EXPLORING THE TRAIL TO HEALTH: ENCULTURATION, SENSE OF
COHERENCE, AND WELL-BEING IN AMERICAN INDIANS
by
Tina S. Simms
A Thesis
Presented to
The Faculty of Humboldt State University
In Partial Fulfillment
of the Requirements for the Degree
Master of Arts
in Counseling Psychology
August 2010
EXPLORING THE TRAIL TO HEALTH: ENCULTURATION, SENSE OF
COHERENCE, AND WELL-BEING IN AMERICAN INDIANS
by
Tina S. Simms
Approved by the Master’s Thesis Committee:
________________________________________________________________________
Dr. Lizabeth Eckerd, Committee Chair
Date
________________________________________________________________________
Dr. Bettye Elmore, Committee Member
Date
________________________________________________________________________
Marlon Sherman, J.D., Committee Member
Date
________________________________________________________________________
Dr. Lou Ann Wieand, Program Coordinator
Date
________________________________________________________________________
Dr. Jená Burges, Vice Provost
Date
ABSTRACT
EXPLORING THE TRAIL TO HEALTH: ENCULTURATION, SENSE OF
COHERENCE, AND WELL-BEING IN AMERICAN INDIANS
Tina S. Simms
The purpose of this study was to examine the relationships between enculturation, sense
of coherence, and psychological well-being in American Indians. Thirty-six participants
completed anonymous, pencil-and-paper questionnaires assessing each of the three
variables under study. Three hypotheses were predicted and tested using Pearson’s
product moment correlations: 1) enculturation and well-being would be positively
correlated; 2) enculturation and a sense of coherence would be positively correlated, and
3) a sense of coherence and well-being would be positively correlated. A fourth
hypothesis was proposed stating that if the first three hypotheses were supported a
regression analysis would be conducted to determine if a sense of coherence mediated the
relationship between enculturation and well-being. The correlational analyses did not
support hypotheses one and two but did support hypothesis three. Sense of coherence and
psychological well-being had a strong, significant, positive correlation. The regression
analysis was not conducted to test hypothesis four because of the nonsignificant results
found for hypotheses one and two. It was concluded that enculturation may not be an
iii
important construct in determining a sense of psychological well-being in American
Indians but that a sense of coherence may be, and that future research is needed.
iv
ACKNOWLEDGEMENTS
I would first like to thank Dr. Bill Reynolds, the professor who got me started on
this process and pointed me in the right direction. Your guidance was an important part of
my success. To my esteemed committee members, Dr. Beth Eckerd and Marlon Sherman,
your flexibility and support was crucial to my personal well-being throughout this
process, and the knowledge and wisdom you brought to this project was invaluable. To
Dr. Bettye Elmore, my mentor and my friend, thank you for your unwavering belief in
me, and for teaching me new ways of thinking. I am eternally grateful for the learning
you have inspired in me. This project would not have happened without you. To my
colleagues, my peeps, I could not have dreamed of a better group of people to have had
this experience with. Liz, Kevs, Noah, Mark, Jane, and Bill, your support, validations,
and encouragements are what got me through this program and made it fun. I will never
forget you. To my friends and family for their constant love and understanding, thank you
for always being there for me. To my husband, Marcus, for your continuous love and
support, and for making me laugh in the hardest of times. To the Counseling department
faculty and staff, thank you for teaching me, inspiring me, and helping me to evolve. And
finally, I offer thanks to all of those American Indians who participated in this project. It
was an honor to be a part of your inner worlds.
v
TABLE OF CONTENTS
ABSTRACT .................................................................................................................. iii
ACKNOWLEDGEMENTS ............................................................................................. v
TABLE OF CONTENTS................................................................................................ vi
LIST OF TABLES ...................................................................................................... viii
CHAPTER I: Introduction and Literature review ............................................................. 1
American Indian Culture .................................................................................... 3
Enculturation ....................................................................................................... 6
Sense of Coherence ............................................................................................ 11
Generalized Resistance Resources ............................................................ 13
Sense of Coherence and Health .......................................................................... 16
Well-Being ........................................................................................................ 19
CHAPTER II: Statement of the Problem ........................................................................ 22
Present Study ..................................................................................................... 23
Research Hypotheses ......................................................................................... 23
Research Hypotheses Rationale .......................................................................... 23
CHAPTER III: Method.................................................................................................. 27
Participants ........................................................................................................ 27
Operational Definitions ...................................................................................... 27
Instrumentation .................................................................................................. 29
Demographic Questionnaire ..................................................................... 29
American Indian Enculturation Scale ........................................................ 29
vi
Orientation to Life Questionnaire ............................................................. 30
Psychological Well-Being Scale ............................................................... 31
Procedure ........................................................................................................... 33
Risks and Benefits.............................................................................................. 34
CHAPTER IV: Results .................................................................................................. 36
CHAPTER V: Discussion .............................................................................................. 43
Primary Analyses ............................................................................................... 43
Supplemental Analyses ...................................................................................... 46
Clinical Implications .......................................................................................... 48
Limitations and Suggestions for Future Research ............................................... 49
Conclusion ......................................................................................................... 50
REFERENCES .............................................................................................................. 52
APPENDIX A. American Indian Enculturation Scale .................................................... 62
APPENDIX B. Orientation to Life Questionnaire .......................................................... 65
APPENDIX C. Psychological Well-Being Scale ............................................................ 73
APPENDIX D. Demographic Questionnaire .................................................................. 94
APPENDIX E. Permission Letter .................................................................................. 96
APPENDIX F. Participation Instructions ....................................................................... 98
APPENDIX G. Informed Consent ............................................................................... 100
APPENDIX H. Mental Health Referrals ...................................................................... 102
vii
LIST OF TABLES
Table
Page
1
Frequency Distributions of Tribes ............................................................................ 28
2
Means and Standard Deviations for Study Variables ................................................ 37
3
Correlational Matrix for Study Variables ................................................................. 39
4
Correlational Matrix for Sense of Coherence and Psychological Well-Being
Subscales ................................................................................................................. 40
5
Correlational Matrix for Psychological Well-Being and Sense of Coherence
Subscales ................................................................................................................. 41
6
Correlational Matrix for Subscales of Psychological Well-Being and Sense of
Coherence ................................................................................................................ 42
viii
CHAPTER I
Introduction and Literature Review
American Indians are the indigenous peoples of the North, South, and Central
Americas, also referred to as Native Americans. These indigenous peoples form cultural
groups composed of regional communities referred to as tribes. In the United States today
there are 564 federally recognized tribes of American Indians and Alaska Natives (U.S.
Department of the Interior, 2010) with nearly two million people identifying themselves
as American Indian (U.S. Census Bureau, 2007). American Indian communities have a
greater proportion of young people than the general population (Ogunwole, 2006; U.S.
Census Bureau, 2007). About one-third of the total American Indian population resides
on federal and state designated tribal lands, with families and children being most likely
to live in these areas (Ogunwole, 2006).
During the period of American colonization the cultural values and traditional
ways of the indigenous American peoples clashed with the ways of the European
colonists. The culture clash resulted not only in the decimation of countless Natives but
in their cultural traditions as well (Brave Heart & DeBruyn, 1998; Garrett & Pichette,
2000; U.S. Department of Health & Human Services [DHHS], 2001). Much of the
research-based descriptions and behavior analyses of American Indians has centered on
the hardships that have been occurring since colonization including poverty,
unemployment, poor living conditions, physical health problems and disparities, and
1
2
substance abuse (Barnes, Adams, & Powell-Griner, 2005; Centers for Disease Control
and Prevention [CDC], 2003, 2008; Jones, 2006; Kunitz, 2008; Ogunwole, 2006; Taylor
& Kalt, 2005; U.S. Census Bureau, 2007).
Despite all of the documents reporting the problems within the American Indian
populations they continue to survive and grow (Day, 2008). Despite the assault on the
American Indian culture during colonization, some American Indians today still maintain
their traditional ways (Trimble & Gonzalez, 2008). The current study is based on the
assumption that because their cultural traditions are unique features that have been
maintained within many American Indian communities there are likely important
resources inherent within those traditional cultural systems that are related to the people’s
ability to cope and to their sense of well-being. Using a positive psychology approach,
this study attempted to identify factors that are significantly related to the well-being of
the American Indian population. Positive psychology suggests that research and
intellectual pursuits should include examinations of the more positive aspects of human
behavior in addition to those of pathology and illness (Seligman & Csikszentmihalyi,
2000).
A focus on the strengths that American Indians have available to them is
important to the development of effective therapeutic interventions that can address the
long-standing health disparities the American Indian people have faced. Understanding
the significance of traditional cultures to the well-being of American Indian clients will
3
better equip health practitioners with knowledge useful for determining how best to
cultivate American Indian health and healing.
A general description of American Indian culture, a discussion of enculturation
and its relationships with indicators of well-being, and the sense of coherence theory and
its relationship with well-being is reviewed here.
American Indian Culture
Cultural systems provide individual members with structural guidelines for how
to think and how to live, as well as supporting beliefs about what makes life meaningful
(Trimble & Gonzalez, 2008). In order to develop a comprehensive understanding of the
role of culture and cultural values in the well-being of the individual members it is
important to first gain an understanding of the unique cultural system and its component
processes. American Indian cultural systems have rich, historical, and spiritual traditions
that likely play significant roles in the health and well-being of the people (Fukuyama,
Sevig, & Soet, 2008).
American Indian tribes vary in their traditional mores and the tolerance for
adherence to, or deviation from, those norms (Locust, 1988), but American Indian
cultures can be described in universals held by a number of tribes. American Indians as a
whole are a collectivist culture that places great value on their relationships with others
and with the natural environment (Garret & Garrett, 1994; Hill, 2006). They are
storytelling cultures that find meaning in their tribal and collective ancestral histories,
4
transmitting down through the generations moral parables and tales that teach the lessons
of their ancestors (Deloria, 1994; Garrett & Garrett, 1994).
Garrett and Garrett (1994) describe cooperation, sharing, and modesty as some
core American Indian values. The authors also explain that there is a focus on internal
self development for American Indians but evaluations of the self are based on the
success or benefit of the tribe. Tribal and familial ancestry provides a source of identity,
elders are revered, and relationships constitute spiritual connections with others (Garrett
& Garrett, 1994). For American Indians specifically, this connection with their cultural
groups may be important to coping and well-being (Hobfoll, Jackson, Hobfoll, Pierce, &
Young, 2002). For those individuals from collectivist cultures in general, positive
interactions with others seem to be more influential on their well-being than on those
from individualistic cultures (Kitayama, Markus, & Kurokawa, 2000).
