Document Type

Capstone Experience

Graduation Date

8-2025

Degree Name

Master of Public Health

Department

Health Promotion

First Committee Member

Regina Idoate, PhD

Second Committee Member

Aislinn Rookwood, PhD

Third Committee Member

Steve Tamayo

Abstract

This research utilized a “Three-Eyed Seeing” approach, which balances contributions from conventional, traditional, and local knowledge systems, to explore metacognitive practices among the urban Native American Elder population nationwide. Researchers asked the question: “What culture-based metacognitive practices do urban Native American Elders engage in?” Existing research demonstrates that metacognitive practices can be a predictor of health and prevention, and a promising approach for reducing harmful stress among Native Americans, a risk factor for brain health outcomes (e.g., cognitive decline, Alzheimer’s Disease and Related Dementias, etc.). This research aims to increase understanding of the types of metacognitive activities that are engaged in, as well as why and how these are practiced, to inform culturally relevant measures and strategies for prevention and treatment.

In partnership with the Native American Health Center, based in CA, the Nebraska Urban Indian Health Coalition, based in NE, and the Indigenous Mindfulness Coalition, based in Rhode Island, the research team purposefully recruited a regionally diverse sample (n=31), including participants age 45+ who identified as Native American and resided in the Eastern, Western, and Midwestern United States. Using Photovoice methods, participants submitted one photograph depicting a culture-based metacognitive activity and responded to related survey questions. Participants were then invited to engage in one of three focus groups to gather additional community insights (n=25). Analysis of the Photovoice and focus group data informed a typology of seven Native American culture-based metacognitive activity domains and four emergent themes reflecting the purpose and meaning associated with these practices. Participants articulated spirituality as a common thread woven throughout the seven domains of metacognitive activity. 100% of participants reported that they practice these culture-based activities regularly, with focused attention and awareness, and the expectation of a positive outcome; three characteristics described in literature as the powerful ways to train the brain or make physical changes in the structure and future functioning of the brain.

This study’s results enhance scientific and academic understanding of culture-based metacognitive practices among urban Native American Elders, advancing research on the association of culture-based metacognitive practices with healthy aging and brain health promotion. One implication of this research is that participant contributions and study findings informed the preliminary adaptation of an existing evidence-based brain health instrument, the Cognitive and Leisure Activity Survey (CLAS) component of the Resilience Index, establishing a more culturally appropriate measure of ADRD risk and protective factors among AI/AN communities. The adapted survey tool will support future research and facilitate more effective and sustainable efforts for brain health promotion among Native American populations.

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