Copyright Kluwer Academic Publishers Jun 2004| [Headnote] |
| Alcohol research in Alaska Native communities has a contentious history. This project has attempted to address a critical need for research to guide alcohol abuse prevention and treatment with Alaska Natives using culturally anchored participatory action research. The process of grounding the research methodology in the culture and community is described, along with its contribution to community psychology's understanding of the importance of cultural factors. Tensions between indigenous values and ways of knowing, and Western research methodologies are delineated, along with how these tensions were resolved. Important issues that arose in doing culturally anchored participatory action research are described. These included the development of a community of inquiry, key methodological decisions, the empowerment of participants as coresearchers, and flexibility in research implementation. |
| KEY WORDS: action research; participatory research; culture; American Indian; Alaska Native; alcohol; recovery; sobriety. |
In many Native communities, alcohol abuse remains at epidemic proportions (Alaska Federation of Natives, 1989) and is implicated in a myriad of physical and behavioral health problems. Our knowledge base regarding best practices for effective prevention and treatment with American Indians and Alaska Natives remains underdeveloped. Further, the experience with alcohol research in Native communities, especially in Alaska, reveals a history of practices that have alienated communities (Manson, 1989).
Implicit in the findings generated by alcohol research has been a subtle message about self and community identity for Native people. The research and the media's reporting of it focused on high rates of alcoholism and consequent negative impacts. The dominant narrative (Rappaport, 2000) suggests Native people who drink are alcoholic, alcohol abuse is inevitable, and recovery or protection is rare. This is reinforced through oversimplification of complex genetic theory (Tarter & Vanyukov, 1997) and stereotypes that most Native people have a drinking problem. The narrative ignores the unheard narratives of sobriety and healing among Alaska Natives that celebrate strength and resiliency, along with findings that estimate abstinence rates for American Indians and Alaska Natives that approach 50%, a rate two times the U.S. general population (Levy & Kunitz, 1974).
Past research efforts with Native people have rarely asked for their participation in their design, conduct, and interpretation. Results have been published with scant useful feedback in practices Smith (1999) has described as "colonizing." Guidelines for American Indian and Alaska Native research now highlight community involvement (Council of National Psychological Associations for the Advancement of Ethnic Minority Interests, 2000) and Native ownership of research process and outcomes (Alaska Native Science Commission, 2001a, 2001b). Similarly, implicit in community psychology's empowerment agenda is a view of research as collaborative.
The People Awakening Project is a collaborative relationship between community members and university scientists (Reason & Bradbury, 2001) born out of a history of conflict, the prehistory of the project (Sarason, 1971). The project developed over 4 years into an effort to identify protective and resiliency factors among Alaska Natives who recover from or do not abuse alcohol, using an approach grounded within an Alaska Native cultural worldview (Hazel & Mohatt, 2001). Our approach drew from community psychology perspectives that attend to the context of community (Sarason, 1971) emphasizes empowerment (Rappaport, 1987; Wallerstein & Bernstein, 1994) and the use of participatory action research approaches (Fals Borda, 2001; Gaventa, 1988). This required building relationships in which community members who have been the objects of representational knowledge reflect with the researchers as equal partners, shaping and constructing the research questions, methods, interpretations, and conclusions. This imbues knowledge with the meaning of the participants. It is intended to build conscientization (Friere, 1970), wherein knowledge is emancipatory (Fals Borda, 2001) and generated in a process of empowering communities.
Emphasis on understanding context in community work becomes even more important as community psychologists work cross-culturally. There is growing awareness of the need for researchers to attend to ways culture influences the choice of research questions, methods, and interpretations (Matsumoto, 1994; Montero, 1994; Orlandi, Weston, & Epstein, 1992), and shapes the research process or various research paradigms (Chataway, 1997; Santiago-Rivera, Morse, Hunt, & Lickers, 1998; Tandon, Azelton, Kelly, & Strickland, 1998). From our experience, researchers must closely attend to their own values and beliefs when they are shaped by a Western scientific paradigm. The following case study delineates the struggles and tensions we experienced in creating a culturally anchored (Hughes, Seidman, & Williams, 1993) approach to participatory research. We present the story chronologically. In so doing, we hope to provide the reader with a sense of discomfort, unknowing, and discovery that has characterized our process. Our story is also intended to highlight our appreciation and awareness of the consequential validity of the project's findings in creating community-sanctioned knowledge (Messick, 1995).
