Acceptability and feasibility of an intervention for Alaska Native and American Indian couples

• Published date: 01 February 2024
• Author: Jaedon P. Avey,Kyle Wark,Polly Andrews,James Donadio,Thomas Bradbury,Bobbi Outten
• Date: 01 February 2024
• DOI: http://doi.org/10.1111/fare.12986

RESEARCH

Acceptability and feasibility of an intervention for

Alaska Native and American Indian couples

Jaedon P. Avey

1

|Kyle Wark

1

|Polly Andrews

2

|

James Donadio

2

|Thomas Bradbury

3

|Bobbi Outten

2

1

Research Department, Southcentral

Foundation, Anchorage, AK

2

Family Wellness Warriors, Southcentral

Foundation, Anchorage, AK

3

Department of Psychology, University of

California, Los Angeles, CA

Correspondence Kyle Wark, Southcentral

Foundation, Research Department, 4085

Tudor Centre Drive, Suite 238, Anchorage,

AK 99508, USA.

Email: kwark@southcentralfoundation.com

Funding information

National Institute of General Medical Sciences,

Grant/Award Numbers: S06GM123545,

U54GM115371

Abstract

Objective: This acceptability and feasibility study assessed

a previously tested movie discussion intervention culturally

adapted for a tribal health setting.

Background: Despite family and relationships being

important in Alaska Native and American Indian (ANAI)

cultures, social health interventions supporting committed

ANAI couples have not been investigated. Couples

watching and discussing movies can promote and sustain

relationship health as effectively as intensive skill-building

classes.

Method: This study culturally adapted a movie discussion

intervention. Multiple stakeholders guided adaptations,

including changes to intervention duration, recommended

movies, discussion guide, and study measures. Eligible par-

ticipants were cohabitating adults in a committed relation-

ship, with at least one person in the couple being ANAI.

Participants watched and discussed movies over 4 weeks at

home or in person. Study measures assessed demographics,

relationship characteristics, and intervention acceptability

and feasibility.

Results: Twenty-three couples participated: 87% chose at-

home participation, 70% completed the intervention.

Almost 90% of couples felt comfortable discussing the

movies, felt the discussion guide improved communica-

tion, and would recommend the intervention to other cou-

ples, but 26% were mildly stressed by the discussions.

Conclusion: This intervention was a feasible and accept-

able way to help ANAI couples maintain positive relation-

ship features.

Author note: Research reported in this publication was supported by the National Institute of General Medical Sciences (NIGMS) of the

National Institutes of Health (NIH) under award number U54GM115371 and by the NIGMS Native American Research Centers for

Health (award number S06GM123545). The content is solely the responsibility of the authors and does not necessarily represent the

official views of the NIH. The authors have no conflicts of interest to declare.

Received: 9 December 2022Revised: 27 November 2023Accepted: 30 November 2023

DOI: 10.1111/fare.12986

© 2023 National Council on Family Relations.

298 Family Relations. 2024;73:298–317.wileyonlinelibrary.com/journal/fare

Implications: This intervention could support ANAI cou-

ples in regions with limited access to behavioral health

services.

KEYWORDS

couples and family therapy, cultural issues, Native American families and

issues, television and media

Although marriage and committed relationships are nearly universal among human

populations, the specific values that govern and expectations that surround being in committed

relationships are both culturally specific and subject to change over time (Ember, 2016). Some-

times these changes are brought about via violent means, such as the historical traumas and

ongoing inequities that deeply destabilized traditional Indigenous social structures (Brave Heart

et al., 2011; Evans-Campbell, 2008; Walls & Whitbeck, 2012), with these traumas presenting

unique risk factors for Alaska Native and American Indian (ANAI) families. As an example of

these traumas, forced assimilation through abusive boarding schools—driven by the ideology of

“kill the Indian …, save the man”(Solomon et al., 2022)—significantly disrupted ANAI fami-

lies, separating parents from children at critical ages, punishing children for practicing their cul-

tures, and so on; see Zephier Olson and Dombrowski (2020) for a comprehensive review of the

impacts of boarding schools on ANAI families.

Despite these disruptions, ANAI cultures still strongly value extended families and mutually

supportive communities (National Healthy Marriage Resource Center [NHMRC], 2017).

Western-style marriages are less salient of a cultural construct for ANAI peoples, however:

“Marriage”is less of a relevant cultural concept than family [for ANAI peoples].

Not all tribes or clans have “wedding ceremonies”and the concept/definition of

marriage is locally derived. …One study with a large sample of Native Americans

…found that Native Americans, on average, ranked marriage lower in importance

than people in all other major racial or ethnic groups. (NHMRC, 2017)

Approximately 39% of ANAI peoples are married, 39% never married, and 13% divorced

(NHMRC, 2017). Regardless of the evidence demonstrating the protective value of family and

relationships in ANAI communities (Chernoff & Cueva, 2017; Gottlieb, 2007,2013; Gottlieb &

Outten, 2011), there is limited research on interventions tailored for committed ANAI couples

(NHMRC, 2017; Skogrand et al., 2008). This study adapted a relationship-focused intervention

for ANAI couples based on an existing framework. Because of the limited salience of marriage

in ANAI communities, this study focused instead on committed couples.

The lack of ANAI couples interventions is significant because the dissolution of committed

couples, married or not, can have severe, destabilizing, and far-reaching implications (Copen

et al., 2013). As early as the 19th century, researchers have found a significant association

between marital discord—even without actual dissolution—and increased risk of deleterious

consequences for physical health (e.g., heart disease, diabetes, elevated stress hormones, weak-

ened immune systems, and delayed wound healing) and mental health (e.g., mood swings, anxi-

ety, and depression; Zineldin, 2019). Modern studies affirm that relationship dissolution may

increase health risks for both adults and children, “including problems with mental health and

individual adjustment, child behavior, physical health, and economic success and stability”

(Zineldin, 2019, p. 141).

One promising therapeutic approach to prevent dissolution is helping couples improve their

communication skills (Lavner et al., 2016; Rogge et al., 2013). Many struggling relationships

can be preserved and those already functioning well can be strengthened through interventions

ACCEPTABILITY & FEASIBILITY OF AN ANAI COUPLES INTERVENTION299