The Elders’ Resilience Curriculum: Co-developing a theoretical model of an Indigenous culturally grounded preventive intervention

Culturally grounded suicide prevention strategies rooted in Indigenous Knowledges and supported through Indigenous self-determination remain under-documented in public health research. This study focuses on the Elders’ Resilience Curriculum (ERC), a school-based, upstream suicide preventive intervention developed by the White Mountain Apache Tribe that centers cultural values, ways of life, and language. Using a community-based participatory mixed methods design, we sought to identify youth strength factors that protect against suicide, understand core components of the ERC that target these factors and potential youth outcomes, and co-develop a theoretical model of the ERC. Data collection included a consensus survey and meeting, Focus Group Discussions, In-Depth Interviews, and participatory activities including Nominal Group Technique and Pile Sorts with youth, Elders, and school and key community members. Four prioritized youth strength factors included 1) connection to family; 2) connection to religion/spirituality; 3) connection to Elders; and 4) connection to culture, which were linked to ERC core component activities and ERC expected outcomes (positive cultural identity, multidimensional constructions of health, and sense of belonging). A theoretical model was designed to demonstrate how the ERC activates strength factors (theoretical mediators) in reciprocal, relational ways to support positive youth outcomes. Results contribute a novel approach to co-developing a theoretical model that is an essential step towards adapting and scaling culturally grounded preventive interventions for mental health and wellness through Indigenous self-determination pathways.