College of Public Health alumna Lena Thompson earned an MPH in 2014 and a PhD in 2023 in community and behavioral health at the University of Iowa. As a graduate student, she pursued her research interests in disaster management, dementia caregiving, and designing and implementing culturally adapted interventions. Thompson shared some of her experiences working alongside others to enhance Native Elders’ health in this interview, which originally appeared in the Summer 2023 newsletter published by the National American Indian & Alaska Native Mental Health Technology Transfer Center.

Tell us about your work with Native Elders and adapting programs to be more culturally responsive.

I have had the honor of working with Elders throughout my time as a graduate student in the Department of Community and Behavioral Health. One of the first projects I worked on, called the “Elders Curriculum” at this time, is a set of two curricula, one designed for health care providers working in the field of aging with Native Elders and one designed for Elders themselves and their family caregivers. The project gives Native family caregivers and health care providers who serve them some language, context, and resources so that they can communicate effectively with one another in a way that is beneficial for all who are involved. I have been able to work on this as part of a team here at the University of Iowa, and we have also connected with three Native providers and three Native caregivers to further inform the work.

As part of my dissertation, I also worked with the Sac & Fox Tribe of the Mississippi in Iowa (also known as Meskwaki Nation) executive director, Department of Emergency Management, senior center, Cultural Center and Museum, police department, and several Elders to determine cultural adaptation needs to a disaster management program. Disaster PrepWise was developed and adapted at the University of Iowa for older adults by Sato Ashida, associate professor of community and behavioral health, and her team. The program guides older adults through the steps needed to create household disaster management plans. To determine cultural adaptation needs, I had the opportunity to sit down with Meskwaki community organizations and community members and read through Disaster PrepWise page-by-page to create a list of what about the program worked well and what might need to be adapted.

Currently, I am working as a postdoc at the University of Minnesota Duluth on an NSF-funded project called The Alaska Native Successful Aging Project. The project is a qualitative study learning about how Alaska Native Elders age well or age in a good way. I am getting lots of opportunities to learn from an excellent team of researchers and from the Elders themselves.

What are the advantages of culturally informed approaches in your program?

The Western systems that we live in were not designed by or for Native people, and while we are working on breaking those systems down, it is important that in the meantime we are supporting Native people as they navigate these systems, such as health care.

Projects like the Elders Curriculum give health care providers language and context they can use when working with Elders and their family caregivers. Supporting culturally informed approaches for health care providers may help Native patients and their families feel less stigmatized, which can lead to earlier diagnoses, improved trust, and more return visits to see a health care provider.

Implementing cultural adaptations to a project like Disaster PrepWise with community organizations and people makes the program more useful for that community. While Disaster PrepWise has been designed for older adults in Iowa, we found that the strong focus on individual/personal preparedness did not fit as well for the Meskwaki community. Without adaptations, Disaster PrepWise may be less useful or not useful at all for Meskwaki community members.

Have you faced any challenges in implementing culturally informed treatment approaches?

There are definitely challenges when conducting community-engaged work around which individuals and organizations are included and to what extent they would like to be involved. It is important to work with trusted community partners who can help build mutual relationships. I would love to continue our work in adapting and testing Disaster PrepWise with a project that includes more Elders and community organizations.

Additionally, some of the topics we discuss in both the Elders Curriculum (physical, mental, cognitive health and aging) and Disaster PrepWise (natural and man-made disasters) can be challenging topics to talk about. It takes time to build trusting relationships where we can have these conversations in a good way.

Do you have any success stories you’re willing to share?

Through conversations with Meskwaki organizations and with Elders, we made a list of 25 specific adaptations that we would like to implement to Disaster PrepWise for the Meskwaki community. Some of these adaptations were cultural adaptations, others were tribal-specific additions, and we also found ways to make the program more user-friendly. We hope to use this list as a guide in writing a grant proposal to fund future work on this project!

What advice would you give to other providers about integrating culturally informed approaches with Westernized approaches?

When I was working in Alaska recently, someone told me that one way they can identify whether someone is an Elder is if they feel like they want to be close and hear more and more from that Elder, and that they felt that Elders have a light about them. Shortly after that, I encountered a 90+-year-old woman who teaches basket weaving and Alaska Native language. I felt like I couldn’t get enough of her stories and found myself trying to come up with more questions so that we could talk longer. Elders have seen many hard times, and they also bring hope, joy, and wisdom to the work that we do. They are integral to preserving culture and to making the world a better place. I never want to lose sight of how much we are gaining from Elders when we work with them.