Fairness First Blog

Researchers’ voices in health equity

The Fairness First blog represents a space where researchers share with the broader community why health equity research matters to them, how do they connect to health equity, and what is the value of community engagement in the research process.

February 2, 2024

Addressing wellness in Navajo schools and promoting Native American representation in health sciences

A Q&A with Professor Regina Eddie

In this post we feature Dr. Regina Eddie, associate professor in NAU’s College of Nursing. Regina discusses how her research and work with Navajo Nation elementary and middle schools address school health and wellness through a health equity lens. She is a former grantee of SHERC’s Community Campus Partnership Support and Pilot Project programs and is currently a CHER Core Scholar.

Dr. Regina Eddie is an enrolled tribal member of the Diné (Navajo) Nation. Her clans are Ta’neeszahnii (Water Mist clan), born for Kiyaa’aanii (Towering House clan); her maternal grandfather’s as Tl’izi’lani (Manygoats clans), and paternal grandfather’s clan as the Todich’ii’nii (Bitter Water clan). Her nursing background and experience has primarily been in public health nursing in rural, underserved Navajo Nation communities. As a Diné nurse researcher, her research focuses on Native American health disparities, school wellness policies and practices, and tribal health policies. As an educator, Dr. Eddie is committed to increasing recruitment and retention of Native American nursing students and facilitates learning experiences for nursing students in Navajo communities.

Q. You’re a CHER Core Scholar and have worked with SHERC as an awardee of both the Community Campus Partnership Support (CCPS) and Pilot Project (PPP) programs. What brought you to CHER and SHERC?

A. I first learned about the Center for Health Equity Research (CHER) through the CCPS and PPP initiatives. CHER was of interest to me for a couple of reasons. First, its mission to address health disparities in underserved, marginalized populations. I was also drawn by the Center’s emphasis on supporting early stage investigators. I felt like that’s where I was at in my career.

Q. SHERC’s goal is to support research that addresses health disparities and increases health equity. What does ‘health equity’ or ‘health fairness’ mean to you?

A. To me, as a nurse, health equity means attaining the best of health – optimal health – for all peoples. Especially for my own communities across Indian Country, this would be through equal opportunities and resources – I think that’s key. Finding ways to increase health and wellness; that would be my definition of health equity.

Q. In much of your work you explore school nutrition and wellness in Navajo Nation schools. Can you describe this work and why it matters?

A. In my work as a nurse – I worked as a public health nurse* for many years on the Navajo Nation – the youth population was always of interest to me, particularly in school settings. Many of the schools are under-resourced and it was appalling to learn and see first hand how most schools in these rural and remote areas don’t have school nurses. So we as public health nurses were often the ones who filled the role and duties of school nurses. We’d do health screening and health education and be a resource to the schools. So this underlies my passion and led to my dissertation work involving schools with an interest and goal to create healthy schools for children. This is why this work matters – children attending schools in rural tribal communities need and deserve quality health programming.

*Public health nurses apply their medical knowledge in community settings to improve the health of everyone in the community.

Focusing on Nutrition and Health in Navajo Schools
In my dissertation work I looked at childhood overweight and obesity and the different factors that contribute to these conditions. There’s a need to get our children to eat healthier, engage in more physical activity, and be more health literate – to understand why eating healthily and exercising are important. So I chose to focus on school nutrition for my dissertation. Working with six schools on Navajo Nation, I looked at the school food environment and wanted to understand how schools were encouraging healthy eating behaviors. I started looking at the school food services program to understand practices and also talked with food service directors and principals.

During this time, President Obama passed a new mandate: the Healthy, Hunger Free Kids Act of 2010. This legislation revitalized the dietary standards for school meals provided through the National School Lunch Program (NSLP) and aligned them with the current dietary recommendations. Right about that time, more people were recognizing that obesity was becoming more of a concern – and in Native communities it was even more alarming. Congress also passed additional legislation in 2014 that requires schools that participate in the NSLP to adopt and implement a school wellness policy**. Part of my dissertation work involved educating school board members, teachers, principals, and administrators and getting them to understand that as participants in the NSLP, they have to adhere to certain standards; the meals that they serve have to meet dietary standards. For the Pilot Project Program I wanted to extend beyond nutrition and look at the broader environment to include physical activity, physical education, and health education in the classroom. What are teachers doing to promote or hinder healthy practices? These are all under the umbrella of school wellness policy.

**School wellness policies provide localized guidance on nutrition/school meals, physical activity, and physical education in school settings.

Laying the Groundwork
My dissertation helped lay the groundwork because there was very little literature describing school nutrition and wellness policies in Native American schools since 2010 when these new, more stringent standards were passed. There were no published studies that documented how Navajo schools were adhering to these requirements and how they were promoting healthy environments. One of the things I wanted to understand with my CCPS partner – I worked with the Diné Bi Olta School Board Association – was their perspective on and knowledge about traditional food systems. Because they oversee the schools, I wanted to understand what they knew about what schools were doing in terms of traditional teaching and traditional practices from a curriculum standpoint. It was huge to be able to partner with the Diné Bi Olta School Board Association. Through our partnership we combined our backgrounds and what we knew. We paired my understanding of the USDA requirements and where schools should be from a policy perspective with their local initiatives and activities they were doing to integrate the NSLP guidelines from a cultural perspective.