PEOPLE AWAKENING ORIGINS AND CONTEXT
In fall of 1995, a 2-day conference in Anchorage, Alaska, brought nationally prominent alcohol researchers to Alaska to share the current state of knowledge on the etiology, treatment, and prevention of alcoholism. Genetic and other biological research, as well as social and clinical research on alcohol and alcoholism funded by the National Institutes of Health (NIH), was presented, with special emphasis on research on American Indian and Alaska Native populations. The audience included academics, researchers, service providers, and members of various Alaska Native organizations. Given that one of the last large research studies of alcohol use in Alaska-the Barrow Alcohol Study-ended in significant conflict (Manson, 1989), enormous suspicion existed among the Alaska Native participants that researchers would violate the trust of Native communities. The researchers shared their research with the media, which led to a newspaper article presenting results that had not been reviewed by the community. The reporting of the results in this manner implied to the people of Barrow that they had been labeled a problem. They felt stigmatized. Many of the people of Barrow and the statewide Native community felt that the researchers had violated the trust that they had put in them to share all results first with them. This led many in the Native community to doubt that research on alcohol would result in respectful treatment of communities and that they could trust the words of researchers. Those of us interested in doing research on alcohol abuse had to face this legacy of distrust. The presentations at the conference did little to dispel that suspicion. Many Alaska Natives, and others in the audience, perceived the discourse as dominated by one-way communication and a deficit focus.
What was clear from this experience was that the social organization of the conference, which was embedded within the culture of the scientific academy, was not "communicatively competent" (Cazden, John, & Hymes, 1972) for Alaska Native participants. It communicated the perspectives and values of the alcohol research community as much as the results of the research. These values include the belief that for research to be "scientific" it must arise out of a particular paradigm, be defined and controlled by the researcher, and involves minimal input from research participants other than as subjects. Could common ground between indigenous and research communities develop to allow for a dialogue from which cultural perspectives could emerge and shape the research process?
A month following the Anchorage meeting the first two authors, both Euro-American university faculty, met with a small group of Alaska Natives (who were not researchers but had significant experience in alcohol recovery or mental health programs) and one Euro-American (who had been involved for decades with Native alcohol programs) to discuss this question and possible future research. Over many later meetings, the members of this group became our coresearchers-the project's coordinating council. As the project progressed, we added additional representation from all the tribal groups.3
During the 1st year of the project, the first two authors listened and translated ideas into potential research questions, methodologies, and potential funding avenues, along with the limitations of each. We worked on consensus, as it is most characteristic of Alaska Native cultural practices. It was important for facilitators of this process to make sure everyone was allowed time to speak to an issue and given enough time for contemplation. Discussions were often long and decisions sometimes made over several meetings. Consequently, the research process time-frame expanded with both positive and negative consequences. On the positive side, this provided the context for community ownership through a culturally based communicative process. On the negative side, from the view of some in the scientific academy this reduces the rapidity of publishing both process and results of the project. In our minds, the positives far outweigh the negatives.
(RE)DEFINING A RESEARCH AGENDA
Interactions within the meetings presented subtle dilemmas. Very quickly everyone agreed that our research should focus on sobriety, rather than on alcohol abuse, and strengths not deficits. The council felt it was important to redefine the research agenda, and our focus on sobriety rather than on alcoholism is a positive step in the redefinition (Seidman & Rappaport, 1986) of alcohol in Native communities, thereby challenging the dominant narrative of alcoholism.
As we began to talk, questions arose which forced us to examine beliefs regarding alcoholism and recovery, as well as the dialogue process within the group. For example, some of council members wanted to develop culturally appropriate interventions, whereas others questioned the common wisdom regarding protective and resiliency factors for Native people. We were unsure as to how we could challenge ideas without alienating each other. In particular, the first author remembers saying during one long discussion, "What people actually experience and what helps them to recover is an empirical question." The use of the word empirical created an immediate sense of a hierarchical power differential. Implicit was a message that the researcher, as someone holding specialized knowledge and language, could tell the community what was right, thereby denigrating their experience. We noticed the reactions of the council members and renegotiated the question. Ultimately, we agreed that we could question our assumptions and try to understand that Native people's stories could teach all of us something new. This initial success at overcoming conflict was based on how we had learned to communicate.
In addition, we were led to frame our project in Alaska Native terms in stressing the importance of not speaking for others and listening to their stories. This required a process that would generate in-depth knowledge, be culturally patterned rather than homogenous for all tribal groups, and tap the person in context rather than object without a community. We chose a methodology suited to discovery that honored the oral traditions of Alaska Native cultures. By collecting people's life stories,4 we would see the person in context, over time, with rich description. The council also stressed sharing these stories to help the community understand their strengths and, in the words of one of the group's members, "to associate" themselves with the lives in the stories to increase awareness and inspire people with their own possibilities.