According to Deloria (1994), being in harmony with nature is highly valued by
American Indian cultures. In his descriptions, American Indians share a deep connection
to and place great value on their sacred lands. Land provides a source of meaning. It
reminds the people of their collective historical experience and provides sacred places
where they can remember what has occurred for their people throughout time. Religion
and worship are connected to the lands on which the American Indians live (Deloria,
1994).
5
American Indian tribes also share an overarching belief that the world was created
by an indefinable Supreme Being and that it is made up of parts that work together to
sustain itself (Deloria, 1994). All things in the world are therefore related and each has a
unique role to play. Some common themes of the American Indian worldview have been
outlined as follows (Locust, 1988, p. 317):
1. American Indians believe in a Supreme Creator. In this belief system there are
lesser beings also.
2. Humans are threefold beings made up of a spirit, mind, and body.
3. Plants and animals, like humans, are part of the spirit world. The spirit world
exists side by side with, and intermingles with, the physical world.
4. The spirit existed before it came into a physical body and will exist after the
body dies.
5. Illness affects the mind and spirit as well as the body.
6. Wellness is harmony in spirit, mind, and body.
7. Unwellness is disharmony in spirit, mind, and body.
8. Natural unwellness is caused by the violation of a sacred or tribal taboo.
9. Unnatural unwellness is caused by witchcraft.
10. Each of us is responsible for his or her own wellness.
In most American Indian belief systems, the view of the person as composed of
spirit, mind, and body has important connections with health (Locust, 1988). Health is
defined by wellness in the three components of the person. Harmony occurs when all
three components are well. Harmony comes from within the person and from interactions
with the Supreme Creator. When illness occurs it affects all three components of the
person, and understanding the illness within a spiritual context is important to
maintaining harmony. This emphasis on spiritual health generally describes how
spirituality and the American Indian sense of well-being are inextricably linked.
6
The relationship between health and spirituality in the American Indian
worldview is consistent with results of empirical research. Religiosity and spirituality
have been found to be significantly related to measures of well-being for various ethnic
and religious groups including American Indians (Ellison, 1991; Yoon & Lee, 2004).
Other researchers have demonstrated that spirituality is significantly correlated with
decreases in psychological distress (e.g., depression and anxiety) and fewer physical
problems, primarily through increasing an inner sense of meaning and peace (Carmody,
Reed, Kristeller, & Merriam, 2008). This study argued that pathology might arise in part
because a separation between American Indian individuals and their cultures occurs. The
previously cited studies provide evidence for the suggestion that an understanding of and
identification with traditional indigenous cultures may benefit the well-being of
American Indians.
Enculturation
Acculturation refers to how an individual is influenced by a secondary culture
whereas enculturation refers to the process of learning about one’s cultural group (Aponte
& Johnson, 2000). When enculturation is successful it is argued that the individual can
become competent within their culture and gain a strong sense of racial or ethnic identity.
American Indian enculturation has been broken down into three components:
participation in tribal activities, cultural identification, and adherence to cultural values or
cultural spirituality, which have all been suggested as important to American Indian well-
7
being (LaFramboise, Hoyt, Oliver, & Whitbeck, 2006; Winderowd, Montgomery,
Stumblingbear, Harless, & Hicks, 2008; Zimmerman, Ramirez-Valles, Washienko,
Walter, & Dyer, 1996). Few studies have investigated the direct link between American
Indian enculturation and well-being specifically, but participation and involvement in
aspects of the traditional culture have been found to have significant relationships with
various measures of health and well-being.
For example, a limited focus group interview of six Alaska natives revealed their
belief in the importance of understanding their traditional culture to the maintenance of
their sobriety (Hazel & Mohatt, 2001). These individuals believed that spirituality and
connection with their native cultures is integral to the recovery process for native peoples,
particularly the connection with both family and community. In the survey component of
their study, nearly half of the sample of 78 participants reported that their culture and
spirituality helped support their sobriety, with the remaining individuals reporting some
sort of “higher power” or Christian-based belief system as important to their recovery.
Although the sample size was limited, the results point to the importance of traditional
culture from the perspective of the people themselves.
In a small, interview study of urban American Indian elders, researchers found
that the elders interviewed experienced a strong sense of well-being despite having to
deal with physical health problems, and that those elders were both knowledgeable about
and involved in their traditional culture (Krouse & Andrews, 2005).
8
Traditional spirituality has been associated with lower rates of attempted suicide
in American Indians (Garroutte, Goldberg, Beals, Herrell, & Manson, 2003). Traditional
spirituality and participation in traditional activities (e.g., pow-wows, the use of tribal
language) has also been associated with alcohol cessation in American Indians living on
various tribal reservations across the continent (Torres Stone, Whitbeck, Chen, Johnson,
& Olson, 2005).
Traditional American Indian activity has also been related to well-being for both
Europeans and American Indians (Wagemakers Schiff, & Moore, 2006). Changes in what
the authors defined as well-being after a sweat lodge ceremony were revealed, with
participants reporting a more positive outlook on human nature, an increased readiness to
help take care of others, and an augmented perception of being able to stand up for and
protect themselves or others in spite of any risks involved. Although the measure they
used to operationalize these aspects of well-being has not been used often and has had
little psychometric investigation, the authors defended its use as one of the only relevant
measures of spirituality and well-being that is consistent with the worldview of their
participants.
Identification with the American Indian culture has also been found to be
significantly related to measures of health. Results from one study assessing cultural
orientation suggest that it plays at least some role in substance use for American Indians
(Herman-Stahl, Spencer, & Duncan, 2003). Participants in this study included 2449
9
American Indians living on reservations in South Dakota. Cultural orientation was
assessed by asking about the use and knowledge of tribal language, participation in tribal
activities, feelings about ethnicity, and how much of a role the American Indian culture
plays in participants’ thoughts and education. The highest substance use rates in this
sample were reported by those reporting a more bicultural and less traditional orientation.
Individuals low in traditional orientation and those with a more bicultural orientation
were found to be three to four times as likely to be heavy drinkers as those who were
more traditional in this sample. Because enculturation is intertwined with the
development of a traditional orientation (Aponte & Johnson, 2000), this research
provides a link to the major assumptions of this study by illustrating the benefits
enculturation may have on the health and well-being of American Indians.
Ethnic identity has been associated with the well-being of other minority groups
as well, not just American Indians, with a positive association found between ethnic
identity and self-esteem, purpose in life, and self-confidence in a sample comprised of
American Indian, African American, Hispanic, and Asian adolescents (Martinez &
Dukes, 1997). Ethnic identity and positive beliefs about their traditional cultural group
were found to be positively associated with psychological well-being for Asian
Americans and international Asian college students (Iwamoto & Liu, 2010).
Another aspect of enculturation, ethnic pride, has been shown to have a
relationship with adolescent drug use beliefs with mixed results. Adolescent students in
10
one study with the strongest sense of ethnic pride held stronger antidrug norms and also
reported a stronger belief in their capacity to deny offers of drugs, but those who
identified solely as American Indian were less sure of their ability to abstain (Kulis,
Napoli, & Marsiglia, 2002). The adolescents in this sample who held negative attitudes
toward their ethnicity reported a weakening of antidrug norms for certain drugs. Other
researchers have illustrated the positive relationship between connection to and pride in
the traditional American Indian culture and the psychosocial adjustment of Navajo
adolescents (Jones & Galliher, 2007). These studies illustrate the complexity of the
relationships between ethnic pride, cultural identification, and health, providing
justification for further investigation into these intricate relationships, particularly for
different tribal groups.
The previous research cited suggests that components of American Indian
enculturation (e.g., participation in tribal activities, spirituality, ethnic pride, and cultural
identification) have some beneficial relationships with various measures of health and
well-being. American Indian cultural belief systems also provide a sophisticated
framework for understanding and behaving in the world (Deloria 1994; Garret & Garrett,
1994; Hill, 2006; House, Stiffman, & Brown, 2006; Locust, 1988; Trimble & Gonzalez,
2008) which are components of what is referred to as a sense of coherence (Antonovsky,
1979, 1987, 1996). Another major assumption of this study was that American Indian
enculturation contributes to the internal perspective that life is understandable,
11
manageable, and meaningful. That is, enculturation contributes to a strong sense of
coherence for American Indians.
Sense of Coherence
The predominant focus of psychology as a science has been the study of the
causes of illness, or pathology. The concept of positive psychology arose out of the
perceived gap in the knowledge base about what makes life meaningful and worth living
(Seligman & Csikszentmihalyi, 2000). Gable and Haidt (2005) define positive
psychology as “the study of the conditions and processes that contribute to the flourishing
or optimal functioning of people, groups, and institutions” (p.104). Positive psychologists
believe that studying these aspects of the human experience will lead to knowledge that
can assist with the relief of suffering and an improvement in quality of life (Gable &
Haidt, 2005; Seligman & Csikszentmihalyi, 2000).
Consistent with the positive psychology approach, Antonovsky (1979) created a
theory focusing on the origins of health. Antonovsky argued that the human system is
subject to the physical processes of entropy and ultimate death, just like the rest of the
physical universe, so the dichotomous organization of disease and health does not fit. All
humans can be placed somewhere along a continuum of health and disease at any point in
time, and this is a more truthful portrayal of reality than the sole focus on risk factors and
diseases.
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Antonovsky (1979) offered the construct of a “sense of coherence” as the answer
to what helps people stay well despite the continuous bombardment of environmental
toxins and stressors that are an inevitable part of the human experience. This sense of
coherence (SOC) is defined by Antonovsky (1987) specifically as “a global orientation
that expresses the extent to which one has a pervasive, enduring though dynamic feeling
of confidence that (1) the stimuli deriving from one’s internal and external environments
in the course of living are structured, predictable, and explicable; (2) the resources are
available to one to meet the demands posed by these stimuli; and (3) these demands are
challenges, worthy of investment and engagement” (p. 19). The three domains of SOC
described above are referred to as comprehension, manageability, and meaning,
respectively.
In theory, a strong SOC gives people the ability to understand the challenges they
are faced with (comprehensibility), believe that they have access to resources to cope
with the challenge (manageability), and the desire to overcome the obstacle
(meaningfulness). This view, coined by Antonovsky (1979) as the “salutogenic”
perspective, is a unique way to identify the origins of health. Antonovsky (1996) argues
that the salutogenic perspective is able to study and develop interventions for all cultures
and people, not just those who are sick, and focuses on the whole complex person, not
just their disease or risk factors.
13
Generalized Resistance Resources. In Antonovsky’s (1979) description,
stressors cause tension within the individual and that tension can have both positive and
negative effects. Whether stressors have positive or negative effects depends on how well
the tension is managed by the individual. When tension management is good, the
experience pushes individuals toward a state of health or at least maintains their current
state of health. Conversely, poor tension management can lead to a state of stress and
negative health. Generalized Resistance Resources (GRR) are those characteristics of
people and their environments that assist in effective tension management, thereby
avoiding harmful stress reactions. GRR include both intrinsic traits of individuals as well
as characteristics of their environmental surroundings.
