Oscar G. Johnson VA Medical Center

Native Americans serve in the U.S. military at the highest rate per capita of any ethnoracial group and have elevated rates of mental health (MH) difficulties compared to other ethnoracial groups, including posttraumatic stress disorder, alcohol use disorders, and suicide. Almost half of Native Veterans live in rural areas; rurality is associated with significant barriers to MH services. Engaging in outreach with Native Veterans is an important pathway for connecting them with MH care, but the outreach process and educational materials must be culturally aligned to be more effective. We collaborated with partners at a rural Department of Veterans Affairs medical center (VAMC) to develop and refine a process for co-creating MH-focused outreach materials that are culturally centered on the needs, preferences, and values of rural Native Veterans. Our model of Co-creating Outreach for Rural Native Veterans' Engagement (CORE) involves five key steps: building strong partnerships with rural VAMC partners (Connect), conducting a needs assessment to identify VAMC partners' and Native Veterans' unique needs (Learn), engaging in ongoing synchronous and asynchronous dialogue during iterative development of materials (Collaborate), piloting materials during outreach (Pilot), and refining materials based on Veteran and partner feedback (Re-evaluate). The process of developing culturally centered outreach materials should involve iterative refinement, partnerships and consultation with cultural experts, and strong relationships founded on respect, trust, and a commitment to bidirectional learning.