One of the most difficult decisions centered on who we should invite to tell their story. We first had to determine what we meant by "sobriety." All the council members were intimately aware of the devastating effects that alcohol has had on Native families and communities. The Alaska Federation of Natives Sobriety Movement has been very influential in helping Native people to become "sober." Their definition of sobriety, similar to Alcoholics Anonymous, is one of total abstinence, for both prevention and recovery. Many of our council members had been active in the sobriety movement. However, from a "scientific" standpoint, if our project was to discover the factors that protect people from alcoholism, the researchers felt that the project should also investigate the experience of Alaska Natives who drink and are not alcoholic. The dominant narrative regarding Alaska Natives and alcohol framed the discussion. No one wanted our project to encourage drinking by suggesting a message that anyone can drink alcohol without harm. As we struggled to define who these "nonproblem" drinkers might be, one of the community representatives commented that it sounded like we were talking about people with "one black eye"-people who drink, but deny that they have experienced problems due to their drinking. Several council members doubted there were any healthy Natives who drank alcohol.
We had to seriously consider the consequences of investigating this group on the community in "doing harm." To resolve the dilemma, the council, through at times intense discussion, decided to take a risk and reframe the issue using the "black eye" metaphor. Rather than concentrate on how much a person has drunk or how often, our research focuses on the consequences people have experienced because of drinking. This allowed us to define health in terms that made sense to the community, while maintaining an opportunity to understand resiliency among nonabstinent Native people. It also allowed us to collect life stories from Native people who both fit the Sobriety Movement's concept of sobriety as recovered from alcoholism and totally abstinent, and from Native people who drink without experiencing negative consequences.5 In so doing, we are uncovering hidden narratives of recovery and strengths.
In this process of discussing ideas and agendas for the research, and working through the various tensions, we created a shared sense of comembership and a common base (Erickson, 1975; Hornby, 1993) that allowed a culturally diverse group to begin to work through a prehistory of conflict (Sarason, 1971). Our experience points to the importance of multidirectional communication that breaks down the distinction between researchers and the researched, and the development of a sense of "we" instead of "us and them" (Friere, 1982). To successfully engage in culturally anchored participatory research, the researcher must have a heightened awareness of differences in the social organization of communication-ways of talking, making decisions, and listening-and work through these differences to understand the ideas and concerns of the coresearchers. As power has traditionally resided in the researcher, the challenge for the researcher is to recognize when ideas and concerns are being expressed. In acknowledging their validity, one enters into a truly equal dialogue. Only then can distinctions between researcher and the researched be broken down. Ultimately, we found a bridge to consensus by acknowledging that knowledge and power are intimately connected (Hall, 1981).
NAVIGATING BEYOND THE CULTURE OF PATHOLOGY
The framing of the research question to one of sobriety rather than alcoholism challenged the research team. Both the language of alcohol research and community discourse has been focused on problems and deficits. We found ourselves continually readjusting our discourse and thinking. For example, we would find ourselves discussing how lack of social support, trauma, or a person's disconnection from their Native spirituality increased a person's risk for drinking. The second author, who was steeped in community psychology theory, recognized the deficit aspect of this formulation. She would bring this to our attention and suggest we refocus our discussions and speak about how spirituality gave meaning to peo-ple's lives or how social support facilitated sobriety and wellness. As such, we were all forced to examine our assumptions.
Perhaps the pivotal point in this process of challenging the dominant paradigm was a discussion of Alaska Native wellness and sobriety as embodied in the Yup'ik concept of Ellam-iinga, or the "eye of awareness." Ellam-iinga is the central power in the universe. It provides healing and balance. As people achieve this type of awareness, they participate in the spirit of the universe (Stachelrodt, 1995). Balance is achieved by becoming connected to all areas of the self and community; to the physical, emotional, cognitive, and spiritual aspects, which are embedded within family and community relationships and integrally connected to the land (Hazel & Mohatt, 2001). Although community representatives came from all Alaska Native tribal groups, this Yup'ik concept helped to redirect the discussion from a pathology framework to an attention on resiliency, and from a focus on Western conceptualizations to an indigenous understanding of wellness.
In the process of carrying out culturally anchored participatory research, we have come to also value the Yup'ik concept of Ellanaq-the process of becoming aware (Stachelrodt, 1995). To be aware is to recognize the connections between events and the reciprocal influence of one event on others. Each individual act of awareness is part of the universal eye of awareness, Ellam-iinga. The collective awareness provides the vessel or foundation from which one's own awareness builds. As a person grows in awareness, they build and increase the universal power of Ellam-iinga . The process of awareness is, therefore, reciprocal and synergistic. Ellanaq has become the guiding principle for the project and motivated us toward constructing ways in which we can make our research process more reflexive-thinking and talking about what we are doing, how we are doing it, what we are being told. In addition, we continually think about the potential implications of our research on the communities in which we work. We continually seek out ways to build awareness so that our research may accurately represent the community's knowledge and experience.
