Indigenous Elder-centered methodology: research that decolonizes and indigenizes

The Two-Eyed Seeing framework

Two-Eyed Seeing is a research framework originating from traditional Elder knowledge from the Mi’kmaq (an Indigenous people of eastern Canada and the northwestern corner of the USA) Nation (Bartlett et al., 2012). It represents a weaving together of Indigenous traditional knowledge and western science to achieve a balance, integration, and mutual understanding. The researcher can view the world through one eye, an Indigenous lens, and the other a western lens to use both eyes and achieve optimal vision and insight. There are three key lessons composing the development of Two-Eyed Seeing: (a) to acknowledge that each group, Indigenous and western, needs each other to accomplish research excellence; (b) to view research through both perspectives as empowering and critical to Indigenous communities intellectual sovereignty; and (c) to “develop an advisory council of willing, knowledgeable stakeholders, drawing upon individuals both from within the educational institution(s) and within Aboriginal communities” is inclusive and traditional practice (Bartlett et al., 2012, p. 334). The Two-Eyes Seeing framework also emphasizes the gift of multiple perspectives in research for gaining an understanding of each knowledge system’s strengths and integrating them. Notably, “the application of the principle of Two-Eyed Seeing . . . can center decolonial goals, addressing the shortcomings of AR [action research]” and decentralize colonial methodologies (Ray, 2021, p. 95). Thus, using a critical lens and gaining an understanding of each knowledge system’s strengths, limitations, and integrating said research methodologies are a decolonial and Indigenous process.

Decolonizing methodologies

Euro-western research methodologies can be reframed to center an “Indigenous method of intellectual engagement that is inextricably connected to land, place stories, and context” (Smith, 2021, p. 149) and incorporates Indigenous cosmology, worldview, and ethics (Wilson, 2008). For example, the method of participant observation used in ethnography grew out of a colonial history of objectifying and othering Indigenous peoples (Asch, 2001; Campbell & Lassiter, 2014; Datta, 2018). Participant observation at its core includes engaging in everyday activities with participants using casual conversation to create meaningful relationships, rather than structured interviews that can feel formal and enact settler–colonizer power dynamics (Campbell & Lassiter, 2014; Wilson, 2008). Observation is an integral aspect of learning among Indigenous communities and embedded in Indigenous ways of knowing. Wilson (2008) states, “traditional Indigenous research emphasizes learning by watching and doing. Participant observation is a term used for this watching and doing in a scientific manner” (p. 40). Moreover, culturally responsive participant observation is a research method that Indigenous peoples have been using for generations.

To provide an example, participant observation was decolonized when a researcher engaged in activities with Elders, such as harvesting, preserving, and preparing traditional foods (Asquith-Heinz, 2018). While having a conversation about the meaning of the food itself and the act of gathering is a traditional value, this co-labor strengthened the relationship and, by extension, the data. From a western academic perspective, this form of interviewing is validated not only by the concept of participant observation, but also by the western concept of emplacement, coined by Pink, which expands embodiment to encompass how the mind and body relate to and engage with the sensory environment (Pink, 2015). Memories and emotions are likely triggered by the sensorial and physical experience of moving across the land, touching what it creates, and preparing food to be shared. Instead of prompting conversation with structured questions, images, or directly, the research embodies Indigenous value and traditional ecological knowledge by joining Elders in activities to elicit conversation about the meaning of the activity (Asch, 2001; Campbell & Lassiter, 2014; Datta, 2018; Kovach, 2021; Wilson, 2008). This example demonstrates how western methods can be decolonized to reflect and uplift Indigenous ways of knowing, relating, and sharing while also integrating western academic frameworks.

The person-centered approach

A further example of how Indigenous and western approaches may be integrated lies within the person-centered care approach. Amid social research, the pressure to hear voices beyond the Euro-centric paradigm is growing as research is now understood as having the power to label, name, condemn, or prescribe solutions to existing challenges, and promote social justice. With this change in perspective, research participants are acknowledged as knowledge bearers and those carrying the expertise of their lived experiences (Chilisa, 2019). This is especially true for groups that have been historically underrepresented, overlooked, or even denied acknowledgment of their experiences. To fully grasp those experiences and access the existing knowledge, a person-centered attitude of the researcher is proposed to gather holistic perspectives of a lived experience (Wilkins, 2016). Increasingly, research argues that for such holistic inquiries to occur, the researcher must foster a set of characteristics needed for a person-centered approach to research (Haselberger & Hutterer, 2013). A person-centered research endeavor emphasizes a collaborative, holistic, and open engagement with the entire lived experience of all involved parties. Nested within Indigenous decolonizing methodologies (Chilisa, 2019; Smith, 2021), this approach can produce knowledge and action that can transform communities (Chilisa, 2019; Haselberger & Hutterer, 2013; Howard & Hoffman, 2018). Furthermore, by its very nature, a person-centered approach is community-driven, whereby the person is considered in their layered sociopolitical and cultural context.

