Working with Tribal Communities in South Dakota: Moving from Cultural Competence to Cultural Humility
Mary Isaacson, PhD, RN, RHNC, CHPN®, FPCN®
Across South Dakota, Tribal communities have demonstrated remarkable resilience, strength, and commitment to the well-being of their people despite generations of colonization, systemic inequities, and historical trauma (Isaacson, Duran, Johnson, Soltoff, Jackson, Petereit, et al., 2023) .
For researchers, clinicians, and community organizations interested in partnering with Tribal Nations, good intentions alone are not enough. Meaningful collaboration requires cultural humility, relationship building, trust, and a willingness to share power (Daubman et al.,2023; Isaacson, 2014) .
Over the past decade, I have had the privilege of working alongside Tribal leaders, Elders, cancer survivors, and community members across three Great Plains reservation communities. The important lesson I have learned is simple: successful interventions are not created for Tribal communities, they are created with Tribal communities (Colclough & Isaacson, 2022; Daubman et al., 2023; Hunter et al., 2024; Isaacson, 2017) .
Begin with Relationships, Not Projects
Too often, organizations approach Tribal communities with a predefined program, research agenda, or intervention and then look for ways to make it “culturally appropriate.”
Tribal communities have repeatedly emphasized that this approach is backwards. Community- based participatory research (CBPR) offers a different path. CBPR centers the community as an equal partner through the process. This ranges from identifying priorities and developing questions to implementing and evaluating interventions (Israel et al., 2018). In our work across Great Plains Tribal communities, Community Advisory Boards (CABs) consisting of Tribal members have guided every stage of our projects. Their expertise shaped recruitment strategies, interview guides, cultural protocols, messaging, and dissemination plans (Hunter et al., 2024; Isaacson et al., 2025; Isaacson, Duran, Johnson, Soltoff, Jackson, Petereit, et al., 2023; Isaacson, Duran, Johnson, Soltoff, Jackson, Purvis, et al., 2023) .
Critical to the CBPR process is understanding that building these relationships (e.g., CABs) takes time. Trust is earned through consistency, transparency, and showing up repeatedly, not just when funding is available.
Recognize the Impact of Historical Trauma
Any effort to work with Tribal communities must acknowledge the lasting effects of colonization, forced assimilation, boarding schools, and policies that disrupted language, spirituality, family structures, and cultural life ways. Participants in our studies frequently described how these experiences continue to influence health, help-seeking behaviors, and trust in healthcare systems today (Isaacson, Duran, Johnson, Soltoff, Jackson, Petereit, et al., 2023) .
Historical (i.e., generational) trauma is not merely a historical event; it is a lived reality that can affect interactions with healthcare systems, researchers, and institutions. Tribal members often share concerns related to racism, cultural misunderstanding, and healthcare environments that failed to honor their values, beliefs, or spiritual practices (Isaacson, Duran, Johnson, Soltoff, Jackson, Petereit, et al., 2023; Isaacson, Duran, Johnson, Soltoff, Jackson, Purvis, et al., 2023) .
Therefore, it is crucial that Tribal communities are approached with humility, understanding that mistrust is rooted in real experiences and historical injustices.
Listen Before You Design
One of the greatest mistakes outsiders make is assuming they already know what the community needs (Isaacson, 2014) . In our palliative care work, we used Indigenous Talking Circles to understand community perspectives before developing any intervention. Through these Talking Circles, Tribal members shared stories of caregiving, serious illness, family responsibilities, privacy, spirituality, and the importance of community support (Hunter et al., 2024) . These conversations revealed insights that would never have emerged from surveys alone.
Participants also taught us that serious illness can be deeply isolating, that many families believe caregiving is simply “what you do,” and that asking for help can be difficult. During times of serious illness, they emphasized the cultural expectation that family members should “just show up” without being asked (Hunter et al., 2024) . By listening first, we were able to co-develop interventions grounded in community realities, rather than outsider assumptions.
Honor Spirituality as a Dimension of Health
For many Tribal members, spirituality is inseparable from health and well-being. In our work co-developing a palliative care community health worker intervention, incorporating spirituality is key. Participants shared that with serious illness, spirituality is an essential source of strength and included prayer, Traditional ceremonies, smudging, sweat lodge (inipi)participation, and other practices.
Participants frequently spoke of the importance of “calling the spirit back” to restore balance, healing, and well-being. Importantly, many also described practicing both Traditional spirituality and Christianity, illustrating the coexistence of multiple faith traditions. Healthcare clinicians and community partners should create space for conversations about spirituality and support patients’ and families’ chosen practices (Isaacson, Duran, Johnson, Soltoff, Jackson, Petereit, et al., 2023a) .
Share Power and Credit
Respectful partnerships require sharing decision-making authority. Tribal Nations are sovereign governments, and sovereignty must be respected throughout project planning, implementation, and dissemination. Tribal approvals, research review boards, and CABs are not administrative hurdles; they are essential mechanisms that protect communities and ensure projects align with local priorities (Isaacson, 2017) . As such, community members are recognized as experts, collaborators, co-authors, presenters, and leaders.
Final Thoughts
Working respectfully with Tribal communities is not about achieving cultural competence as a destination. It is about practicing cultural humility as an ongoing journey (Isaacson, 2014) .
The most successful interventions in South Dakota’s Tribal communities have shared several characteristics: they are relationship-driven, community-led, culturally grounded, spiritually respectful, and developed in genuine partnership by honoring the wisdom already present withinthe community. As healthcare clinicians, researchers, and community leaders, our role is not to arrive with the answers but rather, to listen, learn, and work alongside Tribal communities as they define solutions that reflect their values, traditions, and vision for wellness. By approaching Tribal partnerships this way, we move beyond culturally adapted interventions and begin creating truly “culture-centric” care.
References
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