Antonovsky (1979) described several categories of resistance resources that assist
individuals with tension management. Money is included in the material category of
GRR. Money is a direct resistance resource in that it can immediately assist with coping
with a stressor (e.g. having the money to fix your car when it breaks down), but is also an
indirect resource in that having money allows access to other useful GRR (e.g., having
the money to pay for a private school education). Antonovsky also argued that attention
must be paid to the cultural differences in the value of GRR, and noted that some cultures
may value other traits over material GRR like money. To illustrate his point, American
Indian tribes that value money may have important differences in the way they use
14
money when compared to those people from the dominant culture (e.g., using money in
service of the people vs. using money for personal gain).
Another GRR category Antonovksy (1979) described was the “cognitiveemotional” component (p. 109). The cognitive element is basically the state of having
information about the world and the ability to acquire that kind of information. The
emotional element deals with having a balanced, stable sense of self that is able to adapt
to changing circumstances. For American Indians, the religious and spiritual nature of
their cultures might offer this resource by giving individuals a framework for gaining
knowledge about and making sense of the world (Ellison, 1991). The focus on the
indigenous concept of harmony may engender the development of a stable, balanced
sense of self that offers the emotional component of this GRR.
The way individuals cope is another form of GRR, and includes the belief that
they have access to resources that will assist with coping (Antonovsky, 1979). Individuals
have certain ways of coping and those styles depend in part on their personal and cultural
experiences. For collectivist cultures specifically, a sense of belonging and connection
have been related to successful coping with life stressors and decreases in negative affect
(Hobfoll et al., 2002), providing some evidence to support the argument that
enculturation might include the transmission of important coping skills for the individual.
Religiosity and spirituality, both components of the traditional American Indian
culture, may provide coping skills related to life satisfaction and depression. In a
15
comparison of elderly American Indian, African American, and European individuals,
researchers found that American Indian elders used more religious/spiritual coping skills
than both Europeans and African American elders, and received greater religious support
than the other elderly groups (Yoon & Lee, 2004). The American Indians in this sample
reported higher levels of life satisfaction than African Americans but age was the only
significant demographic predictor of life satisfaction among the three elderly groups. For
the American Indian elderly group, religious and spiritual coping skills were significant
negative predictors of depression. Those American Indian elderly who used religious and
spiritual coping skills were less likely to be depressed than the other elderly groups.
Antonovsky (1979) considered social support as one of the most important GRR.
He suggested that commitment to the social network that one has daily contact with, as
well as the reciprocal commitment of that network to the individual, is very important for
successful coping. He also suggested that culture and religion are important GRR in that
they have the ability to provide an expansive range of answers to individual members that
can facilitate coping with stressors. The collectivist nature of American Indian cultures
may place them in a valuable position to receive the social support GRR. The process of
enculturation might also provide the cultural and religious GRR that Antonovsky
predicted as important for coping with stress.
In sum, there are aspects of the traditional American Indian cultural systems that
likely provide effective resources for tension management, including religion, spirituality,
16
and social support. These resources help create experiences that enhance the internal
sense of coherence that life is understandable, manageable, and meaningful (Antonovsky,
1979). This sense of coherence, in turn, has been shown to have significant relationships
with health and well-being.
Sense of Coherence and Health
Much research has been done investigating the SOC construct and its relationship
to well-being, consistently noting that a strong SOC is associated with greater well-being.
In one such study using an adolescent sample, low SOC scores were associated with
higher levels of life dissatisfaction, feelings of depression, poor psychosomatic health,
and anxiety about family members (Myrin & Lagerström, 2008). There was also a
relationship found between SOC and social supports with those adolescents reporting
fewer social supports being two to three times more likely to have a low SOC.
SOC has also been related to physical health measures. A strong SOC was found
to be predictive of a subjective sense of good health four years later, independent of
occupational training, age, and SOC levels at the initial time of assessment (Suominen,
Helenius, Blomberg, Uutela, & Koskenvuo, 2001). SOC was also strongly associated
with good health after adjusting for age, occupational training, number of close friends,
and having an active leisure time (Suominen, Blomberg, Helenius, & Koskenvuo, 1999).
Another study looking at SOC and both positive and negative measures of health
found similar results (Pallant & Lae, 2002). The analysts controlled for social desirability
17
and the resulting data indicated significant correlations between SOC and physical health
as well as fewer stress symptoms (e.g., headaches, tension). In this analysis, SOC also
had a moderate negative correlation with physical and psychological adjustment. SOC
was found to have negative associations with perceived stress and negative affect, as well
as positive associations with life satisfaction and positive affect. The authors argue that
because SOC was associated with positive and negative psychological health indicators it
likely contributes to well-being, rather than simply an absence of negative affect.
Moderate correlations between SOC and self-esteem, mastery, perceptions of control, and
optimism were found, offering some evidence for SOC being an independent construct.
Other researchers have also found SOC to be moderately negatively correlated with
stress, and anxiety and depressive symptomatology (Flannery & Flannery, 1990).
Using a small clinical sample, investigators have revealed a significant increase in
the strength of participants’ SOC as they underwent treatment for major depression
(Skärsäter et al, 2008). At baseline, the inverse relationship between SOC and depression
severity, anger, global functioning, physical, and mental health was not significant, but
became moderately to strongly associated four years later. SOC was negatively
associated with aggression and hostility at both baseline and the final assessment time,
with their associations being stronger at the final assessment. The authors suggest that
treatment for major depression may have consequently bolstered participants’ SOC
scores and contributed to their recovery. These results also provide evidence for the
18
dynamic nature of the SOC, at least for a clinical sample, and offer some hope for
interventions that may attempt to improve health by strengthening one’s SOC.
Cross-cultural evidence has been provided for the construct of sense of coherence
and its relationship with health using both a European and American Indian sample
(Bowman, 1996). In the American Indian sample, analyses revealed a significant negative
association between SOC and depression, trait anxiety, and physical symptoms. The
comparison between the American Indian and Europeans groups revealed no significant
differences in levels of sense of coherence. Again, because traditional American Indian
cultures have unique features maintained by some people (Trimble & Gonzalez, 2008) it
seems possible that there is something inherent within the cultural systems that provide
resources that enhance American Indians’ sense of coherence.
Examinations of the mediating and moderating role of SOC and health variables
have had mixed support. In one study, SOC was not a mediator of the relationship
between perceived stress and the severity of substance addiction, but it was significantly
and negatively related to perceived stress and posttraumatic stress symptoms (Arévalo,
Prado, & Amaro, 2008).
Although not yet examined within American Indian populations, SOC has been
investigated as a mediator and moderator for other ethnic groups who have experienced
hardships. For those survivors with the most severe cases of trauma during the Holocaust,
SOC moderated the relationship between their traumatic experiences and posttraumatic
19
stress symptoms 60 years later (van der Hal-van Raalte, van IJzendoorn, & BakermansKraneburg, 2008). Assessing a Chinese participant sample, SOC was found to be a full
mediator of the relationship between attachment and depressive symptoms, and partially
mediated the relationship between college challenges and depressive symptoms (Ying,
Lee, & Tsai, 2007). The mediating role of a sense of coherence is complex and not fully
understood, particularly for American Indians, and warrants further investigation. In the
present study, sense of coherence was expected to play a mediating role in the
relationship between American Indian enculturation and well-being.
Well-Being
Much of the previously cited literature refers to the concept of “well-being” with
varying definitions used in each of the studies. Some positive psychologists have broadly
defined well-being as happiness, satisfaction with life, and positive feelings (Diener,
1984; Diener, Oishi, & Lucas, 2003). Many traditional American Indian cultures might
include wellness among the spirit, mind, and body in their definitions of well-being
(Locust, 1988). The concept of well-being has also been referred to as “psychological
well-being” (Ryff, 1995), which is the definition employed by the present study.
Psychological well-being is described as being comprised of several components: selfacceptance, positive relations with other people, autonomy, environmental mastery,
purpose in life, and personal growth.
20
When examining the components of well-being it is important to look at internal
characteristics of the individual (e.g., successful coping) as well as cultural influences
that might be related (Diener, Suh, Lucas, & Smith, 1999). This project intended to
address both by examining a cultural influence (i.e., enculturation) and internal
characteristics (i.e., a sense of coherence) to illuminate their relationships with well-being
in American Indians.
Traditional American Indian cultures have various components that likely make
important contributions to the well-being of American Indians. Religiosity and
spirituality (Carmody et al., 2008; Ellison, 1991; Yoon & Lee, 2004), participation in
traditional activities (Wagemakers Schiff & Moore, 2006), and ethnic identity (Martinez
& Dukes, 1997) have all been found to have significant relationships with well-being.
Examining the variables that contribute to well-being is consistent with the positive
psychology approach to identifying what is good in life and helps contribute to our
comprehensive understanding of the human experience. A focus on how American Indian
people have managed to stay well expands our understanding of American Indian
strengths and can guide therapeutic interventions that foster those strengths rather than
simply alleviate illness.
In conclusion, there is much evidence to support the positive relationships SOC
has with various measures of health and well-being for multiple ethnic groups. There is
also evidence to support the argument that aspects of the traditional American Indian
21
culture have beneficial relationships with the health and well-being of American Indians.
There has yet to be an investigation into the potential relationships enculturation may
have with a sense of coherence and how this might be related to American Indian wellbeing. The major goal of this project was to assess the relationships between
enculturation, psychological well-being, and a sense of coherence, and to determine
whether or not a strong sense of coherence mediates the relationship between
enculturation and well-being.
CHAPTER II
Statement of the Problem
American Indians are considered a population at risk for numerous physical and
mental health problems from diabetes and cardiovascular problems (CDC, 2003) to
substance abuse (DHHS, 2001) and suicide (CDC, 2008). There are many reports that
document the long-standing health disparity between American Indians and the general
population (Kunitz, 2008). There has been less focus on the strengths that American
Indians possess that are facilitating their survival and growth despite all of the obstacles
they face. This project took a positive psychology approach in an attempt to increase our
understanding of American Indian strengths that contribute to their overall sense of wellbeing. Knowledge and understanding of the traditional American Indian culture (i.e.,
enculturation) was viewed here as providing resources that help American Indians
understand their lives, cope with what happens to them, and gives them the motivation to
carry on.
Much of the literature surveying American Indian participants focuses on tribes in
Middle America but California has one of the largest concentrations of American Indians
in the nation (U.S. Census Bureau, 2007). Because there can be significant variations in
tribal political and social structures (Locust, 1988), it is important to include various
tribes in research to assist in documenting both the similarities and differences among the
22
23
tribal nations. This project supplements our understanding of American Indians by
surveying adults in Northern California.
