes of sexual violence?" Thematic analysis of papers revealed that many students altered or expanded their thinking to more complex, structural factors compared to their initial perceptions. An academic course may broaden students' understanding of the determinants of sexual violence.

Healthcare needs and infrastructure obstacles for a state-recognised Indigenous tribe in the United States.

Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state-recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community-based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life-course interviews with participants of a state-recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state-recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs.

"When You Come Together and Do Everything, It'll be Better for Everybody": Exploring Gender Relations Among Two Southeastern Native American Tribes.

Prior to the imposition of patriarchal colonial norms, Native American (NA) gender relations were characterized as complementary and egalitarian; however, little research has explored gender relations within NA communities today. This study used a community-based critical ethnography to explore contemporary NA gender relations with a purposive sample of 208 individuals from the "Coastal Tribe" and 228 participants from the "Inland Tribe." After participant observation, interviews, and focus groups were conducted, a collaborative approach to reconstructive analysis was used to identify themes in the data. Within these communities, gender relations tended to reflect egalitarian and cooperative but gendered norms, and participants provided examples of how tribal members are transcending patriarchal colonialism. Through the lens of the Framework of Historical Oppression, Resilience, and Transcendence, we theorize how these gender norms may protect families from risks associated with historical oppression and promote family resilience with implications for research, practice, and policy.

"Why I Stayed in That Relationship": Barriers to Indigenous Women's Ability to Leave Violent Relationships.

Indigenous women in the United States are among the most vulnerable to intimate partner violence (IPV), which has reached endemic levels. The purpose of this qualitative inquiry was to understand contextual factors and barriers to becoming liberated from violence. Reconstructive analysis of data from a critical ethnography with a sample of 231 women across two tribes who described IPV relationships identified the following themes: controlling relationships, losing sense of priorities, using children, socioeconomic stress, family pressures, and restricting relationships. Results revealed these tactics, which parallel those used in the patriarchal colonialism of historical oppression, impeded women's liberation from relationships.

Healthcare experiences of uninsured and under-insured American Indian women in the United States.

BACKGROUND: Extensive health disparities exist for American Indian groups throughout the United States. Although insurance status is linked to important healthcare outcomes, this topic has infrequently been explored for American Indian tribes. For state-recognized tribes, who do not receive healthcare services through the Indian Health Service, this topic has yet to be explored. The purpose of this study is to explore how having limited access to health insurance (being uninsured or under-insured) impact American Indian women's healthcare experiences?. METHODS: In partnership with a community advisory board, this study used a qualitative description approach to conduct thirty-one semi-structured life-course interviews with American Indian women who are members of a state-recognized tribe in the Gulf Coast (United States) to explore their Western healthcare experiences. Interview were conducted at community centers, participant homes, and other locations identified by participants. Interviews were transcribed verbatim and findings were analyzed in NVivo using conventional content analysis. Findings were presented at tribal council meetings and to participants for member checking. RESULTS: Themes identified by participants included: (a) lack of insurance as a barrier to healthcare; (b) pre-paying for childbirth when uninsured; and (c) access to public health insurance coverage. Twenty-four women mentioned the role or importance of insurance in discussing their healthcare experiences, which was referenced a total of 59 times. CONCLUSION: These findings begin to fill an important gap in the literature about the health insurance experiences of American Indian tribal members. Not having insurance was an important concern for participants, particularly for elderly and pregnant tribal members. Not having insurance also kept tribal members from seeking healthcare services, and from getting needed prescriptions. In addition to promoting knowledge about, and expanding insurance options and enrollment, increased sovereignty and resources for state-recognized tribes is needed to address the health disparities experienced by American Indian groups.

"There's so much they don't cover:" Limitations of healthcare coverage for Indigenous women in a non-federally recognized tribe.

Access to healthcare is an essential component in addressing health disparities. However, the limitations of insurance coverage, and other barriers in paying for and accessing healthcare have seldom been researched for Indigenous peoples. In addition, state recognized tribes do not have access to the healthcare services provided by the Indian Health Service, and there is a need for research documenting their unique healthcare needs. Qualitative description was used to conduct 31 semi-structured interviews with women from an Indigenous tribe in the Gulf South to understand their experiences in paying for healthcare services. Participants described: (1) Discrimination Based on Perceived Ability to Pay for Healthcare; and (2) Limitations of Healthcare Coverage, with sub-themes (a) Difficulties Understanding Coverage Limitations; (b) Inadequate Coverage; and (c) Limited Choice of Providers. These findings indicate that state-recognized tribal members may need specialized insurance programs, and more comprehensive coverage of healthcare services and medications. Future actions should promote tribal sovereignty and increase access to healthcare resources for state-recognized tribes.

