Date of Award

August 2026

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Indigenous Health

First Advisor

Dr. Shawnda Schroeder

Abstract

Programs that center culture as prevention are required for promoting holistic health and well-being in American Indian and Alaska Native communities, however limited research demonstrates how these programs are affected by federal policy instability. Securing and sustaining funding for culturally centered initiatives is essential not only for reducing health inequities, but also for upholding Tribal self-determination and the federal government’s trust and treaty obligations.

This qualitative study examines the impact of federal funding uncertainty related to executive orders issued in 2025 on the Centers for Disease Control and Prevention’s Healthy Tribes program.

This Tribally driven study employed Knowledge Sharing Sessions, a culturally adapted focus group method that integrates storytelling and prayer. Knowledge Sharing Sessions were conducted with Healthy Tribes recipient staff and former Centers for Disease Control and Prevention staff. All virtual sessions were recorded, transcribed, and uploaded into MAXQDA for qualitative analysis. The researcher then conducted coding followed by thematic analysis to generate study findings. Member checking was used to validate preliminary findings and enhance the credibility, accuracy, and trustworthiness of the analysis.

Six themes emerged from the analysis. Findings demonstrate that Healthy Tribes funding supports community health and well-being, equity, and access to culturally appropriate services. Participants described navigating federal policy uncertainty and adapting program operations in response to executive orders, while also experiencing negative impacts on staff, programs, and communities. Results also highlight the need for Healthy Tribes funding, the long-term implications of policy harm, and community and policy advocacy to defend Tribal rights. Implications for Tribal sovereignty and government-to-government relationships were consistently emphasized across sessions.

These findings provide evidence of how executive orders are structural determinants of Tribal funding and emphasize the need for stable federal investments in programs that support Tribal self-determination and culturally centered prevention.

This study provides qualitative evidence on the impacts of federal policy instability on Tribal programs and highlights the importance of protecting initiatives like Healthy Tribes to sustain health, culture, and sovereignty in American Indian and Alaska Native communities.

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