THE SEARCH FOR FUNDING
One of the reasons for the conference in Anchorage that began our story was to stimulate research in Alaska on alcohol abuse. We (the university researchers) were encouraged by the National Institutes of Alcohol Abuse and Alcoholism (NIAAA) to develop a research proposal to pursue research in Native communities. As we wrote the grant proposal with technical assistance funded by NIAAA, the tension between the positivistic/quantitative paradigm and our emergent methodology was quickly confronted. The search for funding for qualitative research has historically been problematic. NIH review panels are often composed of individuals from diverse areas, including scientists with biological, epidemiological, and other training backgrounds that may be unfamiliar with qualitative and community-based participatory methodologies. Concerns are often raised with the scientific merit of qualitative methodologies, such as the lack of generalizeable and predetermined research hypotheses. In addition, concerns regarding community participation in the research process and the requisite new relations in research ownership and control of publication make it difficult for participatory approaches to be reviewed favorably. Our council had clearly voiced their desire for a qualitative life history methodology. We were faced with the dilemma of holding onto a methodology that was developed through consensus with our council, but that risked skepticism and rejection from NIH reviewers, or developing a more positivistic and quantitative design that stood a better chance of being funded.
As we discussed the proposal with our technical advisors6 and staff at NIAAA, we were encouraged to combine the qualitative methodology with an accompanying quantitative design. This news, when brought back to our coordinating council, set us back and forced us to reestablish the trust that we had built. The apprehension of some of the council members was that the researchers would co-opt the goal of the community. They shared these suspicions and we shared what both the qualitative and quantitative methods could contribute. Everyone in the group felt that the proposed research was important as a point of departure. Ultimately, they were pragmatic. They agreed to a combined methodology to be able to do the research we had developed through consensus, as long as we continued the participatory process.
After three submittals and reviews People Awakening was finally funded. At least four factors contributed to our success: our sustained persistence and determination in seeking the funding, availability of technical assistance, support of key personnel at NIAAA, and strong support from the Native community. Ironically, in retrospect, although we had considered the culturally anchored participatory approach to be potentially problematic for reviewers, it was consistently praised by them as one of the strongest elements of the proposal and was lauded as a model for working in Native communities. Throughout the process of developing the research agenda, we learned several important lessons about participatory research. First, we learned there are no short cuts; it is a very time consuming process. Second, we learned we needed to continue our dialogue with our coresearchers, our coordinating council, to insure that we did not become divided while attempting to respond to pressures arising out of the NIH review process. Often, we felt pressured to move into a researcher-dominated paradigm rather than a core-searcher model to address reviewer concerns and to cope with time demands for completing tasks and pub-lications.7 Finally, we cannot highlight enough the importance of finding and working with research consultants who had experience with NIH/NIAAA funding and who were appreciative of our commitment to the participatory approach, rather than dominating the process with their own ideas. What we needed were consultants who could provide technical knowledge of methodology and analysis and who also understood and respected the participatory process. Fortunately, we were able to find individuals who appreciated our attention to the details of community participation and to the combination of qualitative and quantitative methodologies. They brought us research expertise in alcohol research, quantitative and statistical methods, qualitative methods, and how to write an NIH RO1 fundable project. They supplemented our community and cross-cultural research expertise. The lesson one takes from this, though simple, is rather important. Consultants need to know how to participate as equals and as collaborators with the community and research team. To ensure that conflict and confusion does not develop between community coresearchers, our research consultants needed to be able to share their expertise without setting themselves up as isolated "experts."
WORKING THROUGH DILEMMAS OF HUMAN SUBJECTS PROTECTION
Once we were funded, People Awakening faced a very complex human subjects review process involving three Institutional Review Boards (IRBs), six regional tribal boards, and numerous village councils.8 Yet, taking the time to establish cooperative agreements is essential for any research in indigenous community. The significant effort, in both time and money, to develop these relationships needs to be understood by funding agencies as well as graduate programs training community action researchers.
As one might expect, working through the ethical intricacies of conducting cross-cultural research is always a challenge, especially with as many ethical review boards as we had on our project. Interesting dilemmas arose as we worked our methodology and consent process through the IRBs and regional tribal boards. Several times, recommendations from the IRBs were in conflict with our council or research participants, and sometimes with each other. For example, local tribal groups and some IRBs indicated that they wanted us only to offer a stipend to research participants. Our coordinating council had suggested a lottery or prizes. IRBs also indicated we should destroy all of the interview tapes after we completed the data analysis to ensure confidentiality. In contrast, our coordinating council wanted us to use these in dissemination and prevention activities. Within the Alaska Native cultural context, the most highly respected individuals are Elders. When we presented the cash for services and the tape destruction requirement, the Elders rejected both ideas. They stated emphatically that their story was not for sale and that they would refuse to participate if the tapes were to be destroyed. They said that the reason they were agreeing to be interviewed was that they could give their story to the community, to help the community. Within the context of the oral culture, it was inappropriate to destroy the record of the tape interview.
