Date of Award

August 2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Indigenous Health

First Advisor

Brynn Luger

Abstract

American Indian and Alaska Native communities experienced disproportionate impacts during the COVID-19 pandemic, highlighting the need to better understand effective public health response strategies in tribal settings. The purpose of this convergent mixed methods case study was to examine the White Mountain Apache Tribe (WMAT), COVID-19 response by exploring the perceived strengths and limitations of the WMAT contact tracing program and describing temporal patterns of COVID-19 transmission in relation to tribal mitigation mandates. Qualitative data were collected through semi-structured interviews with 11 key informants involved in contact tracing and COVID-19 response efforts. Data were analyzed using inductive thematic analysis. Quantitative data consisted of secondary analysis of WMAT COVID-19 case data and tribal mitigation mandates implemented between April 1, 2020 and April 1, 2021. Descriptive analyses were conducted to examine trends in transmission and case fatality rates.

Five qualitative themes emerged: (a) community centered and culturally grounded public health response; (b) a proactive and intensive contact tracing framework enhanced the COVID-19 response; (c) taking public health into the community: the WMAT field-based response; (d) navigating community resistance, misinformation, and structural barriers to contact tracing; and (e) the personal and emotional toll of contact tracing: exhaustion, grief, and collective resilience. Quantitative findings demonstrated changing transmission patterns throughout the study period, with declines observed following several mitigation measures. Despite periods of elevated transmission, the WMAT case fatality rate remained lower than Arizona’s for the duration of the study period.

Integrated findings suggest that culturally grounded contact tracing, intensive outreach, and community-centered public health practices may have contributed to reduced mortality and strengthened pandemic response efforts. These findings provide insights for future public health emergency preparedness and response in tribal and underserved communities.

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