Present Study
The present study examined the relationships between enculturation, sense of
coherence, and psychological well-being in American Indian adults living in northern
California. Participants were presented with paper-and-pencil questionnaires using Likert
scale formats assessing all three variables.
Research Hypotheses
Hypothesis 1: Enculturation and well-being will be positively correlated.
Hypothesis 2: Enculturation and sense of coherence will be positively correlated.
Hypothesis 3: Sense of coherence and well-being will be positively correlated.
Hypothesis 4: If hypotheses 1 through 3 are significant, a sense of coherence will
mediate the relationship between enculturation and well-being.
Research Hypotheses Rationale
Although there is little evidence to support the direct link between enculturation
and well-being in American Indians, one study found a positive association between
enculturation and subjective well-being in Korean minorities, with social connection to
the ethnic community mediating the relationship (Yoon, Goh, & Lee, 2008). There is also
evidence to suggest that components of American Indian enculturation (e.g., ties to the
traditional culture) are both physically and psychologically beneficial to American
24
Indians. Traditional spirituality and activities have been associated with the cessation of
alcohol (Torres Stone et al., 2005), maintenance of sobriety (Hazel, & Mohatt, 2001), and
increases in well-being (Wagemakers Schiff & Moore, 2006). Spirituality, an important
component of the American Indian culture, has been related to decreases in depression
(Yoon & Lee, 2004) and psychological distress (Carmody et al., 2008). American Indian
identity is positively associated with self-esteem, self-confidence, and purpose in life in
adolescents (Martinez & Dukes, 1997), which can all be considered components of
overall well-being.
Enculturation can be viewed as providing resources that strengthen an internal
sense of coherence and facilitate successful coping with stressors (Antonovsky, 1979).
This relationship has yet to be validated empirically within American Indian populations
but social connection, which is an important component of traditional American Indian
cultures transmitted through the process of enculturation, has been associated with a
strong sense of coherence (Suominen et al., 1999; Volanen, Lahelma, Silventoinen, &
Suominen, 2004).
Evidence has accumulated that suggests sense of coherence has a significant
relationship with health and well-being. A strong sense of coherence has been shown to
have a consistent relationship with good health (Suominen et al., 1999; Suominen et al.,
2001). Negative associations between SOC and stress as well as physical illness are
contrasted by the positive associations SOC has with good health, life satisfaction, and
25
positive feelings (Pallant & Lae, 2002), attesting to the construct’s impact on both
physical and psychological illness and health. A weak sense of coherence is related to
depression, anxiety, and poorer health (Myrin, & Lagerström, 2008), and strengthening
one’s SOC is associated with recovery from depression (Skärsäter et al., 2008). SOC has
a strong negative relationship with depressive symptoms (Ying et al., 2007) and may also
have a protective effect against post-traumatic stress symptoms (Arévalo et al., 2008).
Support for sense of coherence as both a mediator and a moderator has also been
illustrated. SOC had a long-term moderating effect on the relationship between traumatic
Holocaust experiences and post-traumatic stress symptoms (Hal-van Raalte, IJzendoorn,
& Bakermans-Kraneburg, 2008), and was found to mediate the relationship between
stress and depression (Ying et al., 2007). This study takes a similar approach and
hypothesizes the mediating role of sense of coherence between American Indian
enculturation and well-being.
Focusing on the SOC of American Indians veers from the traditional pathogenic
approach to disease and emphasizes the extrinsic and intrinsic strengths American
Indians possess that may help them through difficult times. Increasing our understanding
of American Indian strengths will help in the development of therapeutic interventions
that can focus on nurturing these strengths to assist individuals in managing and coping
with their lives.
CHAPTER III
Method
Participants
Participants were 36 American Indian adults from various tribes residing in
northern California. See Table 1 for the tribal affiliations these participants reported.
Operational Definitions
American Indian enculturation has been defined by participation in tribal
activities, cultural identification, and adherence to cultural values (Winderowd et al.,
2008). Enculturation was assessed in this study by measurement with the American
Indian Enculturation Scale (AIES; Winderowd et al., 2008; see Appendix A).
A sense of coherence (SOC) is defined as comprehension, manageability, and
meaning (Antonovsky, 1979; 1987). Comprehension refers to the ability to make sense of
the events that people experience. Manageability refers to the ability to identify and
access resources to cope with experience. Meaning refers to the desire to overcome the
challenges of experience. SOC was assessed in this study by measurement with the
Orienation to Life Questionnaire (OLQ; Anotonovsky, 1987; see Appendix B).
Psychological well-being (PWB) has been defined by six domains of functioning
(Ryff, 1989). Self-acceptance refers to positive feelings about the self. Autonomy refers
to feelings of independence and control. Environmental mastery reflects the ability to get
26
27
Table 1
Frequency Distributions of Tribes
Tribes
Frequency
Percent
Yurok
Tolowa
Hoopa, Yurok, Tolowa, Choctaw, Chikasaw
Athabascan
Tolowa Dee-ni'
Smith River Rancheria
Yurok, Tolowa
Oglala Lakota
Yurok, Karuk
6
2
1
1
1
2
1
1
1
16.7
5.6
2.8
2.8
2.8
5.6
2.8
2.8
2.8
Navajo, Hualapai
Yurok, Karuk, Abenaki, Shasta
Karuk
Arikara, Hidatsa
1
1
1
1
2.8
2.8
2.8
2.8
Bear River Band of Rhonerville Reservation
Weott
Anishinaabe
Maidu, Paiute
1
1
2
1
2.8
2.8
5.6
2.8
Maidu
Susanville Indian Rancheria
Mandaw, Hidatsa
1
3
1
2.8
8.3
2.8
Tolowa, Maidu
1
2.8
Wyandot, Anishinaabe
Prairie Band Potawatomi
Tolowa, Mountain Maidu
Muscogee
Tolowa, Maidu, Yurok
1
1
1
1
1
2.8
2.8
2.8
2.8
2.8
Total
36
100.0
28
what one wants and needs from the environment. Personal growth suggests an open,
positively evolving person. Purpose in life refers to having meaningful life direction and
goals. The positive relations with others domain reflects someone who is caring about
others and who has meaningful relationships. PWB was assessed in this study by
measurement with the Psychological Well-Being Scale (Ryff, 1989; see Appendix C).
Instrumentation
Demographic questionnaire. For descriptive purposes, participants were asked
to report their age, gender, self-identified status as an American Indian, tribal affiliations,
and whether or not they have lived on or near a reservation. See Appendix D for the
demographic questionnaire.
American Indian Enculturation Scale (AIES; Winderowd et al., 2008). The
AIES is a 17 item scale assessing participation in both behavioral and spiritual tribal
activities (e.g., “attend Indian ceremony”, “use or know the Indian language”, and
“participate in Indian prayers”). Responses on a 7-point scale range from 1 (not at all) to
7 (a great deal). The AIES has a possible range of scores from 7 to 119, with a higher
score reflecting a greater level of involvement with the traditional American Indian
culture. That is, an American Indian reporting a high score on the AIES indicates a
person that participates in traditional American Indian ways including ceremonies,
spirituality, and connection with other American Indians.
29
Initial analyses revealed a high internal consistency for the total AIES using two
non-clinical samples (r=.90) and one clinical sample (r =.91). Evidence for the
convergent validity of the AIES was provided by using the Life Perspectives Scale (LPS)
which assesses American Indian acculturation as traditional (higher scores) or nontraditional (lower scores). The AIES was significantly positively correlated with the LPS
behavioral (r =.55, p<.01) and spiritual (r =.54, p<.01) subscales. Discriminant validity
was shown by distinguishing between enculturation and acculturation, with the AIES
negatively associated with the Native American Acculturation Scale (r=-.68, p<.01).
Orientation to Life Questionnaire (OLQ; Antonovsky 1987). The OLQ is a 29item scale assessing the perception of life’s comprehensibility, manageability, and
meaningfulness. The OLQ has a 7-point response format with two anchoring phrases
provided for each question (e.g., very often to very seldom or never). The OLQ has a
range of scores from 29 to 203 with higher scores representing a stronger sense of
coherence. Thirteen of the items on the OLQ are reverse scored. A high score on the
OLQ reflects the participant’s internal perspective that their life makes sense, they have
the ability to cope with what happens to them, and they possess the motivation to cope
with those challenges. Example items include: “Do you have very mixed-up feelings and
ideas” (comprehensibility); “How often do you have feelings that you’re not sure you can
keep under control” (manageability); and “Do you have the feeling that you don’t really
care about what goes on around you” (meaningfulness).
30
A study investigating the psychometric properties of the OLQ found the internal
consistency of the total scale to have a Cronbach’s alpha of α =.93 (Frenz, Carey, &
Jorgensen, 1993). This study also revealed a high one week test-retest reliability of the
OLQ with two non-clinical samples (r=.92, r=.93). Sense of coherence was negatively
associated with perceived stress (r=-.73, p<.0001) in three groups comprised of clinical
and non-clinical participants, and was also negatively associated with depression (r=-.60,
p<.0001) and trait anxiety (r=-.85, p<.0001) in two clinical samples. This analysis
revealed a high correlation between the SOC and a measure of social desirability.
Psychological Well-Being Scale (PWB; Ryff, 1989). The complete PWB scale
contains 84 items assessing six dimensions of well-being: autonomy, environmental
mastery, personal growth, positive relations with others, purpose in life, and selfacceptance. Participants respond on a six-point scale ranging from 1 (strongly disagree)
to 6 (strongly agree) with high scores representing a greater sense of well-being on the
domain being assessed. A total of 40 items on the PWB are reverse scored with a possible
range of scores from 84 to504. Example items include: “I have confidence in my
opinions, even if they are contrary to the general consensus” (autonomy); “In general, I
feel I am in charge of the situation in which I live” (environmental mastery); “For me,
life has been a continuous process of learning, changing, and growth” (personal growth);
“I know that I can trust my friends, and they know they can trust me” (positive relations
31
with others); “I have a sense of direction and purpose in life” (purpose in life); and “In
general, I feel confident and positive about myself” (self-acceptance).
Using a non-clinical sample of 321 adults, initial analyses of the original 20 item
PWB scale revealed high internal consistency of the six dimensions: autonomy (α =.86);
environmental mastery (α =.90); personal growth (α =.87); positive relations with others
(α =.91); purpose in life (α =.90); and self-acceptance (α =.93; Ryff, 1989). Test-retest
reliabilities were reported after a six-week time period assessing 117 participants and
were found to be greater than r=.80 for each of the dimensional scales. Convergent
validity was demonstrated by significant positive associations between the PWB
dimensions and other measures of well-being (e.g., life satisfaction) ranging from r=.25
to .73 (p<.0001). Discriminant validity was demonstrated by significant negative
associations between the PWB dimensions and other measures of negative functioning
(e.g., depression) ranging from r=-.30 to -.60 (p<.0001).
