Ethnographic Approaches to Alaska Native Oral Health Research

Objectives: Dental caries occurs at epidemic levels among rural Alaska Natives. Recent estimates suggest as many as 60% of Native children in the Yukon-Kuskokwim (Y-K) Delta region will have their mouths rebuilt before first grade. In 2000, the Northwest/Alaska Center to Reduce Oral Health Disparities (NACROD) at the University of Washington began a study with 10 Y-K Delta villages and Bethel, the regional center. Investigators anticipated recruiting 250 end-of-pregnancy women to undertake scheduled daily use of xylitol in chewing gum form. The objective was to prevent dental caries transmission to the soon-to-be-born infants. The study had very limited success (36 recruited, 27 retained). The current study, "Ethnographic Approaches to Alaska Native Health Research," still underway, investigates underlying causes of recruitment and retention difficulties by: conducting ethnographic research with 3 stake-holder groups (investigators, dental providers, Alaska Native residents); and, utilizing resulting qualitative data to establish a groundwork for more culturally relevant, participatory studies having meaningful local-community/research-community collaboration.

Methods: The study employs ethnographic methods common to socio-cultural anthropology, including: 67 semi-structured interviews with individuals from the 3 stakeholder groups; village-based group interviews; participant-observation; field notation; and qualitative data analysis (utilizing Atlas.ti).

Results: Preliminary interview assessments indicate problems derived from an array of cultural misunderstandings and from: lack of widespread distribution of engaging and attractive advertising of the study and its objectives within villages; lack of face-to-face presentations and other local community-level interactions; lack of community-based personnel “on-the-ground” as village research site managers and counselors; and general lack of input from and partnership with participating communities.

Conclusions: Investigator unfamiliarity with local cultures and a failure to promote community-based partnerships and regularly scheduled in-person interactions with Alaska Native villagers negatively impacted all phases of the original study's achievement of its objectives.

Supported by NIDCR/NIH grant U54DE014254.