In response to the Elders' wishes, our research group went back to the IRBs or boards who had raised these two issues and negotiated a compromise. We modified our consent procedures to allow a person to give the honorarium to charity, to create a positive check-off request procedure for tapes to be preserved, and to develop a procedure that will allow for recontact and reinterview of participants identified through People Awakening for later action-oriented prevention projects. These solutions to our dilemma came from listening to our research participants as coresearchers in the process and members of our coordinating council, thereby grounding the process within the cultural traditions of our participants. Interestingly, culturally anchored participatory research can lead to conflicts within the indigenous community itself about who defines "best" practices, particularly in situations where local community agencies are the gatekeepers for doing the research.
MOVING THE RESEARCH INTO THE COMMUNITY: GAINING PERMISSION AND DEALING WITH RECRUITMENT SUCCESS
Culturally anchoring the research process forced us to reexamine our procedures and goals that had been set prior to entering the setting. We planned to interview 36 people. However, People Awaken-ing's sampling method required locating a minimum of 120 volunteers9 who would be willing to participate in an extensive life history interview (6-9 hr of interviewing). After 152 people volunteered we knew we would have to stop accepting nominations or volunteers. Everyone who had contacted us was very enthusiastic and eager to tell his or her story. In a qualitative and grounded theory paradigm, we could have interviewed just 36 people to develop our heuristic models and theory for later testing. Given our short-time frame and budget, this made the most sense. However, our coordinating council pointed to an important cultural value that was at odds with a "thank you, but we don't need you" approach. People had made a commitment to participate. From a Native cultural perspective, not to allow everyone to participate after volunteering would have been an insult, a violation of cultural values. As a result, the project set out to interview everyone who volunteered with either the "long" life history protocol or a "brief" life story protocol that was subsequently developed. We asked NIAAA for a funding supplement to do this (for additional travel and personnel expenses) and they were very helpful in acquiring it.
What accounted for this response of the community to our recruitment was a number of factors. First, the study was framed in a positive manner. People wanted to contribute to their community and felt that their success could contribute to others. It is an indigenous value to be concerned for one's grandchildren and future generations. Second, we were asking people to tell their story in their own way rather than do a questionnaire. This fit an oral and narrative cultural context. Finally, we used a nominative sampling approach that had people contact others who they thought would be good role models. As a result by the time that we talked to our prospective participants, we and our project had been recommended and had the seal of approval of people who themselves would participate, were known, and were respected by the community. What this process also did was recognize the indigenous value placed on personal choice and provide the space for people the opportunity to reflect on whether they wanted to participate rather than pressing them to decide "on the spot."
CULTURALLY ANCHORING THE INTERVIEW PROCEDURES: FINDING THE RIGHT ANSWERS TO THE RIGHT QUESTIONS
People Awakening attempted to find the right answers to the right questions by designing interview protocols in collaboration with our coordinating council, seeking their input and advice on interview questions and instrument design10 (e.g., linguistic modification, selection and wording of items, response formats, etc.). But our goal was to go beyond an emphasis on community input in the research process to an emphasis on the empowerment of research participants, allowing them to also shape our methodology. We allowed each participant to decide where and in what setting he or she would represent him-or herself (e.g., at home, at the office, in the home village, or in a regional hub or urban center), and to whom he or she would represent him-or herself (e.g., male or female, someone from their own village or culture or someone outside). These setting and interviewer characteristics were viewed by the project to be as important as the content of the interview. Given the historical legacy of suspicion of researchers, we were attuned to the subtleties that make individuals agree to participate or refuse. Historically, there has been more of reluctance in Alaska to tell personal stories in a research context. Given this it was very important to devise our methods so they increased trust, ensured the participants sense of control, and communicated that we could understand and care about their story. The interview needed to allow them to tell their story as freely as possible. By paying attention to contextual features, People Awakening created contexts in which participants could speak. Cross-cultural communication demands communicative competence that is as much within the situation as the interaction. It allows the interviewer to know not only when and how to speak to a person but how to arrange the situation so that they will respond. The first author had interviewees tell him that the pace and control of the interview to make it "slow down" was important for their revealing as much as they did to an interviewer. Some preferred being interviewed in a motel room away from their home, whereas others preferred the kitchen with children playing and food cooking. Within the limits of our ability we tried to maximize choice.
To further involve participants in the research process, we asked each participant to review their transcript and to make changes if they wanted to. We also gave them feedback based on our analysis and engaged them in a dialogue that allowed them to shape the analysis.