This study used the shorter version of the PWB scales containing 14-items for
each of the six dimensions of well-being (Ryff, C.D., personal communication, February
13, 2010). Each of the dimensional scales have demonstrated high correlations with the
20-item parent scale, all ranging from .97 to .99, and high internal consistency ratings, all
ranging from .83 to .91.
Cronbach’s alphas were computed for each of the measures from the data
obtained for these participants and are discussed in the Results section.
32
Procedure
Institutional Review Board (IRB) approval was granted prior to data collection
(IRB #09-78). Permission to distribute survey packets was sought by a letter sent to
various agencies and organizations that serve American Indians throughout the northern
California Humboldt county community and within the Humboldt State University
(HSU) campus, a four-year public university (see Appendix E for Permission Letter).
Community agencies that received survey packets for distribution included United Indian
Health Services (UIH) in Arcata, California. UIH provides medical services to local
American Indian communities.
The following HSU organizations were also asked for permission and received
survey packets from the principal investigator for distribution: The Indian Teacher and
Educational Personnel Program (ITEPP); the Indian Natural Resource, Science and
Engineering Program (INRSEP); Center for Indian Community Development (CICD);
and the Native American Studies Department (NAS). All of these organizations support
American Indian students in their academic pursuits and some are also involved in
outreach with American Indian communities.
Two hundred coded survey packets were delivered to the recruiting agencies for
distribution to American Indian adults residing in the northern California area. Survey
packets included a pre-paid return envelope addressed to the principal investigator, a
participation instruction form requesting that no identifying information be used on any
33
of the pages in the survey packet (see Appendix F), as well as an informed consent form
describing the nature of the study (see Appendix G). Participants were instructed that the
return of their completed surveys implied their consent to participate. Survey packets also
included the following four questionnaires: demographic information, the AIES, the
OLQ, and the PWB scale. The last page of the survey packet was a list of local mental
health referrals instructing participants on the services available should they have felt any
distress or discomfort after having completed the survey packets (see Appendix H).
Survey data was collected over an 18-week time period and yielded an 18.5% response
rate.
Risks and Benefits
No more than minimal risk was expected from participation in this project.
Management of risks included obtaining anonymous informed consent from all
participants. To ensure participant anonymity, participants were instructed that the return
of their completed questionnaires implied their consent. Participants were instructed not
to put their name on any of the forms included in the survey packets. All completed
questionnaires were kept in a locked file cabinet in the principal investigator’s possession
until the research project was completed. Upon completion of the project all completed
questionnaires were shredded.
It was assumed that some feelings of discomfort might have arisen from
participants being asked to report on their ethnicity. There was also a minimal risk of
34
psychological discomfort from the questions directed at self constructs (e.g., sense of
coherence and well-being).The risk of asking participants to report on their ethnicity was
minimized by surveying only those self-identified American Indians who patron agencies
and programs involved in assistance for American Indians. In the case of psychological
discomfort due to responding to questionnaire items, a list of local counseling services
was made available to participants. Participants were also instructed to contact the
principal investigator or the committee advisor if they had any questions or concerns
about their participation in this project.
Several of the participants (n = 6) wrote notes on their survey packets indicating
some concerns over the questions or the survey itself. Their comments are reviewed in
the Discussion section. These participants, however, did not remove the mental health
referrals contact list from the last page of the survey packet. None of the participants
contacted the thesis advisor or the principal investigator with questions or concerns about
their participation.
Through their involvement in this project participants had an opportunity to learn
something about themselves by reflecting on their cultures and attitudes towards life. The
participants’ contribution to this project enhanced our current understanding of American
Indians and the factors that may be related to their well-being. The components involved
in American Indian well-being have the potential to provide important and useful
resources that can help lessen the problems experienced by this community.
CHAPTER IV
Results
Participants were 37 American Indian adults residing in the northern California
area. One participant failed to complete a page of items within the survey packet so was
removed from statistical analyses, leaving n = 36 to be included in the analyses.
Descriptive statistics were computed for the demographic variables. Ages ranged
from 20 to 68 with a mean age of 45 (SD=14). Sixty-seven percent of participants were
female. A majority of the participants reported living on or near a reservation (n = 24;
67%) as well as having been raised on or near a reservation (n = 29; 77%).
Means and standard deviations were computed for the AIES, OLQ, and PWB
measures, and are presented in Table 2.
Reliability coefficients were calculated for each of the three scales (i.e., AIES,
OLQ, and PWB) as well as for the subscales within the OLQ and PWB using Cronbach’s
alpha. The AIES had a reliability coefficient of α = .92. This result is in line with other
researchers examining the AIES in an American Indian sample (Winderowd et al., 2008).
The following reliability coefficients were found for the OLQ and its corresponding
subscales: Total OLQ, α = .73; Comprehension subscale, α = .66; Manageability
subscale, α = .43; and Meaning subscale, α = .58. The internal consistency of the total
OLQ found in this sample differs from that found by other researchers
35
36
Table 2
Means and Standard Deviations for Study Variables
AIES
OLQ
PWB
Mean
75.03
122.11
388.69
SD
22.04
19.36
53.08
(Frenz et al., 1993), but is still within the acceptable range. The following reliability
coefficients were found for the PWB and its corresponding subscales: Total PWB, α =
.84; Autonomy subscale, α = .66; Environmental Mastery subscale, α = .86; Personal
Growth subscale, α = .62; Positive Relations with Others subscale, α = .54; Purpose in
Life subscale, α = .66; and the Self-Acceptance subscale, α = .46. The internal
consistency of the PWB and its subscales differs from that found in previous research
(Ryff, 1989) but the total scale reliability is still within the acceptable range.
One-tailed, bivariate correlational analyses were conducted to examine the first
three hypotheses. Hypothesis one predicted a positive correlation between enculturation
and psychological well-being. Results were nonsignificant. This hypothesis was not
supported. Hypothesis two predicted a positive correlation between enculturation and
sense of coherence. Results were nonsignificant. This hypothesis was not supported. The
correlational matrix for hypotheses one and two is presented in Table 3.
37
Hypothesis three was supported with significant results, i.e., a sense of coherence
was positively correlated with psychological well-being (r = .84, p < .01). The results are
presented in Table 3. Because these results were significant, supplemental correlational
analyses were conducted on the subscales of both the OLQ and PWB in order to further
examine the details of significance. In order to test the effect size of the correlation, the
coefficient of determination (r2) was computed by squaring the correlational coefficient
(i.e., r = .84), resulting in a value of r2 = .71. That is, in this participant sample,
approximately 71% of the deviation in psychological well-being can be accounted for by
its relationship with a sense of coherence.
Significant correlations between the PWB subscales and the total OLQ were as
follows: autonomy (r = .47; p < .01); environmental mastery (r = .75; p < .01), personal
growth (r = .68; p < .01), positive relations with others (r = .54; p < .01), purpose in life
(r = .77; p < .01), and self-acceptance (r = .82; p < .01). Results are presented in Table 4.
All subscales of the OLQ had significant correlations with the total PWB. The
results are presented in Table 5. Significant correlations of the OLQ subscales and PWB
were as follows: comprehension (r = .52; p < .01), manageability (r = .79; p < .01), and
meaningfulness (r = .70; p < .01).
38
Table 3
Correlational Matrix for Study Hypotheses
AIES
OLQ
PWB
AIES
OLQ
PWB
1
.209
.142
.209
1
.842**
.142
.842**
1
* p <.05; **p < .01
Note. Enculturation (AIES); sense of coherence (OLQ); psychological well-being (PWB).
All of the subscales of the PWB and OLQ were significantly correlated with each
other except for autonomy and comprehension, and personal growth and comprehension.
Correlational coefficients for the subscales were as follows: autonomy and manageability
(r = .41; p < .01), and meaningfulness (r = .43; p < .01); environmental mastery and
comprehension (r = .60; p < .01), manageability (r = .68; p < .01), and meaningfulness (r
= .51; p < .01); personal growth and manageability (r = .63; p < .01), and meaningfulness
(r = .70; p < .01); positive relations with others and comprehension (r = .38; p < .05),
manageability (r = .61; p < .01), and meaningfulness (r = .38; p < .05); purpose in life
and comprehension (r = .39; p < .01), manageability (r = .69; p < .01), and
meaningfulness (r = .72; p < .01); and self-acceptance and comprehension (r = .54; p <
.01), manageability (r = .76; p < .01), and meaningfulness (r = .66; p < .01). The
correlational matrix for these results are presented in Table 6.
39
Table 4
Correlational Matrix for Sense of Coherence and Subscales of Psychological Well-Being
PWBAUT
OLQ
.465**
PWBEM PWBPG PWBPR
.753**
.679**
.544**
PWBPL
PWBSA
.767**
.817**
* p <.05; **p < .01
Note. Psychological well-being subscales are presented in the table as follows: autonomy
(PWBAUT), environmental mastery (PWBEM), personal growth (PWBPG), positive
relations with others (PWBPR), purpose in life (PWBPL), and self-acceptance (PWBSA).
Sense of coherence is presented as OLQ in the table.
Hypothesis four stated that if the first three hypotheses were found to be
significant, a regression analyses would be conducted in order to determine if a sense of
coherence mediated the relationship between enculturation and well-being. Because the
first two hypotheses were nonsignificant the test for mediation was not conducted (Baron
& Kenny, 1986).
40
Table 5
Correlational Matrix for Psychological Well-Being and Subscales of Sense of Coherence
PWB
OLQCOM
OLQMAN
OLQMEAN
.519**
.787**
.704**
* p <.05; **p < .01
Note. Sense of coherence subscales are presented in the table as follows: comprehension
(OLQCOM), manageability (OLQMAN), and meaningfulness (OLQMEAN).
Psychological well-being is presented as PWB in the table.
41
Table 6
Correlational Matrix for Subscales of Psychological Well-Being and Sense of Coherence
PWBAUT
PWBEM PWBPG
PWBPR
PWBPL
PWBSA
OLQCOM
.266
.599**
.246
.385*
.390**
.543**
OLQMAN
.406**
.680**
.626**
.611**
.686**
.758**
OLQMEAN
.433**
.515**
.704**
.377*
.724**
.663**
* p <.05; **p < .01
Note. Psychological well-being (PWB) subscales are presented in the table as follows:
autonomy (PWBAUT), environmental mastery (PWBEM), personal growth (PWBPG),
positive relations with others (PWBPR), purpose in life (PWBPL), and self-acceptance
(PWBSA). Sense of coherence (OLQ) subscales are presented in the table as follows:
comprehension (OLQCOM), manageability (OLQMAN), and meaningfulness
(OLQMEAN).
