Co-designing the Indigenous Evaluation Toolkit for Opioid Prevention in American Indian/Alaska Native Communities.

American Indian and Alaska Native (AIAN) people living on reservations and in urban areas have been disproportionately impacted by the ongoing opioid epidemic, as demonstrated by higher opioid overdose fatality rates. AIAN communities have mobilized to address opioid misuse through community-centered approaches, including revitalizing and enhancing Indigenous epistemologies. While Tribal and urban Indian opioid misuse prevention programs aim to support critical healing, these programs often have funding requirements that prioritize Western evaluation methodologies that may not be responsive to the successful implementation of culturally grounded solutions. Indigenous evaluation is a long-relied-upon practice to adjust and improve community efforts using Indigenous ways of knowing and continuous community involvement. Although Indigenous evaluation approaches have been used in education, violence prevention, youth-focused, and other Indigenous public health programs, the literature lacked an actionable guide for implementing Indigenous evaluation approaches for opioid overdose prevention programs. Leveraging professional and cultural expertise, lived experience, and a multi-year, community-based participatory consultation process, Seven Directions developed the