Uplifting the voices of rural American Indian older adults to improve understanding of physical activity behavior

Maja Pedersen, Kari Jo Harris, Jordan Lewis, Mattea Grant, Chelsea Kleinmeyer, Ashley Glass, Niki Graham, Blakely Brown, Diane King

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


American Indian (AI) older adults experience pronounced health disparities and demonstrate one of the lowest levels of physical activity (PA) among racial and ethnic groups. Nearly half of AI older adults live in rural areas, indicating distinct challenges to participation in PA. Research to identify factors influencing PA in this population is missing from the literature, yet is critical to informing culturally relevant PA intervention development and implementation. The purpose was to identify barriers to and facilitators of PA among rural AI older adults using the ecological model and qualitative methods. A community-based approach was used to conduct semi-structured interviews with rural AI older adults. Interview questions were based on a multilevel ecological model. Content analysis was performed, using an iterative coding process to identify findings. The mean age of participants (n = 21) was 66 years. Barriers to and facilitators of PA were identified across ecological model levels. Barriers included factors such as caregiving and community responsibilities, lack of acceptable areas for walking, and overall lack of community-level support for older adult health. Facilitators included a personal connection to the land and ancestors through PA, multigenerational participation, and supportive tribal policies. This study addressed a gap in the literature by identifying barriers to and facilitators of PA among rural AI older adults, which can inform PA intervention development. With barriers and facilitators identified by AI older adults themselves, the voices of those directly affected are uplifted to shape efforts toward addressing longstanding health disparities through relevant public health interventions.

Original languageEnglish (US)
Pages (from-to)1655-1664
Number of pages10
JournalTranslational behavioral medicine
Issue number9
StatePublished - Sep 1 2021

Bibliographical note

Funding Information:
The authors would like to express gratitude for the support and assistance of members of the Community Advisory Board throughout the research and writing process. They would also like to thank the tribal communities and leadership that supported this research project, and the participants who shared their perspectives and experiences for this study. The research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number U54GM115371. M. Pedersen was supported by a National Cancer Institute predoctoral fellowship under Award Number F99CA253761. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© Society of Behavioral Medicine 2021.


  • American Indians/Native Americans
  • Community-based participatory research
  • Exercise
  • Physical activity
  • Qualitative methods

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


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