What to do when things don't work? In pilot testing our measurement instruments, we discovered several problems, especially with our measure of coping in sobriety. In this measure, we asked how important (in the last year) certain activities (e.g., subsistence, avoiding drinking friends, etc.) were for a participant's sobriety or for not developing a problem with alcohol abuse. This measure had been developed through a focus group process with Alaska Natives who were recovered from alcoholism (Hazel & Mohatt, 2001) and pilot tested with a similar sample using a paper-pencil questionnaire. During the face-to-face life history interviews, we found that many participants would answer "very important" to the coping items because they interpreted the query as "how important it was to their tribe," rather than to them as individuals. Sometimes, with further explanation they could answer the question as it pertained to them, but our sense was that it was ultimately problematic for all even if they complied with our way of asking the question. Second, participants who had not drunk for many years said that the coping methods made no sense because they had "recovered" and were not actively dealing with sobriety anymore. They were beyond sobriety. For the nonproblem drinkers, the coping items did not even touch on their reasons for not abusing.
This feedback from research participants forced us to think about changing our methodology in midstream and stimulated intense discussion among the university researchers about the importance of sticking to procedures, giving them a chance to work versus making changes. After much discussion, we decided to make changes in the procedures. We asked people to tell us how important the item was to them "currently" and how important the item was to them "ever." However, we still were not measuring the strategies that helped nonproblem drinkers and abstainers maintain a healthy lifestyle. We were potentially asking the right questions, but from the wrong people (people who were not currently "in" sobriety as traditionally defined). But most centrally, even when we were asking the right people, we were asking a question that did not make cultural sense. Our participants were telling us that what was important to their culture was important to them even if they had not used it nor considered it important to their sobriety process. They perceived the question through an interdependent and collective perspective rather than an individually self-focused perspective that our instrument assumed. We have come to realize how easily researchers can fail to understand what they are discovering if they are not aware of the way in which participants interpret the questions. An important lesson for all research, but one that may be most evident when pursuing culturally anchored research.
ANCHORING THE DATA ANALYSIS AND INTERPRETATION
People Awakening was committed to a data analysis and interpretation process that would maintain our coresearcher relationship with our coordinating council and participants, and ensure that we worked within an indigenous, culturally grounded interpretative frame. Each of our long life history participants was contacted to review their transcript. The members of the coordinating council were trained in the "emergent" process we are using for coding the life histories and involved in discussions regarding interpretation. One of the joys of the project was when we met with our council to code and interpret a sample of the long life histories. We felt it was important to involve our council early on in the data-coding process in order to audit what we, the university researchers, had accomplished. Did we generate the same codes and interpretations? We were pleased that their process yielded the same themes (codes) we saw emerging from the data. In addition, our ensuing discussions added a more clearly differentiated understanding of how the research participants' actions to achieve sobriety were culturally patterned, for example, subsistence as part of a traditional Native worldview. They shared with us how they identified with the stories and how deeply the narratives affected them, which confirmed the power of the narrative format for enhancing understanding of difficult issues. Throughout this participatory process, we were struck by how the attention to cultural meaning enriched our data interpretation and understanding of people's pathways to sobriety.
CULTURAL ADAPTATION OF QUANTITATIVE METHODOLOGIES
As rewarding as the qualitative narrative process had been in generating an in-depth understanding of Alaska Native sobriety, our funding was dependent upon pursuing the development of quantitative measures of salient constructs arising from the grounded theory analysis of the narratives. The inclusion of this quantitative agenda was never the vision of the coordinating council. Some of the council members distrusted the quantitative approach, whereas the university researchers have significant concerns regarding issues associated with construct and scaling equivalence with self-report measures. Our concerns included the irony that the more sophisticated the quantitative methodology, the more likely the research would be incomprehensible to the potential beneficiaries (Reinharz, 1992). The challenges associated with the quantitative elements of People Awakening highlight the critical role of communicating measurement ideas and instruments in a way that community members can understand and make a meaningful contribution.
As we moved to the measurement development phase of the project, we organized an additional group of coresearchers who were Yup'ik Eskimo.11 The measurement development phase of People Awakening occurs in the Yup'ik Eskimo region of the state. Culturally anchoring quantitative measurement instruments is a lengthy and technically difficult process. As such, People Awakening proposed to NIAAA that the quantitative phase of the research would occur in only one cultural group. The Yup'ik Eskimo group was chosen because it is the largest cultural group in the state and already had positive working relationships developed with the University All of our Yup'ik coresearchers were fluent Yup'ik and English speakers. Most of them had college degrees, and some had graduate-level degrees. We presented a variety of methods of data gathering to them, including card sorting and projective techniques, and various ways of presenting Likert-type scales. Much of the discussion was in Yup'ik, replete with jokes and lots of laughter. We were advised that some simple card-sorting tasks as well as a 3-point Likert scale would make the most sense. One of our cultural experts suggested a mechanical solution to our scaling dilemma: use a slide rule type of device that would allow the person to represent their answer by sliding a bar along a continuum. The techniques that we had thought might fit the best (e.g., narrative projective techniques) we were told would not work because Elders would be insulted: telling stories about pictures was for children. And, we needed to be careful with card-sorting procedures as people may want to make sure the piles were all even. As we developed the various measurement procedures, we presented each of them to our Yup'ik coresearchers for refinement. Again, attention to the cultural meanings of our methods through the participatory process led us to methods that have solid potential for gathering accurate information.