Community-based and tribal-participatory research approach

Community-based participatory research (CBPR) designs have been established as a framework permitting independence, autonomy, and collaborative and participant-led research approaches (Dadich et al., 2019; Stanton, 2014). Thus, CBPR has been adopted and is considered a best practice when engaging in research with Indigenous, marginalized, and oppressed populations (Dadich et al., 2019; Holkup et al., 2004; Lewis & Boyd, 2013; Stanton, 2014). This approach to inquiry privileges community self-determination and community-identified issues, and respect for Indigenous ways of knowing. The use of CBPR invites participants to share their voices where they traditionally have had limited input, which is particularly important for research involving Indigenous Elders given their history with colonialism and the historical lack of consultation with Indigenous populations throughout research (Dadich et al., 2019; Smith, 2021). The goal of those who employ CBPR is research that results in action, social transformation, and positive change (Baum et al., 2006; Cox et al., 2021), such as policy change, program development, allocation of funds, community empowerment, and mobilization. However, within an Indigenous context, CBPR can be applied to a tribe or tribal community by a tribal-participatory research (TPR) approach (Jernigan et al., 2015). The key difference is that the TPR approach takes into consideration historical trauma, tribal diversity, tribal oversight is sought, and there are efforts for inclusion of tribal members as study staff (Fisher & Ball, 2003). Namely, the “hermeneutic epistemological underpinnings of the approach diverge from western empiricism, instead emphasizing socially constructed reality within which multiple interpretations of a single phenomenon are possible” (Fisher & Ball, 2003, p. 210). Moreover, community and tribally centered approaches that are Indigenous-derived, culturally humble, mindful of people within their context, and aimed at the simultaneous action of decolonizing and indigenizing are foundational to an Elder-centered research methodology. However, one must first consider the role and designation of Indigenous Eldership to fully realize implications for research.

The central role of Elders

Western perspectives of Elders, Indigenous or non-Indigenous, differ significantly from an Indigenous perspective (Lewis et al., 2021). Elderhood is primarily based on advanced age, and importance is placed on physical, financial, and youthful abilities relative to western standards of productivity and values. This western view of older adults in society fails to acknowledge the lived experiences and knowledge that older adults hold; thus, it is limiting and reductive, whereas the title of Elder is a cultural convention distinguishing an Indigenous person who serves as an integral part of their family and community. Since this research focuses on Elders recognized by their community as leaders, the term is capitalized to establish their importance and signify their role within their tribe or community. Indigenous knowledge and culture are rooted in the tribal context, and Elders are highly respected by their community and are holders of the traditional values. Elders are typically appointed by the community when they have been deemed to have lived a holistic life; are knowledgeable in traditional ways of living from the land’s natural resources; and have immersed themselves in the connections of multi-generational families. Elders are most valued for their contribution of wisdom that supports the well-being and prosperity of the community, and their role guides the interests of the peoples’ future.

The foundations of Elder-centered research

From 2010 through 2014, a collaboration between researchers and AN Elders worked together to develop health care, memory, and Alzheimer’s Disease and related dementia (ADRD) teaching modules for community members and providers pertaining to culturally appropriate care, access, utilization, and learning resources through the Stanford Geriatric Education Center (Graves et al., 2010). This collaboration created dialogue around the need for more investigation of AN Elder’s beliefs about aging, memory, and related disease; inquiry into caregiving of the aging AN population, namely, in the face of high projected rates of dementias; and a need for Elder inclusion in all aspects of the research process became evident and central.

