An Intersectional Mixed Methods Approach to Understand American Indian Men's Health.

This study used a parallel convergent mixed methods design with TribalCrit theory and intersectionality as analytical frameworks to identify how American Indian men's identities intersect with broader structures and systems to shape their eating and physical activity choices and behaviors, and to elicit recommendations for a men's lifestyle intervention. AI men were recruited in Minneapolis, Minnesota and Portland, Oregon between March and December 2017 and in Phoenix, Arizona in December 2019 to participate in a survey and focus groups. The survey included demographic questions and questions about physical and cultural activities men engage in, perceived social support for lifestyle behaviors, masculine characteristics, and values important to American Indian men. The 6-item Kessler Psychological Distress Scale was used to assess psychological distress. Focus groups were audio recorded and transcribed for a phenomenological analysis. Descriptive statistics and correlations were computed for survey data. We conducted 15 focus groups with 151 adult American Indian men in three urban sites. The mean age of participants ranged from 36-51 across the sites; 7%-32% were college graduates; 13%-22% were currently married and 28%-41% were working full time. The most important values reported by participants were being: strong mentally and emotionally, a good parent, responsible, spiritual, and a good spouse or partner. On the K6 psychological distress scale, 63%-70% scored ≥5 but <13 (moderate mental distress), and 8%-15% scored ≥13 indicating severe mental distress. Younger age was significantly correlated with higher mean K6 score (p < .0001). Colonizers and missionaries that settled in the U.S. imposed cultural and gender hegemony which enforced a patriarchal capitalist system that have had long-lasting and deleterious effects on American Indians, particularly American Indian men.