Date of Award

August 2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Indigenous Health

First Advisor

Grace Karikari

Abstract

Indigenous populations in the United States and internationally experience persistent disparities in healthcare access, patient communication, and health outcomes, including disproportionate cancer mortality rates and inequitable engagement with diagnostic imaging services. Communication barriers, limited health literacy, historical trauma, cultural incongruence, and structural inequities reduce meaningful participation in imaging-related care and contribute to delayed diagnosis and poorer outcomes. Despite the critical role of diagnostic imaging in disease detection and clinical management, the intersection of Indigenous health, health literacy, patient communication, and cultural safety within diagnostic imaging contexts remains substantially understudied.

This applied dissertation addresses that gap through three integrated scholarly products that create a progression from evidence synthesis, to policy recommendation, to community-engaged research design. The first product is a scoping review that systematically mapped peer-reviewed literature related to health literacy, patient communication, cultural safety, and culturally responsive strategies within diagnostic imaging contexts for Indigenous populations. Guided by Joanna Briggs Institute methodology and reported using PRISMA-ScR, the review synthesized 31 eligible studies and identified five thematic areas, generating an original conceptual framework and revealing significant evidence gaps beyond mammography and within Tribal healthcare systems specifically. The second product is a policy brief that translates those findings into actionable recommendations for Tribal healthcare leaders, proposing a cautiously implemented, Tribally governed approach to AI-supported patient communication tools grounded in Indigenous data sovereignty principles and the CARE Principles for Indigenous Data Governance. The third product is a pilot grant proposal for an exploratory mixed-methods cross-sectional study at Tuba City Regional Health Care Corporation on the Navajo Nation, designed using community-based participatory research principles to generate the first site-specific radiology health literacy data from within a Tribally governed healthcare organization.

Titled Improving Health Literacy in Diagnostic Imaging for Indigenous Populations: Evaluating Practices, Integrating Policy, and Bridging Gaps, this dissertation evaluates what existing evidence confirms and where it falls short, integrates that evidence into governance-centered policy recommendations, and bridges the gap between research and practice through a community-engaged research design. Together the three products argue that equitable diagnostic imaging care for Indigenous populations is not a distant aspiration but an achievable goal. It is one that requires culturally safe communication, Tribal data sovereignty, and genuine community partnership at every level.

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