Developing Cultural Competency
Cultural Knowledge, Awareness, Sensitivity, Competence
VI. American Indian/Alaska Native Culture
American Indians (AI) and Alaska Natives (AN) are terms identifying the indigenous peoples of North America. As of the 2000 Census, four million people identified themselves as American Indian or Alaska Native and most live near urban areas. There are more than 500 federally recognized tribes and over 245 tribes without this federal designation. It is important to be aware that there is variability between tribes in their health care seeking and health promotion behaviors.
In American Indian/Alaska Native culture there is historical mistrust of mainstream institutions. Acknowledging their history is an important step in building trust with the resident. While it is important to have a basic knowledge and respect for this culture, remember that all, some or none of these beliefs may be associated with each resident.
How do the American Indians/Alaska Natives culture deal with illness?
- The American Indian/Alaska Native resident may have a holistic view in which people, community, nature, and spirituality are interconnected and interrelated. This perspective views physical, spiritual, mental and emotional health in unity, instead of in discrete categories. Sickness may be viewed as a result of disharmony between the sources of life.
- The resident may seek Western medicine for treatment of symptoms of illness. However, residents may also seek traditional healers to address the disharmony that cause the illness.
- Traditional practices may include different rituals and ceremonies as well as herbal remedies.
- Ask the resident if he/she uses traditional healings or practices.
- Acknowledge the value of traditional practices.
- Time orientation may be perceived as cyclical, present-oriented, and "in-the-moment" as compared to linear, future oriented, and "time-by-the-clock" as in Western culture. As a result, residents may have trouble adjusting to a facility schedule.
- Schedule visits within a window of the time to allow for more flexibility.
- Whenever possible, use natural events such as sunset or meal times when you tell the resident when you are coming to visit.
- The concept of family may include immediate family, extended family, and community and tribal members.
- Urban AI/AN may not have family living nearby, and AI/AN who live in reservations may be receiving care far away from home.
- Lack of family support during care planning and decision making may be a source of stress for the resident.
Understanding Norms about Eye Contact, Expressions of Pain, and Use of Silence or Storytelling
- Direct eye contact may be avoided out of respect or concern for soul loss or theft.
- Traditionally, AI/AN have been taught to resist any expression of pain. The resident may not express pain directly and instead report feeling uncomfortable or use storytelling.
- Time and silence may be used to maintain harmony and be non-confrontational.
- Listen for at least 2 minutes without saying a word. Let the resident talk or let them be silent.
- Be aware that it may take 3 or 4 encounters before trust and dialogue emerge.
- Storytelling and circular conversation may be used to build trust or describe problems. For example, a personal story about an ill friend of family member may be a metaphor for the resident having the same problem.
- Sharing a personal experience may be a way to build trust with the resident.
What are the AI and AN cultural norms about touch and sacred objects?
- Touch may be very personal for the resident. The head and hair may be considered particularly sacred.
- Always ask permission before touching.
- Hair, jewelry, ornaments, or other regalia may have spiritual meaning.
- Ask the resident if they have any spiritual objects with them before touching or moving any objects around them.
- Circles of Care, a SAMHSA program launched in 1998 that gives tribes and urban Indian organizations 3-year grants to identify and analyze community needs systematically.
- SAMHSA resources and articles on American Indians and Alaska Natives - This population is included in many of SAMHSA's Strategic Initiatives. Resources include:
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