Chukka Auchaffi' Natana: The Weaving Healthy Families Program to Promote Wellness and Resilience and Prevent Alcohol and Other Drug Abuse and Violence

Project Summary: Alcohol and other drug (AOD) abuse and family violence are secondary health effects of COVID-19 and riskfactors for the Native American (NA) health disparities that drive mortality rates. Given the gap in culturally-grounded programs to address these secondary effects of COVID-19-AOD abuse and violence in families-there is a critical need to test the efficacy of digitally enhanced and sustainable community-basedinterventions. The long-term goal of the parent research is to promote health and wellness, while preventingand reducing AOD abuse and violence in NA families. The supplement will extend this to address thesecondary health effects of COVID-19 promoting access, sustainability, and engagement with a digitallyassisted intervention. Using community-based participatory research methods (CBPR), the overall objectivesof the proposed parent award are to use a stepped-wedge trial design (SWTD) to test the efficacy of thecommunity-based, "Weaving Healthy Families program (WHF)", which will prevent, reduce, and postpone thesecondary health effects of COVID-19, namely AOD use and violence in families while promoting resilienceand wellness (including mental health) among NA adults and youth. Objective 1 of the Supplement is toexamine the secondary health effects of COVID-19, namely AOD abuse, IPV, as well as family functioning,and mental/physical health. Our working hypothesis is that the greater stress imposed by COVID-19 willworsen AOD abuse, IPV, and family conflict, but the WHF program will ameliorate these secondary healtheffects. We continue to use the parent grant's SWTD where groups (i.e. 175 MBCI families) are randomlyassigned the order in which they receive the intervention. We examine the sex differences for COVID-19, usingsex as a moderator to understand whether and how sex moderates the secondary health effects of COVID-19and the differential effect of the WHF program by sex. We also integrate the explanatory sequential mixed-methods design to evaluate socio-behavioral impacts of COVID-19 through 30-50 qualitative interviews withfemale heads of household. Objective 2 of the Supplement is to evaluate the sustainability and feasibility ofthe WHF program with the inclusion of the mHealth component through the use of SMS text messaging toenhance the reach, access, engagement, efficiency, quality, and sustainability of the adapted evidence-basedintervention. Our working hypothesis is that the inclusion of SMS text messages for survey and sessionreminders, engagement, and psychoeducation during and after the WHF program will improve the reach,access, engagement, efficiency, quality, and sustainability of the program. We use the parent grant's CFIR andthe explanatory sequential mixed-methods design to evaluate the impact of qualitative and quantitativeengagement methods enhanced with SMS text messaging. This research is well-matched to the supplementas the digitally enhanced WHF program directly addresses the secondary health effects of COVID-19, inparticular AOD abuse, violence and family conflict, as well as health and mental health.