ASU researchers to amplify voices of Native students to explore underrepresentation in health care

The statistics are alarming: Less than 1% of active physicians identify as American Indian or Alaska Natives, and 90% of U.S. medical schools have reported three or fewer such students. 

In nursing, it’s a similar story — just 0.3% identify as American Indian or Alaska Natives. The underrepresentation is also present in nursing education, with an average of 0.5% of nursing students who identify as American Indian or Alaska Natives.

These numbers are problematic for many reasons, but one of the biggest is that research consistently shows race and ethnic similarities between patients and health care providers result in more satisfying care interactions and better health outcomes. Less representation equals worse outcomes.

A group of Native and non-Native scholars from Arizona State University will be exploring this critical issue of underrepresentation through the support of a newly awarded grant under the Robert Wood Johnson Foundation's Community Research for Health Equity program, managed by AcademyHealth.

“We couldn’t be more excited and energized by this prestigious award provided by the Robert Wood Johnson Foundation, as well as the outstanding opportunity to work with partners at AcademyHealth and the Community Research for Health Equity (CRHE),” said Barret Michalec, a co-principal investigator and the director of ASU’s Center for Advancing Interprofessional Practice, Education and Research in the Edson College of Nursing and Health Innovation.

He says while there has been recent attention to the structural barriers and hurdles faced by health profession students from some communities of color, it is essential to explore key factors influencing health workforce development for American Indian and Alaska Native populations in order to address persistent and consistent health inequities.

“Minimal effort has been made to understand the experience of American Indian and Alaskan Native health profession students – especially their experiences within their undergraduate education and training related to the pre-med and BSN pathways,” Michalec said. “What’s more is that it's essential that we start looking at these issues from an interprofessional lens.” 

Although some medical and nursing schools have created pipeline programs aimed at increasing the number of American Indian and Alaska Native students, Michalec points out that little is known about how these students experience these programs or about the impact that discriminatory practices and policies, prejudice and racism have on academic and professional success, as well as eventual health outcomes for the communities they serve. 

Plus, not everyone has access to these specific pipeline programs.

“In short, these pipeline programs and other diversity-focused programs have yet to move the needle. We believe this is primarily because these programs are working on the students, and not working with the students and their larger communities,” he said.

Fellow co-principal investigator Angela Gonzales is an enrolled citizen of the Hopi Nation and an associate professor in the School of Social Transformation at ASU. A community-engaged scholar, she has worked closely with Indian tribes to develop culturally relevant health promotion and education programs that involve the community in the design and implementation of health interventions.  

“A common challenge in many rural communities is the shortage of medical personnel; a problem that is even more severe in remote reservation communities. ASU is uniquely positioned to help address this shortage. Arizona is home to 22 Native tribes, the most of any state, and over a quarter of its land base is designated as Indian reservation land,” Gonzales said.

She says this grant will enable the team to collaborate with tribal partners to help address the health care needs of their communities by identifying and developing effective practices to attract, support and graduate American Indian and Alaska Native students pursuing a career in nursing or other health professions.

“Ultimately, it will not only help to build a more diverse health care workforce, but it will better ensure culturally relevant health care, because these students have a deeper understanding, respect and appreciation for the lifeways of their people,” Gonzales said.

Both Gonzales and Michalec say ASU is well positioned for this work because the university has one of the largest communities of American Indian and Alaska Native students among all colleges and universities. 

Currently, of the more than 3,000 American Indian and Alaska Native undergraduate students enrolled at ASU, 618 consider themselves pre-med, and 29 are enrolled in Edson College’s undergraduate nursing program.

“By working together with all stakeholders, we’ll highlight the key factors that impact American Indian and Alaskan Native students’ trajectory towards the medical and nursing professions and identify factors that could encourage, sustain and protect current and future students interested in these professions — not just during undergraduate, but through their graduate-level education and into their professional practice,” Michalec said.

It’s a unique approach and one Michalec says has the potential to significantly impact the health and well-being of tribal communities, by highlighting systemic inequalities in pathways in higher education, and hopefully lend to positive shifts in policy and practice.

While Michalec and Gonzales are the project leads, they are working with an interdisciplinary team of dedicated Native and non-Native scholars from various colleges and roles with ASU. 

Along with Michalec and Gonzales, co-investigators on the project include Timian Godfrey, a member of the Navajo Nation, and Richard Montague, PhD candidate and member of the Quechan Indian Nation. Both Godfrey and Montague are leaders within their fields and graduate students in Edson College.

Other team members include Shanondora Billiot (United Houma Nation), Matt Ignacio (Tohono O’odham), Sue Pepin, Brad Doebbeling, Jacob Moore (Tohono O’odham) and Bryan Brayboy (Lumbee), as well as project manager Nina Karamehmedovic. This interdisciplinary team spans the university, bringing together the Edson College, Watts College of Public Service and Community Solutions, College of Health Solutions, The College of Liberal Arts and Sciences and the Office of the President.

Together, they have outlined a three-year timeline for the project, which officially started on April 15. First up is listening to and amplifying the voices of American Indian and Alaska Native pre-med and undergraduate students. 

“By elevating the voices of the community of American Indian and Alaskan Native students, as well as local tribal leaders, and working with academic and clinical partners, we hope to have a clearer understanding of the micro-, meso- and macro-level barriers and hurdles encountered by American Indian and Alaskan Native pre-medical and nursing students, in order to advocate for and design a more just and equitable system that promotes and protects American Indian and Alaskan Native students on their professional trajectory,” Gonzales said.

Support for this research was provided by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the foundation.