CONCLUSION: THE IMPORTANCE OF DISCOVERY AND AWARENESS
To create moments of discovery in our research, we needed to become more aware of alternative ways of thinking about and perceiving the world. This is important for work in cultural settings that are different than the communities of origin for Western psychological methodologies, epistemologies, and interactional systems. Such cultural settings are best served by research that fosters a space for shared reflection in which knowledge is created, interpreted, and acted on by those who constitute the communities of concern. Privileging language and culture is key to libratory community action and research.
It is not enough "to involve participants" or "to create forums for participation." It is not enough to "create a research advisory board." Deeper levels of inquiry become possible when community representatives with differentiated roles and expertise reciprocally share the responsibility for inquiry with the researchers. People Awakening began when a group of community representatives and university researchers came together to share responsibility for defining the research question and designing appropriate methodologies that linked the research to praxis. At a very simple level, both groups had to learn how to listen and respond in ways that showed respect, and built trust and consensus and are communicatively competent (Cazden et al., 1972). This demands understanding both the rules for social interaction and the values on which they are based. It is a mutual responsibility for both community and university12 coresearchers. But given the history of oppression and colonization, much of the responsibility falls first to the university researchers.
Differentiated roles can produce fragmentation and hierarchy if they are not part of creating a community that respects and uses the skills and knowledge of all members. People Awakening has attempted to expand the diversity of those who define and shape research to include participants, new voices from those who never have experienced a problem with alcohol abuse, and policy-makers concerned about the implications of the research on communities. Those involved in People Awakening possess different yet complementary types of experience. Their experience base ranges from the wisdom of linguistic experts and Elders to the statistical and measurement expertise of alcohol and psychological researchers and to the knowledge of each participant of their individual life experience. This allows us to actualize what Friere (1972) described when he said,
For me, the concrete reality is something more than isolated facts. In my view, thinking dialectically, the concrete reality consists of more than the concrete facts and (physical) things but includes the ways in which the people involved with these facts perceive them. (p. 29)
Key issues of concern have been the historical context of research and how it has oppressed minority communities, how these concerns become present in the choice of methods and the way in which we interpret data, and how convinced we are that cultural factors are important for shaping research. Ellanaq describes the vessel of Ellam-iinga, the process of becoming aware. This may be at the heart of both the process of sobriety of Alaska Native people and the research process. This concept holds promise for researchers doing culturally anchored participatory research because it highlights the importance of creating ways for continual reflection on process. It is this awareness that situates the researcher and research within the community moment by moment.
ACKNOWLEDGMENTS
This research has been supported by a grant from the National Institute of Alcohol Abuse and Alcoholism (1RO1AA11446-03) and the National Center for Minority Health Disparities (NCMHD). We thank the many members of the Alaska Native community who placed their trust in us and who contributed so generously of their time and knowledge. We thank them for their trust and guidance. We also are very appreciative of all the professional colleagues from the research community who shared so much of their expertise. Finally, we thank all of the key NIAAA staff and the NIAAA Council who assisted us, and without whom, this project would not have happened.
