Lessons from collaboration with an American Indian Health Center

Abstract

This presentation highlights a community‑informed research approval process developed through partnership with an American Indian-serving clinic. Since December 2024, quarterly virtual meetings, followed by monthly meetings beginning in November 2025, support relationship building and collaborative priority setting. An in‑person visit in March 2026 further deepened trust and clarified community expectations. The collaboration began with discussion of a potential NIH R01 grant application focused on cultural determinants of gestational diabetes. Through dialogue, partners collectively determined that a large‑scale research project was not aligned with the clinic’s capacity. Instead, the team co‑designed a smaller feasibility‑focused project aimed at building research infrastructure and addressing a community‑identified priority: maternal mental health. This approach allowed the researcher to contribute skills and expertise while following the lead of the community. Surveillance data, maternal mortality data, and community insights show maternal mental health as a driver of maternal mortality among American Indian people. The approval pathway reflects layered Indigenous governance structures, ensuring alignment with university, Tribal, and federal standards. The project first underwent review by the tribal-serving clinic, which provides topic‑level approval. Following clinic endorsement, the study will be submitted to the University of North Dakota Institutional Review Board, which includes members with expertise in Indigenous ethics. Final approval was obtained from the Indian Health Service, an agency of the federal government. Participants will learn how community‑driven priority setting produces more feasible study designs, and that layered Indigenous governance strengthens ethical rigor while reinforcing sovereignty throughout the approval process.