From Research and Partnership Building to Intervention
In sum, this work is much needed. It’s an area where little research has been done. There’s limited research exploring the broader school environment and recognizing the role of schools in health.

A big part of this too is a lot of these schools are highly focused on academics because they have to meet educational benchmarks. There’s a huge need in the education system to understand the role of health in learning. If you want students to be better learners they have to be healthy. This was also part of my message throughout this work. A lot of my work was getting principals – principals are the gatekeepers – to understand the connection between health and academic success. I also met with teachers and school board members to educate them on this. And there’s been a lot of acceptance and appreciation for this work. Through these CCPS and PPP projects my partners and I were able to expand that work.

My next step is to introduce intervention work. Part of my PPP project was a policy analysis of the school wellness policy. I provided feedback on how to strengthen it. It’s one thing to have a policy in place but implementation is another whole realm. So that’s my next step. We need to study specific practices in the schools to understand how effective they are. Then that could help inform school policies. Also, the federal government has minimum guidelines for school wellness. Schools have an opportunity to extend beyond this and tailor their policies according to the local needs of the community and consider culture as well.

Q. You’re also an associate professor in the College of Nursing. How do you address health equity in your teaching?

A. In my teaching role, I emphasize the need to improve health equity among underserved and culturally diverse populations – with a special focus on populations that live within our region here in the southwest such as Native Americans. For students to wholeheartedly learn about health equity, they must first understand the root causes of these inequities. As part of my teaching, I have leveraged partnerships with Tribal communities and arranged for public health nursing practicum experiences addressing Native American community health needs. Through these experiences students have had firsthand exposure to see and learn about the unique and complex health and social needs Native Americans experience. They are taught to consider how a people’s context, environment, and history influences health.

Native American Representation in Health Professions and Supporting Indigenous Students
Another important role I’d like to highlight is my commitment to efforts that increase the representation of Native Americans in nursing and other health professions. It’s critical that patients, families, and communities are cared for by nurses who look like them, understand them, come from similar backgrounds, or speak the same language.

I also serve as a PI/program coordinator for a college-wide program, NAU’s Native Journey to Academic Success (NJAcS) program. The goal of NJAcS is to increase recruitment and retention of Native students. Efforts to support and retain Native students who are accepted to competitive and rigorous health profession programs is a key step to ensure students successfully complete their coursework and graduate. We have dedicated faculty who serve as mentors to help students with this path.

On the side of recruitment, one of our initiatives aims to raise awareness of health careers among Native youth through a pipeline program, known as Dream Catchers. Native American middle school students are invited to campus for a day to learn about health careers. Faculty and students from each of our health programs/departments set up engaging, hands-on activities for youth to learn about the different health careers. For this age group, it’s important to provide an event where they can see and experience some of the instruments and be shown what a nurse, physician’s assistant, or dental hygienist does. We hope to inspire and motivate Native American youth and part of our messaging through this day is that you have to start now in preparing for a health career. Your schooling now – math, science, reading, writing – is going to prepare you for high school. To emphasize these opportunities we have some of our Native American health professions students engage with them. The youth need to see Native students in health professions programs. That’s a powerful way to show them that they can be a nurse, dental hygienist, or athletic trainer someday. We’re actually preparing to bring in junior high students from the Hopi reservation right now.

Q. Tell us about a moment in your life when you decided, “This is the type of research I want to do!”

A. I never thought that I would ever be in research. But I always wanted to be a nurse and I always found myself presented with opportunities. I had one Elder, and even a supervisor of many years, tell me, “If you don’t do this, who else is going to do this?” So that’s always been my inspiration and motivation. I share those words with my students today. Seeing the underrepresentation of Native American researchers, the health disparities, and really recognizing the need and the gaps in nursing – that inspired me to continue my education. When it came to choosing a topic of research we were asked, “what’s your passion?” And my passion has always been promoting the health of our youth.

Q. How do you want your research and other work to make a difference or change?

A. I want to see schools and communities understand the importance of having strong policies and their role in supporting healthy behaviors among their students. For this to happen, there has to be complete buy-in from community members, school board members, administrators, teachers, staff, and food service personnel. Everyone has to be involved in this change; change that values the importance of health.

Q. The CCPS program focuses on partnership building. What’s one thing you’ve learned about building collaborative relationships – either through your CCPS work or other projects?

A. You have to be flexible and expect the unexpected. Be patient. Especially when working with schools, things come up and you have to rearrange your meetings. Also, I learned that building relationships is a two-way effort; and by this I mean even after completion of my research project, I continue to be a resource to schools. This includes sharing important information with schools regarding their school lunch program, such as funding opportunities through the USDA or the AZ Department of Health, Food and Nutrition Services.

Q. Self-care is a vital part of our collective work towards health equity. What is one thing you do to make sure you are caring for yourself—emotionally, mentally, physically, or spiritually?

A. I have several things. I enjoy hiking and trail running; my husband and I are active. And spending time with my family is important.

More Reading
Check out Dr. Eddie’s recent co-authored resource, “Pathways to Promote Academic Success for American Indian/Alaska Native Nursing Students: A Mentoring Curriculum for Nursing Faculty.”

Interested in learning more about health equity research at NAU and in the community?
Visit CHER’s social media for short stories that highlight SHERC researchers, students, lab spaces, and more! Look for “Fit it in a Minute” posts.