CHAPTER V
Discussion
The goal of this study was to enhance our current understanding of those aspects
of traditional American Indian culture that might have important relationships with the
health and well-being of American Indian people. In order to meet this goal, analyses of
the relationships between enculturation, sense of coherence, and psychological wellbeing in American Indian adults were conducted. A review of previously published
literature inspired the hypotheses that 1) enculturation would be positively related to
well-being; 2) enculturation would be positively related to a sense of coherence; 3) a
sense of coherence would be positively related to well-being, and 4) if the previous
hypotheses were supported and significant, a regression analysis would determine if a
sense of coherence mediated the relationship between enculturation and well-being.
Primary Analyses
Before discussion of the results of the primary analyses, it is important to note
that, for this sample, all of the subscales on the well-being and sense of coherence
measures, with the exception of environmental mastery, had internal consistency ratings
below those that are generally thought to be acceptable in scientific research even though
the reliability coefficient was good for the overall measures. This brings the both the
42
43
sense of coherence and psychological well-being measure into question for use in this
sample, and these results should be interpreted with caution.
Hypotheses one was not supported, i.e., enculturation was not related to
psychological well-being. These research findings contradict previous research on
enculturation and well-being (Iwamoto & Liu, 2010; Krouse & Andrews, 2005; Martinez
& Dukes, 1997; Wagemakers Schiff & Moore, 2006; Yoon et al., 2008), which warrants
a deeper investigation into the potential reasons underlying these results. It may be that
enculturation does not have a significant relationship with well-being and these results
are an accurate depiction of the true relationship between the variables for this particular
sample. It seems noteworthy that, although small and nonsignificant, the association
between enculturation and well-being was in the predicted direction so it is plausible that
this study did not have enough power to detect the significance due to its small sample
size.
Another potential explanation for the lack of relationship between enculturation
and well-being may lie in the definitions of well-being. Previous researchers have related
American Indian enculturation not only to different definitions of well-being (Krouse &
Andrews, 2005; Wagemakers Schiff & Moore, 2006) but also to indicators of well-being,
e.g., alcohol cessation (Torres Stone et al., 2005), the maintenance of sobriety (Hazel &
Mohatt, 2001), and lower rates of attempted suicide (Garroutte et al., 2003). It is possible
that American Indian enculturation is related more to these types of indicators that
44
suggest a sense of well-being, rather than to an overall sense of well-being as was
assessed in this study. Moreover, some of the previously cited research using
components of enculturation (e.g., spirituality, religiosity, and a sense of belonging)
looked at their relationships to decreases in psychological or physical problems
(Carmody et al., 2008; Ellison, 1991; Hobfoll et al., 2002; Yoon & Lee, 2004). The
absence of psychological symptoms is not necessarily the same as psychological wellbeing. It may be that enculturation and its components have more important implications
for decreasing psychological or physical distress.
Hypothesis two was also not supported, i.e., enculturation was not related to a
sense of coherence. A review of the literature did not reveal research examining
enculturation and its relationship to a sense of coherence but Antonovsky (1979)
theorized that culture and religion are important resources that contribute to a strong
sense of coherence. These results do not support his assumption. Again, it could be that
our results are accurate and there is no relationship between enculturation and sense of
coherence. It could also be that there is a relationship between enculturation and a sense
of coherence but that this study’s limited sample size was not powerful enough to detect
it. Again, as with sense of coherence and well-being, the results between enculturation
and sense of coherence were small and nonsignificant but were in the predicted direction.
Another explanation is that enculturation may be too broad a construct and should be
broken down into its components. To illustrate this point, some research found that social
45
connection is associated with a strong sense of coherence (Suominen et al., 1999;
Volanen et al., 2004), so it might be this aspect of the American Indian culture that has
the more important relationship with a strong sense of coherence for these participants.
Another possibility that could explain the nonsignificant results between
enculturation, well-being, and sense of coherence is derived from the differences that can
be found between tribal groups. Many of the participants of this study reported
affiliations with multiple tribes who might have significant differences in the way they
practice or in what they value or believe. These participants might associate
predominantly with one or another of their tribal groups, but they may also, for example,
subscribe to one tribal group’s value system but practice according to another tribal
group’s rituals. These differences may have influenced how these participants scored on
the enculturation measure. It is possible that enculturation might have significant
relationships with sense of coherence or well-being in another participant sample.
Sense of coherence and psychological well-being had a strong, positive
correlation in this American Indian sample supporting hypothesis three with significant
results. The effect size of this relationship was strong as well. This result is impressive
considering the small sample size but should also be interpreted with caution due to the
low reliability found for the subscales of both the sense of coherence and well-being
measures. This result is, however, consistent with previous research findings using the
sense of coherence construct and various other measures of health and well-being
46
(Bowman, 1996; Flannery & Flannery, 1990; Myrin & Lagerström, 2008; Pallant & Lee,
2002; Suominen et al., 2001) and these results contribute to that growing body of
knowledge. The results of this study also contribute to the field of positive psychology by
focusing on what contributes to wellness (Gable & Haidt, 2005; Seligman &
Csikszentmihalyi, 2000). Furthermore, this is the only study that we know of using the
Ryff (1995) measure, which details six components of psychological well-being, with the
sense of coherence construct. Additionally, this research is the only study we know of
using these constructs in an American Indian sample.
Supplemental Analyses
Out of all the subscales on the well-being measure, autonomy, while still being
significant, had the weakest relationship with a sense of coherence. One possible
explanation for this is that autonomy might not be as relevant a construct to the American
Indian people as say, interdependency, might be, due to the collective nature of their
cultures (Garrett & Garrett, 1994; Hill, 2006). Therefore, being “autonomous” is likely an
uncommon behavior in American Indian cultures and would not be expected to be related
to how the people understand and manage their lives. For example, Ryff (1995) notes that
low scorers on the autonomy subscale concern themselves with other people’s desires and
judgments, rely on others to inform their decision-making, and conform to their social
group’s ways of thinking and behaving. This description seems to fit well with the
cooperative nature of the American Indian cultures (Garrett & Garrett, 1994).
47
Self-acceptance and purpose in life had the strongest relationships to the overall
sense of coherence measure out of all the subscales on the well-being measure. When
considering the definitions proposed by Ryff (1995) it makes logical sense to conclude
that those who feel good about themselves (i.e., self-acceptance), are goal-directed, and
find their lives meaningful (i.e., purpose in life) are better able to understand their
subjective worlds, cope with what happens to them, and have the motivation to do so.
Purpose in life and meaning also had strong relationships in the subscale correlations.
Antonovsky (1987) defined “meaning” as the motivational component of a sense of
coherence, suggesting that people who score high in this area believe their lives are
worthwhile enough to pursue coping with what happens to them. Again, it makes logical
sense to conclude that people who feel their lives are meaningful are motivated to cope
with the challenges they are faced with. Trimble and Gonzalez (2008) posit that cultural
systems can provide individual members with a purpose in life, leaving open the
possibility that there is some aspect of the American Indian culture that is related to a
sense of coherence.
Out of all the subscales on the sense of coherence measure, manageability had the
strongest relationship with overall psychological well-being, suggesting that being able to
recognize and utilize resources to facilitate coping is most beneficial to an overall sense
of well-being. This makes some sense considering that many mental health treatments
focus on coping skills in an attempt to reach therapeutic goals (Sharf, 2008). The
48
relationship between manageability and well-being suggests that these American Indian
participants are likely able to identify and utilize the resources available in their
environments to assist in their coping.
Clinical Implications
This results obtained from this study have an important implication for clinical
applications dealing with American Indian clients. Because sense of coherence and wellbeing were strongly and positively related in this sample it seems worthwhile to
supplement current therapeutic interventions with a focus on strengthening the sense of
coherence in American Indian clients. By doing so, clinicians might better assist their
clients in reaching therapeutic goals aimed at finding some sort of contentment and
happiness for their lives.
Limitations and Suggestions for Future Research
The survey packet used in this study was lengthy (i.e., 130 items) so it is plausible
that the test was too long, took too much time to complete, and resulted in burdening or
fatiguing the participants which may have influenced their responses.
As mentioned previously, one of the important limitations of this study was the
sample and the low reliability found for the subscales of the sense of coherence and wellbeing measures. Because the sample size was so small (N = 36) it is likely that this study
did not have enough power to detect a relationship between enculturation and well-being,
or enculturation and sense of coherence. The limited sample size was also likely not
49
adequately representative of American Indian communities at large. As an example, the
mean age of participants in this study was 45 and only nine participants were age 30 or
under. Replication of this study with sufficient numbers of participants from a diverse
sampling of tribes might be a focus for future researchers because, as noted previously,
tribes differ on their practices and beliefs (Locust, 1988) which might influence outcome
variables. Because of the strong relationship with well-being found in this study, it is
important to understand if American Indian enculturation can be viewed as a resource
that strengthens a sense of coherence and if not, what constructs do.
Another important limitation is the possible discrepancy between the constructs
under study and the cultural values of the participants. It is important to note that six
participants gave feedback on items within the measures or the survey itself indicating
discontent with the relevance of the questions to their cultural beliefs and values. One
participant found some of the questions to be “too invasive”. Another participant wrote a
paragraph on one of the sheets contained within the survey packet commenting that the
survey is “unreflective of cultural values” and that “fussing or thinking too much about
yourself, or judging others, is inappropriate”. The same person responded with
“community values are important” to an item on the sense of coherence measure that
emphasizes self values over others’ values. One person remarked on the value of the
cultural community, writing “I do what I do to help Indian country survive. I do it
because it’s my responsibility”. Yet another person wrote comments reflecting a
50
discrepancy between the surveys and cultural values saying “…to be Indian means to
have different ways to respond”.
An interesting and useful line of research that could be pursued in the future
would be to use both qualitative and quantitative approaches to assess the sense of
coherence and well-being constructs in American Indians. The answers obtained from
interview methods, particularly for cultures that emphasize oral history and storytelling
components, might illuminate what kinds of questions on the sense of coherence and
well-being measures should be included and excluded in order to be validated for use
with American Indians.
Conclusion
This study examined the relationships between enculturation, sense of coherence,
and psychological well-being in the American Indian community. Sense of coherence and
psychological well-being were found to be strongly related in this small sample,
validating existing research efforts that connect a strong sense of coherence with various
measures of health. This research contributes to the positive psychology literature by
focusing on constructs that are related to making life meaningful (e.g., psychological
well-being), and lends some evidence to support the use of the sense of coherence
construct in the American Indian population. This research effort also makes an
important contribution to the American Indian literature by illuminating one of the many
51
strengths they have available to survive and cope with the difficulties they may face in
their daily lives.
