North Carolina Community and Academic Partners Facilitate Talking Circles to Strengthen Vaccine Confidence in Tribal Communities

PRCs participating in the VCN designed, implemented, and evaluated various behavioral interventions in partnership with health departments and community-based organizations. UNC HPDP’s VCN program, led by Melissa Gilkey, PhD, Associate Professor of Health Behavior, had multiple components.

As one part of this effort, UNC HPDP collaborated with tribal partners to engage three rural North Carolina tribes with low COVID-19 vaccination rates: Coharie (Clinton), Waccamaw-Siouan (Bolton), and Lumbee (Pembroke).

In May and June 2022, UNC HPDP teamed up with tribal partners and the Tribal Liaison for Blue Cross North Carolina to hold three Talking Circles with 44 participants to gather insights on the impact of COVID-19 on their communities and to understand the barriers and facilitators to vaccination.
 

Figure 1: Graphic illustration designed by A Visual Approach synthesizing findings from Talking Circles across three tribal communities in North Carolina.

About Talking Circles

Talking Circles are deeply rooted in traditional practices of many Native American communities and, for some communities, can be used to bring people together in open dialogue and healing. This practice has been used for centuries around conflict resolution and consensus building, team building, decision-making, communal support, healing and ceremonial practices, and grieving loss.

“Talking Circles empower tribal communities in practicing a traditional Indigenous way,” explained Tony V. Locklear, an experienced Talking Circle facilitator, community researcher, and member of the Lumbee Tribe in North Carolina. “Because of assimilation, we lost so much when it comes to language, tradition, and beliefs.”

Since 2017, Locklear has worked closely with tribal communities and at the local health department, one of several partners that supported this effort. “[The Talking Circle] is a strong healing modality. The circle is symbolic and sacred, with no beginning or end in which everyone is connected. There is a lot that goes into the circle to build trust and sacredness of the circle,” he added.

During a Talking Circle, the facilitator plays a crucial role in setting ground rules, including:

• Designating a sacred item for the speaking participant (e.g., a talking stick)
• Ensuring only one person speaks at a time
• Emphasizing that participation is voluntary
• Protecting confidentiality
• Establishing a respectful atmosphere without arguments or power dynamics

The facilitator’s role is pivotal in grounding what everyone has said, reinforcing each participant's voice, summarizing key points, and moving the conversation forward organically. The facilitator meticulously prepares for the upcoming Talking Circle event long before it officially begins. Furthermore, the facilitator provides context and significance to ground the circle, setting the tone for the conversation, shaping the environment, and reiterating its sacred nature.

The choice of location for the Talking Circle is crucial. It is typically held in an inviting, communal space, often within a local tribal community center. Beyond a safe space, it is a brave space where participants feel comfortable and empowered to share their voice and vulnerability to create healing and restoration.

Talking Circles to Engage About COVID-19 Vaccines

UNC HPDP has longstanding ties with tribal communities in North Carolina. The state has the largest population of American Indian and Alaska Native (AI/AN) people east of the Mississippi River: 3% of the state’s population identifies as AI/AN, alone or in combination with another race—compared to just over 1% nationally.

Tribal partners involved in this project, Tony V. Locklear (Lumbee), Rocky Locklear (Lumbee), and Vivette Jeffries-Logan (Occaneechi Band of the Saponi Nation) have used Talking Circles to facilitate health-related discussions through The Healthy Native North Carolinians initiative supported by Blue Cross Blue Shield Healthy Blue and Tribal Liaison, Teryn Brewington (Sappony). These partners came together to launch this collaborative effort and use Talking Circles to not only address COVID-19 vaccine hesitancy, but also to explore stronger sentiments of vaccine resistance.

Alexandra Lightfoot, EdD, UNC HPDP lead for this effort and director of its Community Engagement Core, described what makes these long-term partnerships in community-based participatory research efforts successful: 

“When a community-academic partnership has a challenge to work through, we bring in both community members and academics to strengthen research partnerships, but there is always a stronger emphasis on community. We’ve worked together in different ways for over a decade, and recognize the strengths, assets, and expertise that the partner brings [to this work]. There’s a level of trust between us as partners—we've always done community-based participatory research work together. When we received the VCN funding, we reached out to our community partner to help us incorporate the community voice into our efforts to understand COVID-19 vaccine barriers.”

In the Talking Circles, participants expressed the sense of collective spirit, strength, and power they gained in sharing their stories. They also talked about how listening to community partners’ “truths” offered potent insights that brought about new learning that could lead to changing attitudes and behaviors going forward.

COVID-19 Vaccine Talking Circle Findings

Motivators for vaccination included:

• Trust in medical professionals
• Desire to protect family
• Mandates
• Experience receiving childhood vaccinations

Factors that undermined vaccine confidence included:

• Misinformation
• Perceptions that the vaccine was made too quickly 
• Distrust in science
• Concern about government conspiracies
• History of extractive research
• Collective fear from historical trauma

Factors that undermined vaccine demand included:  

• Fear of side effects
• Belief in God's protection
• Belief in their immune system

Overall, the Talking Circles strengthened UNC HPDP’s relationship with tribal partners and communities, deepening their connection and engendering trust between HPDP and tribal partners. Demonstrating cultural humility in collaboration can help build trust between healthcare organizations and Native American tribes, not only concerning COVID-19 vaccination, but also across all health outcomes.

“When it comes to community-based participatory research (CBPR) and cultural sensitivity, we have the utmost respect for Dr. Lightfoot and what she and her team does,” Locklear said. “Through UNC HPDP, we had the opportunity to connect our community and people [during] this [time of] isolation. This was a healing modality in more ways than one – bringing us together, building resilience, and informing research efforts.”