Indigenous Strengths, Community Care, and Cancer Disparities: Insights from Talking Circles with American Indian Tribes in North Carolina

Abstract Background: American Indian communities experience disproportionally higher cancer incidence and mortality rates compared to other populations in North Carolina (NC). As part of the SAICEP (Southeastern American Indian Cancer health Equity Partnership) initiative, talking circles were conducted to understand and address cancer-related health needs among NC American Indian communities. Methods: Between February and September 2023, members from the Coharie, Haliwa-Saponi and Lumbee tribes participated in six culturally grounded talking circles (approximately 1.5 hours each). Talking circles are a well-established cultural practice for research in American Indian communities rooted in voice equality. American Indian community facilitators led each session and co-developed a discussion guide. Discussions were transcribed and analyzed using the Penchansky and Thomas healthcare access framework via thematic analysis in NVivo 12. Results: A total of 81 participants participated in talking circle sessions. Participants highlighted cultural resiliency and community assets as protective factors. Key challenges included affordability, inadequate local health infrastructure, and limited geographic accessibility. Recommendations included increasing local cancer education and awareness, promoting regular talking circles to foster community care and traditional healing, and expanding access through culturally competent clinical providers. Conclusions: Enduring community networks, faith traditions, and indigenous healing practices are foundational to shaping how NC American Indian communities experience cancer. However, culturally responsive healthcare and improved access to quality care are needed to meet American Indian cancer care needs. Impact: Advancing cancer equity in American Indian communities demands approaches that honor indigenous knowledge systems and redesign healthcare delivery through authentic, sustained partnership with American Indian nations.