Barriers to Achieving Reproductive Justice for an Indigenous Gulf Coast Tribe.

Reproductive justice is increasingly being utilized as a framework for exploring women's reproductive health experiences. However, this topic has not yet been explored among Indigenous state-recognized tribes who do not utilize the Indian Health Service, and little research explores what other factors impact women's ability to reach their reproductive goals. A qualitative descriptive research methodology was used to explore experiences of reproductive justice among members of an Indigenous state-recognized tribe in the Gulf Coast. Data were collected through qualitative semi-structured life-history interviews with female tribal members. Several key themes emerged illustrating barriers related to women achieving their reproductive desires. These included: (a) High Prevalence of Hysterectomy or Sterilization; (b) Experiences with Infertility Common; and (c) High Frequency of Polycystic Ovary Syndrome or Endometriosis. Findings of this study reveal that Indigenous women face multiple barriers to achieving reproductive justice. This study is unique in exploring the family planning desires and goals, and the barriers experienced in achieving these reproductive desires, for women in a Gulf Coast, non-federally recognized Indigenous tribe. These results contextualize national trends and suggest that Indigenous women in this study experience reproductive injustices that harm their ability to achieve their reproductive desires.

"I Have to Watch Them Closely": Native American Parenting Practice and Philosophies.

One of many ways that Native American (NA) families demonstrate resilience is by parenting children in some of the most adverse contexts in U.S. society. We use the framework of historical oppression, resilience, and transcendence (FHORT) in a critical ethnography to qualitatively explore the parenting philosophies and practices that NAs use to protect children from the risks of an oppressive context. Data were drawn from 436 members of two Southeastern NA tribes. A team-based critical ethnographic data analysis approach was used to analyze these findings, revealing the following themes: (a) "Your Kids Come First": Prioritizing Children's Needs; (b) "They Should Enjoy their Childhood": Sheltering Children from Family Stressors; (c) "I Have to Watch Them Closely": Closely Monitoring Children; and, (d) "There's No Drinking at My House": Preventing Children's Exposure to Substance Abuse. Results indicate that NA parents adopt child-centric mindsets and use a number of positive practices to protect their children from the potentially harmful environments created through historical oppression.

"A Dad Can Get the Money and the Mom Stays at Home": Patriarchal Gender Role Attitudes, Intimate Partner Violence, Historical Oppression, and Resilience Among Indigenous Peoples.

Research has shown that gender role attitudes influence a number of health-related outcomes, including intimate partner violence (IPV). Yet the gender role attitudes of Indigenous peoples - a population that experiences persistent health and violence disparities - have received scant scholarly attention. Using the Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this mixed methodology was to qualitatively explore U.S. Indigenous peoples' gender role attitudes and quantitatively examine how key social determinants of health, including IPV perpetration, historical oppression, and resilience, relate to gender role attitudes. This research integrates qualitative and quantitative data from two Southeastern tribes with a total of 563 unique data sources. Regression analysis revealed male sex and IPV victimization were associated with higher patriarchal gender role attitudes, while historical oppression and resilience were associated with lower patriarchal gender role attitudes. Resilience was also associated with lower "victim blaming." Ethnographic team-based data analysis methods revealed qualitative themes of patriarchal gender role attitudes and gendered socialization processes. This work highlights how key aspects of the FHORT might explain Indigenous peoples' patriarchal gender role attitudes, suggesting the need to redress historical oppression and patriarchal roles through decolonization.

"She's the Center of My Life, the One That Keeps My Heart Open": Roles and Expectations of Native American Women.

Historically, Native American (NA) mothers have proven essential to the survival of their families and communities, yet scant research has examined their roles today. Current gender roles in NA communities are influenced by historical oppression (both historic and contemporary forms) that acted to reverse matrilineal gender norms in favor of patriarchy. The present study sought to explore norms and expectations for women among two NA tribes located in the southeastern region of the United States. The framework of Historical Oppression, Resilience and Transcendence (FHORT), Hill-Collins's concept of "motherwork," and a framework of reproductive justice were used to frame the study and interpret findings. This critical ethnography included data from field notes, semistructured interviews, and focus groups. Reconstructive analysis, a specific type of thematic qualitative analysis for critical ethnographies, was used to interpret data. Participants from both tribes described themes related to the expectations and roles of mothers. These expectations included themes of (a) mothers as caretakers, (b) mothers as the centers of family and role models, (c) women to prioritize family over economic and educational aspirations, and (d) decolonizing norms for mothers. While historical oppression and patriarchal norms have constrained and regulated expectations for motherhood and the domestic roles of NA women, these findings also highlight how women decolonize these norms and find ways to reclaim their power through their roles as mothers.