COVID-19 Perceptions Among North Carolina Native Americans: Using a Qualitative Approach.

Background: COVID-19 has amplified the health and economic disparities in Native American communities. However, there are limited data from Native American populations. This study is the first phase of the Building Resilience And Vital Equity (BRAVE) project, the scope of which is to understand Indigenous perceptions, attitudes, and behaviors about COVID-19 and design and implement culturally sensitive interventions to increase testing and vaccinations among Native American communities. Method: We recruited 26 Native Americans and conducted open-ended, semi-structured interviews to explore participants' perceptions of COVID-19 and related themes, such as needed support, informational sources, trust, communication, and protection of elders. Results: The results show that wearing a mask, hand sanitizing, and social distancing had very high support while perceptions of testing and vaccination decisions were mixed. Additionally, two themes stand out: the lack of reliable information resources to learn about COVID-19 and the lack of trust in the government. Limitation: This study included a small sample size, which makes it difficult to include participants from diverse demographic backgrounds. Lack of familiarity with the online meeting format and the limited internet access in some indigenous communities may have prevented some people from participating. Conclusion: The findings confirmed the need to improve existing public health information infrastructure and helped explain the intensified impact of COVID-19 on the Indigenous marginalized community. The findings help identify the key factors that affect Native Americans' testing and vaccination decisions and provide guidance on the designs of community intervention programs.