52
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APPENDIX A:
American Indian Enculturation Scale
62
63
PLEASE DO NOT WRITE YOUR NAME ON THIS FORM
AIES
In general, how much do you participate in the following activities: (circle the number that best
represents your participation for each item)
1..........2..........3..........4..........5..........6.........7
not at all
a great deal
a) attend Indian church
1..........2..........3..........4..........5..........6.........7
b) attend Indian ceremony
1..........2..........3..........4..........5..........6.........7
c) choose Indian activity before others
1..........2..........3..........4..........5..........6.........7
d) socialize with Indians or have Indian friends
1..........2..........3..........4..........5..........6.........7
e) use Indian medicine
1..........2..........3..........4..........5..........6.........7
f) seek help from Elders
1..........2..........3..........4..........5..........6.........7
g) attend pow-wows
1..........2..........3..........4..........5..........6.........7
h) sing Indian songs
1..........2..........3..........4..........5..........6.........7
i) participate in Indian prayers
1..........2..........3..........4..........5..........6.........7
j) write Indian stories
1..........2..........3..........4..........5..........6.........7
k) eat or cook Indian food
1..........2..........3..........4..........5..........6.........7
l) do Indian art
1..........2..........3..........4..........5..........6.........7
64
m) use or know the Indian language
1..........2..........3..........4..........5..........6.........7
n) attend Indian dances
1..........2..........3..........4..........5..........6.........7
o) know or participate in tribal politics
1..........2..........3..........4..........5..........6.........7
p) know or share Indian history
1..........2..........3..........4..........5..........6.........7
q) work in Indian communities/population
1..........2..........3..........4..........5..........6.........7
APPENDIX B:
Orientation to Life Questionnaire
65
66
PLEASE DO NOT WRITE YOUR NAME ON THIS FORM
OLQ
Here is a series of questions relating to various aspects of our lives. Each question has
seven possible answers. Please mark the number which expresses your answer, with
numbers 1 and 7 being the extreme answers. If the words under 1 are right for you, circle
1; if the words under 7 are right for you, circle 7. If you feel differently, circle the number
which best expresses your feeling. Please give only one answer to each question.
1. When you talk to people, do you have the feeling that they don’t understand you?
1
2
never have
this feeling
3
4
5
6
7
always have
this feeling
2. In the past, when you had to do something which depended upon cooperation with
others, did you have the feeling that it:
1
2
3
4
5
6
7
surely wouldn’t
get done
surely would
get done
3. Think of the people with whom you come into contact daily, aside from the ones
to whom you feel closest. How well do you know most of them?
1
2
3
4
5
6
7
you feel that
they’re strangers
you know them
very well
4. Do you have the feeling that you don’t really care about what goes on around
you?
1
2
3
4
5
6
7
very seldom
or never
very often
67
5. Has it happened in the past that you were surprised by the behavior of people
whom you thought you knew well?
1
2
3
4
5
6
7
never
happened
always
happened
6. Has it happened that people whom you counted on disappointed you?
1
2
3
4
5
6
7
never
happened
7. Life is:
1
2
always
happened
3
4
5
6
full of
interest
8. Until now your life has had:
1
2
3
4
5
no clear goals or
purpose at all
7
completely
routine
6
7
very clear goals
and purpose
9. Do you have the feeling that you’re being treated unfairly?
1
2
3
4
5
6
7
very often
very seldom or never
68
10. In the past ten years your life has been:
1
2
3
4
5
6
full of changes
without your
knowing what will
happen next
7
completely
consistent and
clear
11. Most of the things you do in the future will probably be:
1
2
3
4
5
6
7
completely
fascinating
deadly
boring
12. Do you have the feeling that you are in an unfamiliar situation and don’t know
what to do?
1
2
3
4
5
6
7
very often
13. What best describes how you see life:
1
2
3
4
5
6
one can always
find a solution
to painful things
in life
very seldom
or never
7
there is no
solution to
painful things
in life
14. When you think about your life, you very often:
1
2
3
4
5
6
7
feel how good it
is to be alive
ask yourself why
you exist at all
69
15. When you face a difficult problem, the choice of a solution is:
1
2
3
4
5
6
7
always confusing
and hard to find
16. Doing the things you do every day is:
1
2
3
4
5
6
a source of deep
pleasure and
satisfaction
17. Your life in the future will probably be:
1
2
3
4
5
6
full of changes
without your
knowing what
will happen
next
always completely
clear
7
a source of pain
and boredom
7
completely
consistent and
clear
18. When something unpleasant happened in the past your tendency was:
1
2
3
4
5
6
7
“to eat yourself
up” about it
to say “ok,
that’s that, I
have to live
with it,” and
go on
70
19. Do you have very mixed-up feelings and ideas?
1
2
3
4
5
6
7
very often
very seldom
or never
20. When you do something that gives you a good feeling:
1
2
3
4
5
6
7
it’s certain that
you’ll go on
feeling good
it’s certain that
something will
happen to spoil
the feeling
21. Does it happen that you have feelings inside you would rather not feel?
1
2
3
4
5
6
7
very often
very seldom
or never
22. You anticipate that your personal life in the future will be:
1
2
3
4
5
6
7
totally without
meaning or
purpose
full of meaning
and purpose
23. Do you think that there will always be people whom you’ll be able to count on in
the future?
1
2
3
4
5
6
7
you’re certain
there will be
you doubt
there will be
71
24. Does it happen that you have the feeling that you don’t know exactly what’s about
to happen?
1
2
3
4
5
6
7
very often
very seldom
or never
25. Many people—even those with a strong character—sometimes feel like sad sacks
(losers) in certain situations. How often have you felt this way in the past?
1
2
3
4
5
6
7
never
very often
26. When something happened, have you generally found that:
1
2
3
4
5
6
7
you overestimated
or underestimated
its importance
you saw things
in the right
proportion
27. When you think of difficulties you are likely to face in important aspects of your
life, do you have the feeling that:
1
2
3
4
5
6
7
you will always
succeed in
overcoming the
difficulties
you won’t
succeed in
overcoming the
difficulties
72
28. How often do you have the feeling that there’s little meaning in the things you do
in your daily life?
1
2
3
4
5
6
7
very often
very seldom
or never
29. How often do you have feelings that you’re not sure you can keep under control?
1
2
3
4
5
6
7
very often
very seldom
or never
APPENDIX C:
Psychological Well-Being Scale
73
74
PLEASE DO NOT WRITE YOUR NAME ON THIS FORM
PWB
The following set of questions deals with how you feel about yourself and your life. Please
remember that there are no right or wrong answers.
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
1. Most people
see me as
loving and
affectionate.
1
2
3
4
5
6
2. Sometimes I
change the way
I act or think to
be more like
those around
me.
1
2
3
4
5
6
3. In general, I
feel I am in
charge of the
situation in
which I live.
1
2
3
4
5
6
4. I am not
interested in
activities that
will expand my
horizons.
1
2
3
4
5
6
75
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
5. I feel good
when I think of
what I’ve done
in the past and
what I hope to
do in the future.
1
2
3
4
5
6
6. When I look
at the story of
my life, I am
pleased with
how things have
turned out.
1
2
3
4
5
6
7. Maintaining
close
relationships
has been
difficult and
frustrating for
me.
1
2
3
4
5
6
8. I am not
afraid to voice
my opinions,
even when they
are in
opposition to
the opinions of
most people.
1
2
3
4
5
6
76
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
9. The demands
of everyday life
often get me
down.
1
2
3
4
5
6
10. In general, I
feel that I
continue to
learn more
about myself as
time goes by.
1
2
3
4
5
6
11. I live life
one day at a
time and don’t
really think
about the future.
1
2
3
4
5
6
12. In general, I
feel confident
and positive
about myself.
1
2
3
4
5
6
13. I often feel
lonely because I
have few close
friends with
whom to share
my concerns.
1
2
3
4
5
6
77
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
14. My
decisions are
not usually
influenced by
what everyone
else is doing.
1
2
3
4
5
6
15. I do not fit
very well with
the people and
the community
around me.
1
2
3
4
5
6
16. I am the
kind of person
who likes to
give new things
a try.
1
2
3
4
5
6
17. I tend to
focus on the
present, because
the future nearly
always brings
me problems.
1
2
3
4
5
6
18. I feel like
many of the
people I know
have gotten
more out of life
than I have.
1
2
3
4
5
6
78
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
19. I enjoy
personal and
mutual
conversations
with family
members or
friends.
1
2
3
4
5
6
20. I tend to
worry about
what other
people think of
me.
1
2
3
4
5
6
21. I am quite
good at
managing the
many
responsibilities
of my daily life.
1
2
3
4
5
6
22. I don’t
want to try new
ways of doing
things - my life
is fine the way
it is.
1
2
3
4
5
6
23. I have a
sense of
direction and
purpose in life.
1
2
3
4
5
6
79
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
24. Given the
opportunity,
there are many
things about
myself that I
would change.
1
2
3
4
5
6
25. It is
important to me
to be a good
listener when
close friends
talk to me about
their problems.
1
2
3
4
5
6
26. Being
happy with
myself is more
important to me
than having
others approve
of me.
1
2
3
4
5
6
27. I often feel
overwhelmed
by my
responsibilities.
1
2
3
4
5
6
80
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
28. I think it is
important to
have new
experiences that
challenge how
you think about
yourself and the
world.
1
2
3
4
5
6
29. My daily
activities often
seem trivial and
unimportant to
me.
1
2
3
4
5
6
30. I like most
aspects of my
personality.
1
2
3
4
5
6
31. I don’t have
many people
who want to
listen when I
need to talk.
1
2
3
4
5
6
32. I tend to be
influenced by
people with
strong opinions.
1
2
3
4
5
6
81
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
33. If I were
unhappy with
my living
situation, I
would take
effective steps
to change it.
1
2
3
4
5
6
34. When I
think about it, I
haven’t really
improved much
as a person over
the years.
1
2
3
4
5
6
35. I don’t have
a good sense of
what it is I’m
trying to
accomplish in
life.
1
2
3
4
5
6
36. I made
some mistakes
in the past, but I
feel that all in
all everything
has worked out
for the best.
1
2
3
4
5
6
37. I feel like I
get a lot out of
my friendships.
1
2
3
4
5
6
82
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
38. People
rarely talk to me
into doing
things I don’t
want to do.
1
2
3
4
5
6
39. I generally
do a good job of
taking care of
my personal
finances and
affairs.
1
2
3
4
5
6
40. In my view,
people of every
age are able to
continue
growing and
developing.
1
2
3
4
5
6
41. I used to set
goals for
myself, but that
now seems like
a waste of time.
1
2
3
4
5
6
42. In many
ways, I feel
disappointed
about my
achievements in
life.
1
2
3
4
5
6
83
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
43. It seems to
me that most
other people
have more
friends than I
do.
1
2
3
4
5
6
44. It is more
important to me
to “fit in” with
others than to
stand alone on
my principles.
