Dataset from Building Resiliency and Vital Equity (BRAVE)

Background: The purpose of this study was to partner with American Indian communities in North Carolina to improve access to COVID-19 services and resources. American Indian communities faced unique cultural, geographic, and social barriers to testing and vaccination. The study aimed to identify these barriers, increase testing through community-driven outreach, and reduce vaccine hesitancy through culturally grounded education. The long-term goal was to strengthen trust, improve perceptions of COVID-19 prevention efforts, and support health equity for American Indian populations.

Materials/Methods: This study was conducted in three phases using a community-engaged approach. In Phase 1, the team used a grounded theory design and collected qualitative data through semi-structured, open-ended interviews and focus groups with American Indian community members. These interviews explored perceptions of COVID-19, barriers to testing and vaccination, and community-specific concerns. In Phase 2, insights from the interviews were used to design culturally sensitive health surveys measuring barriers and facilitators to COVID-19 testing and vaccination. These surveys were then administered across partner tribal communities. In Phase 3, the study used the combined findings from Phases 1 and 2 to develop culturally appropriate educational materials and implement the “Protect Your Elders” campaign. This campaign served as a behavioral intervention that promoted testing and vaccination through culturally aligned messaging and outreach strategies. Data from all phases were shared back with tribal partners to guide community-driven improvements in COVID-19 response efforts.

Outcome/Impact: The study increased understanding of cultural, social, and structural barriers that shaped testing and vaccination behaviors in American Indian communities. Findings informed the development of tailored outreach activities, including the Protect Your Elders campaign, which aimed to increase testing uptake and reduce vaccine hesitancy. The community-driven framework strengthened trust, improved communication pathways, and supported tribal leadership in addressing COVID-19 concerns. By returning data to tribal partners and embedding local voices into the intervention design, the study enhanced the relevance and acceptance of COVID-19 prevention strategies and improved long-term capacity for public health response in American Indian communities.