Study 1: Alaska Native peoples and perceptions of memory and dementia

To explore AN Elder’s cultural beliefs and perceptions about memory and aging, a purposive sample of 12 AN Elders (four males, eight females) was recruited through a snowball sampling method (Crouch & Rosich, 2022). Referrals were generated from personal contacts of the researchers, colleagues with established partnerships with the AN Elder community, and participant referrals. The mean age of participants was 73, ranging from 62 to 89, and tribal heritage included Aleut (an Indigenous people of coastal southwest Alaska), Athabascan (an Indigenous people of Interior Alaska), Inupiaq (an Indigenous people of north and northwest Alaska), Tsimshian (an Indigenous people of southeast Alaska), and Yup’ik (an Indigenous people of west and southwest Alaska). Semi-structured interviews included memory, ADRD, and healthy aging practices; prevalence; assessment and management; caregiving; personal and cohort experiences of ADRD; health care services and utilization; and lastly, participants were asked to share what they thought we needed to ask and did not. The final question becomes critical to the iterative process. For example, one Elder stated that it was integral to the research to ask, “What is Alaska Native spirituality?” (Elder 6, Alaska Native [AN], man, age 89). This was incorporated into the following interviews and prior participants were contacted and asked this question. As it were, AN spirituality became a foundational theme. Qualitative analysis in NVivo software observed a total of eight themes: (a) Traditional Knowledge and Values; (b) Caregiving Networks; (c) Memory Function; (d) AN Spirituality; (e) Stories, Generative Sharing, and Healing; (f) Historical Change; (g) Connection, Communication, and Compassion; and (h) Assisted Living. All were interrelated and fit a cultural perspective and narrative related to colonization, societal change, health disparities, and the healing nature of culture on healthy aging, disease, and caregiving.

Notably, the research was created and guided by two AN Elders who were original collaborators on the Stanford Geriatric Education Center teaching modules. One of these Elders shared an AN life cycle theory called Elluarrluteng Ilakutellriit as a framework for the research collaboratively conducted: Elluarrluteng Ilakutellriit in the Yup’ik language translates to the proper way to be in a relationship. This theory posits that AN peoples are in healthy relationships with self, other, and world by experiencing cultural milestones across the life span. Specifically, people are born and move through four life quadrants, including (a) the physical world, characterized as understanding love, place, and community; (b) the emotional world which represents roles, expectations, sharing, and community engagement; (c) the mental world is where one deals with historical trauma and learns to live well, and how to be in healthy families; and (d) the spiritual world represents the significance of all things being related, fruition of relationships, and death and dying (E. Sunnyboy, Yup’ik Elder, personal communication, October 10, 2015). Importantly, the AN cultural view of aging and memory is rooted in who one is as an Indigenous person, how they deal with and heal from historical and contemporary trauma, and the ways in which a person develops across both western and Indigenous markers of success in their lifetime. In the context of research and the research process, the Elluarrluteng Ilakutellriit highlights how Elders’ involvement in research is an act of love from them and toward them; it fulfills a critical role in their lives and communities, as Elders are the culture bearers; it is an act of inclusion, reparation, and recognition of the traumas inflicted through settler-colonial research practices; and it honors the spiritual nature of being, as Elders hold wisdom and are closest to the universe, in Indigenous context, physical death. This indigenized framework and view of memory and aging among the AN community, along with the research and themes observed, was the foundation for more research.

Study 2: AN caregiver and provider understanding of dementia

To explore culturally relevant understandings of diagnosis, treatment, and general experience of ADRD, AN caregivers (n = 21) of AN peoples experiencing ADRD and AN and non-Native health care providers (n = 12) in Alaska were interviewed (Lewis et al., 2021). The caregivers were selected based on self-identified AN heritage and reported caregiving for a person with diagnoses or suspected ADRD. The average age of the AN caregivers was 51 years old, and most were female (86%), living in an urban area (62%), and providing care for a spouse (60%) or grandparent (25%). The health care provider group had an average age of 54 years; were predominantly women (83%) living in an urban area (67%); represented varying levels of training, namely, community health aide, nurse, or medical doctor; and provided an average 17 years of health care in Alaska, 14 years of which were specific to the AN population with ADRD. Recruitment and referrals for participation were generated from ADRD partners and AN organizations. Both groups were primarily English-speaking and located in Alaska. Open-ended questions using Kleinman’s Explanatory Model of Illness (EMI) were used as a framework for gathering insights into culturally specific conceptualizations of ADRD from different perspectives such as AN caregivers and health care providers. Qualitative analysis in NVivo software (version 11) observed a total of five themes that characterized caregivers’ understandings of ADRD across each of the domains of Kleinman’s EMI: (a) Growing Old, which represented ADRD onset; (b) Part of Aging, reflective of the causes of ADRD; (c) Lack of Resources associated with barriers and problems to ADRD diagnoses and treatment; (d) Traditional Healing, which is a key aspect of treatment and expression of culture as medicine; and (e) Loss of Elders, representing the fears around death, depletion of culture, and spiritual, moral, and cultural leadership. A total of five themes were observed for health care providers’ understanding of ADRD across the same domains of Kleinman’s EMI: (a) Aging-Related Disease represented ADRD onset; (b) Health Behaviors were viewed as causal; (c) Lack of Resources, again, as problems and barrier; (d) Western Treatments were predominantly cited as treatments for ADRD; and (e) Difficult to Determine, which typified the intersecting nature of disease progression and importance of cultural conceptualizations of disease and treatment. All themes highlight the imperativeness of rural outreach, culturally tailoring services, and an emphasis in the health care system on meeting the needs of the AN population’s growing incidence and prevalence of ADRD. Importantly, this research grew out of a progression of Elder-centric research (Crouch & Rosich, 2022; Graves et al., 2010). Thus, AN inclusion specifically at the Elder level was present in the research team, the caregivers, patients, and health care providers to best nuance an authentic and intrinsic cultural experience. Moreover, this is exemplary of how Elder-centered research is iterative and generative in the research context.