1
2
3
4
5
6
45. I find it
stressful that I
can’t keep up
with all of the
things I have to
do each day.
1
2
3
4
5
6
46. With time, I
have gained a
lot of insight
about life that
has made me a
stronger, more
capable person.
1
2
3
4
5
6
84
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
47. I enjoy
making plans
for the future
and working to
make them a
reality.
1
2
3
4
5
6
48. For the
most part, I am
proud of who I
am and the life I
lead.
1
2
3
4
5
6
49. People
would describe
me as a giving
person, willing
to share my
time with
others.
1
2
3
4
5
6
50. I have
confidence in
my opinions,
even if they are
contrary to the
general
consensus.
1
2
3
4
5
6
85
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
51. I am good
at juggling my
time so that I
can fit
everything in
that needs to be
done.
1
2
3
4
5
6
52. I have a
sense that I
have developed
a lot as a person
over time.
1
2
3
4
5
6
53. I am an
active person in
carrying out the
plans I set for
myself.
1
2
3
4
5
6
54. I envy
many people for
the lives they
lead.
1
2
3
4
5
6
55. I have not
experienced
many warm and
trusting
relationships
with others.
1
2
3
4
5
6
86
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
56. It’s difficult
for me to voice
my own
opinions on
controversial
matters.
1
2
3
4
5
6
57. My daily
life is busy, but
I derive a sense
of satisfaction
from keeping up
with everything.
1
2
3
4
5
6
58. I do not
enjoy being in
new situations
that require me
to change my
old familiar
ways of doing
things.
1
2
3
4
5
6
59. Some
people wander
aimlessly
through life, but
I am not one of
them.
1
2
3
4
5
6
87
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
60. My attitude
about myself is
probably not as
positive as most
people feel
about
themselves.
1
2
3
4
5
6
61. I often feel
as if I’m on the
outside looking
in when it
comes to
friendships.
1
2
3
4
5
6
62. I often
change my
mind about
decisions if my
friends or
family disagree.
1
2
3
4
5
6
63. I get
frustrated when
trying to plan
my daily
activities
because I never
accomplish the
things I set out
to do.
1
2
3
4
5
6
88
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
64. For me, life
has been a
continuous
process of
learning,
changing, and
growth.
1
2
3
4
5
6
65. I sometimes
feel as if I’ve
done all there is
to do in life.
1
2
3
4
5
6
66. Many days
I wake up
feeling
discouraged
about how I
have lived my
life.
1
2
3
4
5
6
67. I know that
I can trust my
friends, and
they know they
can trust me.
1
2
3
4
5
6
89
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
68. I am not the
kind of person
who gives in to
social pressures
to think or act in
certain ways.
1
2
3
4
5
6
69. My efforts
to find the kinds
of activities and
relationships
that I need have
been quite
successful.
1
2
3
4
5
6
70. I enjoy
seeing how my
views have
changed and
matured over
the years.
1
2
3
4
5
6
71. My aims in
life have been
more a source
of satisfaction
than frustration
to me.
1
2
3
4
5
6
90
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
72. The past
had its ups and
downs, but in
general, I
wouldn’t want
to change it.
1
2
3
4
5
6
73. I find it
difficult to
really open up
when I talk with
others.
1
2
3
4
5
6
74. I am
concerned about
how other
people evaluate
the choices I
have made in
my life.
1
2
3
4
5
6
75. I have
difficulty
arranging my
life in a way
that is satisfying
to me.
1
2
3
4
5
6
91
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
76. I gave up
trying to make
big
improvements
or changes in
my life a long
time ago.
1
2
3
4
5
6
77. I find it
satisfying to
think about
what I have
accomplished in
life.
1
2
3
4
5
6
78. When I
compare myself
to friends and
acquaintances,
it makes me feel
good about who
I am.
1
2
3
4
5
6
79. My friends
and I
sympathize with
each other’s
problems.
1
2
3
4
5
6
92
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
Strongly
Disagree
Disagree
Somewhat
Disagree
Slightly
Agree Agree
Slightly Somewhat
Strongly
Agree
80. I judge
myself by what
I think is
important, not
by the values of
what others
think is
important.
1
2
3
4
5
6
81. I have been
able to build a
home and a
lifestyle for
myself that is
much to my
liking.
1
2
3
4
5
6
82. There is
truth to the
saying that you
can’t teach an
old dog new
tricks.
1
2
3
4
5
6
83. In the final
analysis, I’m
not so sure that
my life adds up
to much.
1
2
3
4
5
6
93
Circle the
number that
best describes
your present
agreement or
disagreement
with each
statement.
84. Everyone
has their
weaknesses, but
I seem to have
more than my
share.
Strongly
Disagree
1
Disagree
Somewhat
Disagree
Slightly
2
3
Agree Agree
Slightly Somewhat
4
5
Strongly
Agree
6
APPENDIX D:
Demographic Questionnaire
94
95
Demographic Information
Thank you for your participation in this survey. Please do not put your name or any
identifying information on this or the following questionnaires.
Please fill in the answers to the following questions or circle the answer that best matches
your opinion.
1. What is your age? ______________
2. What is your gender?
MALE
FEMALE
3. Do you identify yourself as an American Indian?
YES
NO
4. Do you identify with a specific tribe or tribes?
YES
NO
5. If the answer to question 4 was yes, what is the name of your tribe(s)?
__________________________________________________________________
6. Were you raised on or near a reservation?
YES
NO
7. Do you now live on or near a reservation?
YES
NO
APPENDIX E:
Permission Letter
96
97
To whom it may concern:
My name is Tina Simms and I am a graduate student at Humboldt State
University working on my master’s thesis in counseling psychology under the
supervision of Bettye Elmore, Ph.D. We are conducting research regarding American
Indian adults and their level of involvement in their traditional culture. We are also
concerned as to how this might be related to their sense of well-being. We are hoping to
illustrate some of the strengths that American Indians have that assist some in being very
resilient through difficult times. This research is important because much of the researchbased descriptions of American Indians have focused on illness, health disparities, and
other problems experienced by American Indian people. Additionally, there are fewer
research-based descriptions of American Indians living in California than there are of
various tribes throughout the country. The results of this study might help add to the
growing body of literature that describes how the traditional American Indian culture
should be incorporated into therapeutic interventions in order to facilitate health and wellbeing.
This letter is a request for the opportunity to include your American Indian adult
patrons in our research study. With your permission, we would like to distribute our
survey packets through your facility. Survey packets include an instructional letter, a
demographic information form, three questionnaires on the variables under study, and a
pre-paid return envelope addressed to the principle investigator (i.e., Tina Simms). Your
patrons may take the survey packets and complete them at their leisure. Surveys are
anonymous and will take approximately 30-40 minutes to complete. When completed,
participants can return the survey packets in the pre-paid envelope to any convenient
United States Postal Service carrier.
Thank you for considering our request. If you would like to grant us access to
your facility or have any questions or concerns regarding this study, please call the
supervisor, Bettye S. Elmore, Ph.D., Professor of Psychology by phone at (707) 8264313, or by email at: [email protected].
Sincerely,
Tina Simms
APPENDIX F:
Participation Instructions
98
99
Participation Instructions
Thank you for your participation in this research. Your time and energy is greatly
appreciated.
In this packet you will find the following survey materials:
1. An informed consent form identifying the nature of this research and participation
information
2. A demographic information form asking general questions about who you are
3. The “AIES” questionnaire
4. The “OLQ” questionnaire
5. The “PWB” questionnaire
6. A pre-paid return envelope addressed to the principle investigator of this research
This survey is anonymous so please do not put your name or any identifying information
on any of the sheets within this packet. When you are finished answering the material in
this packet, please place your completed questionnaires in the pre-paid return envelope
and deliver to any convenient United States Postal Service center or mailbox.
Should you have any questions or feel the need to discuss the process, please feel free to
contact either of the following people:
Tina Simms, Principle Investigator
[email protected]
(707) 272-7840
Bettye Elmore, PhD, Thesis Advisor
[email protected]
(707) 826-4313
APPENDIX G:
Informed Consent
100
101
Informed Consent
Thank you for agreeing to participate in this research. The following questionnaires will
assess your level of participation in traditional American Indian culture as well as your
general feelings about your experiences. Your participation will help to increase our
collective knowledge about the potential benefits the traditional culture may have for
American Indian well-being.
Your involvement in this survey should not pose any discomfort or risk to you. Please do
not answer these questions if you are less than 18 years of age. If you choose to
participate please answer the questions as honestly and completely as possible. By
submitting these questionnaires you are indicating your consent to participate and
understanding of the following statement:
I understand that the principle investigator will answer any questions I may have
concerning the investigation or the procedures at any time. I also understand that my
participation in any study is entirely voluntary and that I may decline to enter this study
or may withdraw from it at any time without jeopardy. I understand that the investigator
may terminate my participation in the study at any time.
The packet of questionnaires should take approximately 30-40 minutes to complete.
Please do not put your name or any identifying information on the questionnaires.
All information will remain anonymous and will only be viewed by the principle
investigator and the thesis advisor. Completed, anonymous questionnaires will be kept in
a locked research lab in the psychology department on the Humboldt State University
campus and will be destroyed after five years. Although the results of this study may be
published at some time, at no time will any identifying information be used.
The principal investigator is Tina Simms, a graduate student working on her master’s
thesis at Humboldt State University. Any questions regarding the questionnaires and/or
your participation can be directed to her through email at: [email protected], or
by phone: (707) 272-7840.
You can also direct any questions to the thesis advisor, Bettye Elmore, PhD, Professor of
Psychology at Humboldt State University. Dr. Elmore can be contacted at:
[email protected] or by phone: (707) 826-4313. If you would like a summary of this
project’s results you may request a copy from the principle investigator or from Dr.
Elmore.
APPENDIX H:
Mental Health Referrals
102
103
PLEASE REMOVE THIS PAGE FROM THE PACKET
We want to thank you for your involvement in this project. We recognize that some of
the items on the questionnaires are of a personal nature and may create feelings of
discomfort for you. Through participation in projects such as this, people sometimes have
certain thoughts or feelings that might best be addressed by seeking out further
information or professional consultation.
If you recognize uncomfortable feelings after completing the questionnaires that may be
creating problems or concerns for you, we strongly urge you to contact a professional
who can talk to you about your concerns or provide answers to any questions that you
may have.
The following local agencies are available for professional consultation
Potawot Health Village, Arcata
(707) 825-5000
Humboldt County Mental Health, Eureka
(707) 268-2900
Eureka Community Health Center
(707) 441-1624
Humboldt Open Door Clinic, Arcata
(707) 826-8610
HSU Counseling and Psychological Services
(707) 826-3236
HSU Community Counseling Clinic
(707) 826-3921
Thank you again for your participation.