Exploring the Role of Indigenous Determinants of Health in the Resilience of Native Nations during COVID-19.

American Indians and Alaska Natives (AI/ANs) were disproportionately affected by the COVID-19 pandemic, experiencing excess hospitalization, mortality, and economic losses compared to the non- Hispanic Whites. This study sought to document the Indigenous determinants of health (IDOH) in AI/AN communities that shaped mental wellbeing for four groups: educators, traditional knowledge holders/practitioners, first responders, and substance abuse recovery community, during the pandemic. This work was a collaboration with and had research approval from three Native nations in Arizona. In-depth interviews were conducted from May to November 2021; 92 participants were interviewed. The most prevalent IDOH and associated themes included strategies to cope with emotional and social stressors and the impact on physical and mental health, relationships, kinship, cultural continuity, and self-determination. The groups experienced differences in mental wellbeing aligned with their occupation. For example, first responders experienced disruption and social dissonance in the workplace due to varying political views, and traditional knowledge holders/ practitioners experienced a revitalization of cultural strategies to maintain health. Although the differences between occupational groups are striking, the similarities that did exist were grounded in Indigenous identity and worldview that emphasize relationships and connection to the natural environment.