Cultural adaptation and preliminary validation of a measure of grief for American Indian and Alaska Native populations

Abstract

Grief research among American Indian and Alaska Native (AI/AN) people has been limited to studies focused on unresolved grief associated with historical trauma or epidemiological studies focused on reporting mortality rates among AI/AN people. Grief measures developed and tested in non-Native populations have not been validated for use with AI/ANs and may not reflect a culturally appropriate Native perspective on grief. Additionally, research on adaptive grieving, or how people grow while healing from grief, has not been studied in this population. The current study aimed to: 1) work with AI/AN community members to culturally adapt the Inventory of Complicated Grief and the Posttraumatic Growth Inventory, and 2) test the psychometric properties of the resulting culturally adapted Indigenous Grief Inventory. In Study One, interviews were conducted with AI reservation-based community members (N = 12) to gain insight into Native perspectives on grief. Findings suggested unique cultural considerations related to grieving and healing following the loss of a loved one in Native communities. Some items were revised and new items were developed based on participant feedback, and a pool of 60 items was generated for further testing. In Study Two, a sample of AI/AN community members (n =10) and academics (n = 7) was recruited to provide feedback on the measure items adapted or developed in Study One. Based on participants' ratings and feedback, items with low cultural appropriateness and comprehension scores were removed, and other items were revised, leaving 45 items remaining for psychometric testing. In Study Three, a web-based survey including the culturally adapted Indigenous Grief Inventory and mental and behavioral health measures was administered to 600 AI/AN people who reported experiencing a significant loss in their lifetime. Exploratory and confirmatory factor analyses using separate randomly selected samples from the survey data (ns = 300) were conducted to identify the factor structure of the culturally adapted measure. Items were trimmed following these analyses, resulting in a two-factor Indigenous Grief Inventory. Additional analyses were conducted to examine the convergent and discriminant validity and measurement invariance of the revised measure. Findings suggest that the final 26-item Indigenous Grief Inventory developed in this dissertation is valid, reliable, and suitable for use in health research with AI/AN people.