Quadrant 1: respect, honoring, and taking care of others

The first quadrant of the Elder-Centered Research Methodology speaks to the intellectual sovereignty and ownership of culture, ideas, and research, which can be restorative and undo some of the past hurts of research. For example, to overcome the historical distrust of research among AN communities, TPR and CBPR approaches emphasize the importance of hearing and addressing community concerns early in the research process to establish trust between researchers and Indigenous populations (Fisher & Ball, 2003; Tobias et al., 2013). Previous studies employing CBPR approaches with AN communities have yielded positive feedback, resulting in increased competence and trust of researchers and community members, improved critical awareness of the environment, and development of resources for social and political action (Mohatt et al., 2004; Rasmus, 2014).

Research relationships are established by meeting people and communities where they are at, engaging from a place of cultural humility, and making all efforts to be transparent and open (Dadich et al., 2019). From earlier experiences in working collaboratively with AN communities, Lewis and Boyd (2013) detailed effective collaboration practices such as introducing the communities to the TPR and CBPR approach, asking for the community’s guidance in formulating the issue, choosing the most appropriate methodological approach, and the most effective dissemination activities, including interpretation of the findings. The establishment of regional Elder Advisory Committees (EACs) by nominations from the participating Native villages gave Elders the voice and space to actively participate in mentoring, co-leading, and managing the research process from conceptualization to dissemination. This process ensures the goal of shared power and decision-making, including the aim to benefit all stakeholders (Farquhar et al., 2014; Lewis & Boyd, 2013). Furthermore, doing research within an Indigenous community can be very different from doing research with an Indigenous community.

Quadrant 2: living carefully and having patience

The process of decolonization in research methods ensures that Indigenous peoples’ relations with the living and nonliving are foundational, formative, and integrated (Chilisa, 2019). This process is strategized by (a) the deconstruction of colonial narratives and paradigms and the simultaneous reconstruction of indigenized epistemology and ontology; (b) self-determination, voice, inclusivity; (c) language that supports both reclamation and enculturation, and recognizes the truths of the past while re-envisioning the present and future; and (d) continual critique of western research methodologies for the enhancement, advancement, and embracement of indigeneity (Chilisa, 2019; Smith, 2021). Thus, a careful examination of living knowledge outlining similarities and differences in western and Indigenous methods is a methodology that lends to rigor and decolonization. Moreover, cultural dialogues, centering Indigenous worldview and voice, and integrating methodologies like western and Indigenous are optimal for indigenizing.

While an Elder-center methodology is rooted in both inclusion of Elders and their knowledge, it is also important to understand that community-driven, Elder-centered, and tribal-participatory research takes time and is alive. The way in which CBPR and TPR centralize the community and tribe is an example of Elder-centered methods. Furthermore, CBPR principles create the opportunity for research to benefit involved academic and community parties and focus on the community-defined priorities. The eight key principles of CBPR are also applicable and analogous to centering research to the Indigenous Elder and cultural knowledge: (a) recognizes community as a unit of identity; (b) builds on strengths and resources within the community; (c) facilitates collaborative partnerships in all phases of the research; (d) integrates knowledge and action for mutual benefit of all partners; (e) promotes co-learning and empowering processes that attend to social inequalities; (f) involves a cyclical and iterative process; (g) addresses holistic well-being and the social determinants of health; and (h) disseminates findings and knowledge gained to all partners (Baum et al., 2006; Cox et al., 2021; Dadich et al., 2019; Woodbury et al., 2019). This iterative process strengthens community and researcher relationships resulting in trust, bidirectional opportunities for learning and building strengths, appropriate methods for disseminating findings, and emphasizing long-term commitment of all involved parties (Holkup et al., 2004; Woodbury et al., 2019). In addition, this methodology encourages researchers to be critically reflexive of their work and the research process, all of which could have profound consequences on how the community is viewed, views themselves through the lens of the research, and nurturing relationships and continued collaboration.