| [Footnote] |
| 3 There are over 250 Native "tribes" in Alaska as defined by the U.S. government. These can be roughly grouped into five Alaska Native cultural groups based on language, cultural practices, and region of the state. Within each of the groups there is a wide variation in language dialects, acculturation, history of contact with "outsiders," subsistence practices, migration patterns, religion, and cultural traditions. Thus, any brief description is but a simplification of a very complex and heterogeneous population. That said Athabascan Indians historically have lived primarily in the interior of Alaska, living along the river and highway system. Yup'ik, Cup'ik, and Siberian Eskimos live primarily in the southwestern region of the state, along the coast as well as the river system. Inupiaq Eskimos live in the northern region of the state, whereas Tlinget-Haida-Tsimshian Indians live in the southwest panhandle. Aleut and Alutiiq people live on the Aleutian Islands and coastal areas in the south-central part of the state. As part of the Alaska Native Land Claims Settlement, Alaska Natives established 12 regional for-profit corporations to manage the land and resources of the "tribe." Each of these for-profit organizations is partnered with a nonprofit health corporation that receives federal funding and provides health services for tribal members. The People Awakening project is partnered with seven of these health corporations. |
| [Footnote] |
| 4 Life history methodology has been used quite successfully in Alaska Native communities, especially with Elders who have been encouraged to tell their stories as a way of preserving and revitalizing culture. Story telling is an integral part of Alaska Native culture. |
| [Footnote] |
| 5 Utilizing a grounded theory analysis of the qualitative data, we are identifying the most salient protective and resiliency factors of our life history participants. We will then utilize the qualitative findings to either culturally adapt existing instruments or develop new, culturally grounded ways of quantitatively measuring these salient factors among Yup'ik Eskimos, the largest Alaska Native tribal group. This instrument development process is the quantitative phase of the project. This process of both identifying a model grounded in the experience of Alaska Natives, mapping the cultural constructs of protection and resiliency, and then developing ways to measure them quantitatively will allow future research to more likely yield valid results. It will also generate confidence in the Native community, as their worldview shaped the research and informed the results. |
| [Footnote] |
| 6 NIAAA provided support for fees and travel of several prominent researchers in the field of addictions who had significant experience working in American Indian communities. This was through a special request to the staff at NIAAA. An important issue for us was to find researchers who understood and supported our PAR model for the project, as well as to establish credibility with reviewers. To accomplish the latter, we invited the research advisors to join our RO1 application as consultants. Although perhaps not the normal process for most RO1 researchers the consultants were quite important both in developing the project and in assuring the reviewers that we had the expertise to organize a multisite project involving qualitative and quantitative methodologies addressing alcohol research. |
| [Footnote] |
| 7 One of the things we learned in the first review was that NIH ex pected us to have completed and published several pilot studies on issues that were relevant to the research that was submitted. For tunately, the College of Rural Alaska of the University of Alaska Fairbanks was very supportive of the research and provided us with funding to complete this pilot work (see Hazel & Mohatt, 2001). |
| [Footnote] |
| 8 At the time, research that involved more than one tribal group needed to obtain a multiple project assurance (which was available from Indian Health Service IRB), as well as gain approval for conducting the research from each tribal group. According to federal law, each village in Alaska is a tribal group-more than 250 tribes! Since NIH had very little experience with statewide research in Alaska, we had to negotiate with the Office for the Prevention of Research Risk to allow the Alaska Native Tribal Health Consortium IRB to represent the tribe in each of the regions. |
| [Footnote] |
| 9 Through the NIH review process, our sampling method for the qualitative life history interviews moved from a convenience sampling process to a more purposive design that stratified participants by gender and sobriety type (5+ years sober, life-time abstainer, nonproblem drinker) with a fair representation within each cultural group of people in three age categories (21-35, 36-55, 56+ years). Our goal was to recruit at least two people for each sobriety and gender category for each of five cultural groups (Aleut-Alutiiq, Athabascan, Inupiat Eskimo, Tlingit-Haida, and Yup'ik Eskimo) with a fair representation of each of the age categories. We set a goal of 120 volunteers from which 36 would be selected (6 from each cultural group with the exception of Yup'ik from which 12 would be selected). |
| [Footnote] |
| 10 Two measurement instruments were developed and tested as part of the life history interview format. One focused on measuring the extent to which the person had experienced any negative consequences of drinking. The other focused on cultural-spiritual supports in sobriety. These instruments were administered after the life history process. |
| [Footnote] |
| 11 People Awakening proposed to NIAAA that the quantitative phase of the research would occur in only one cultural group to have a large population base. Communities in the Yukon-Kuskokwim Delta have the seventh largest town in the state with approximately 5,700 residents of which 2,700 are Yup'ik and other villages that exceed a population of 1,200 and in which the majority of residents are Yup'ik. Although this may seem like small populations to our urban readers, these are considered large rural villages or towns by Alaskan standards. |
| [Footnote] |
| 12 We recognize that not all "researchers" are university based and that many may come from other government and nongovernment organizations. Some may even be of origin in the culture they are working. However, the advice holds whenever there is a perceived power differential between those who traditionally control the research and those who are the researched. |
| [Reference] » View reference page with links |
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| [Author Affiliation] |
| Gerald V. Mohatt,1,2 Kelly L. Hazel,1 James Allen,1 Mary Stachelrodt,1 Chase Hensel,1 and Robert Fath1 |
| 1 University of Alaska - Fairbanks, Fairbanks, Alaska. |
| 2 To whom correspondence should be addressed at Department of Psychology, P.O. Box 756480, University of Alaska-Fairbanks, Fairbanks, Alaska 99775-6480; e-mail: tfgvm@uaf.edu. |