Quadrant 3: sharing, relationships, and reciprocity

An Elder-centered method is a balancing of power toward the sovereignty and self-determination of Indigenous communities and is critical in the way that researchers work with Elders to understand and interpret results. Balancing the power differential in favor of Elders serves Indigenous knowledge, and not only reflects Indigenous ways of learning and knowing but deconstructs the power dynamic of western methods that can cause harm (Wilson, 2008). For instance, the dominant interview method often creates an asymmetrical relationship between the interviewer and interviewee, thus allowing western academic thought to determine the questions asked and, therefore, the information elicited (Chilisa, 2019). In this way, the western method can create harmful asymmetrical power and collect knowledge that is biased, thus potentially harming both the community and the academy. Research (Chilisa, 2019; Cox et al., 2021; Fisher & Ball, 2003; Saini, 2012; Smith, 2021; Wilson, 2008; Wright et al., 2019) offers a variety of frameworks to decolonize interviews, all of which challenge western academic norms to make space for Indigenous opinions, preferences, and choices. As noted in Study 1 and Study 2, the unstructured interview—which is a conversation guided by a theme or framework—makes more space for Elders to lead not only the content of the conversation, but also the pace and direction. Pairing this conversation with Elder-led traditional activities further relinquishes the interviewer’s power and centers the Elder’s knowledge and pace.

The symbiotic relationships of researcher, participant, Elder, and knowledge are integral. Importantly, the research is self-reflective, self-aware, and embodies ancestral knowledge, culture, and context. Thus, the Indigenous research paradigm is relational in nature (Wilson, 2008). The ontology and epistemology of Indigenous research are based upon relationality and axiology, and the research itself is based on accountability to that reciprocity. Wilson (2008) recounts his own research, saying, “All of us were research participants, rather than me being the researcher and them my subjects” which aptly describes the relationality intrinsic in all Indigenous research frameworks (p. 69). Furthermore, research is a ceremony, and every ritual and method is devised to bring people into a similar space focusing on discussing one topic. For example, a talking circle is like a focus group, whereby people gather in a circle, and each shares their thoughts on a particular subject. This form of research is more culturally congruent, inclusive, and thus, engaging. Moreover, knowledge and truth in western conceptions exist and can be attained, even owned; however, in an Indigenous research paradigm, reality, truth, and knowledge are co-created based on lived realities and the result of relationships.

Quadrant 4: Indigenous knowledge and seeing connections

Importantly, direct comparisons between western and Indigenous research have demonstrated that Indigenous research is equally as valid if not more contextually and culturally salient than western research (Braun et al., 2014; Cox et al., 2021; Dadich et al., 2019; Mohatt et al., 2004; Rasmus, 2014; Saini, 2012). In addition, the involvement of Indigenous peoples in the creation of knowledge about themselves is critical due to the history of misuse and abuse of Indigenous peoples and their knowledge. To this extent, research is ceremony and has the capacity to heal and undo past hurts (Wilson, 2008). Furthermore, Indigenous research elevates spirituality and spiritual connection, which is often antithetical within the western scientific community. This further alienates an Indigenous paradigm where spirituality is rooted in every relationship. The relevance of spirituality, Elders, and Indigenous worldview is integral to research methodology. Moreover, cultural humility, Elder-centered knowledge, and seeking to understand the holistic nature of being are cornerstones of Indigenous knowledge and, thus, Indigenous research.

A systematic review of Indigenous research has observed that community-based approaches and methodology that are central to Indigenous knowledge like spirituality, ancestral wisdom, and traditional practices are most salient and favored by Indigenous communities (Saini, 2012). Furthermore, a comprehensive review of applications of the Two-Eyed Seeing framework that integrates Indigenous and western methods used in research emphasized key characteristics salient to Indigenous communities and an Elder-centered methodology (Wright et al., 2019). Foremost, the application is requisite to authenticity and inclusivity. In other words, simply acknowledging Indigenous perspectives without comprehensively integrating the two knowledge systems is insufficient and deprecatory. Elements across application include (a) reciprocity which is requisite for benefit to both the researcher and the community; (b) Indigenous involvement of Elders and community members throughout the research process and incorporation of local customs are key; and (c) inclusion of Indigenous ways of knowing, namely, storytelling, language, and traditional ecological knowledge in the conceptualization of the research and research processes. The importance of authenticity, research as a trust-building exercise, and accountability and transparency in research are foundational to the Two-Eyed Seeing framework, decolonizing methodologies, and, by extension, the proposed Elder-centered methodology (Bartlett et al., 2012; Smith, 2021; Wilson, 2008; Wright et al., 2019).