Navajo Parents’ Beliefs About Cradling and Early Mobility for Infants: A Qualitative Study

Indigenous Culture and Early Intervention

Indigenous communities, including American Indians and Alaska Natives (AI/AN), represent unique populations whose cultural worldviews frequently diverge from the Western models that underpin most EI research and practice. Early intervention frameworks in the United States are predominantly based on Western models of child development (Menon, 2025); for Native American families, frameworks that honor Indigenous culture and voice are needed. The Indigenous Ecological Systems Model (Fish et al., 2022) offers a strengths-based alternative that reconceptualizes Bronfenbrenner’s socioecological model (Bronfenbrenner, 1977) to foreground historical, cultural, and intergenerational contexts. This model opposes deficit-based narratives that pathologize Native American communities and instead emphasizes interconnectedness, relationality, and cultural sovereignty as central to healthy development. Rather than treating Indigenous practices as deficiencies to be corrected, this approach contextualizes wellness within the historical and political realities of Indigenous life.

The Theory of Cultural Humility (Foronda, 2020) further guides effective practice with diverse families. According to this theory, culture is shaped by political history, the physical environment, and personal circumstance; when these factors differ between provider and family, cultural conflict can arise. Providers who approach cultural variations with indifference—treating cultural background as irrelevant—create power differentials and poor outcomes. Conversely, providers who approach families with cultural humility, actively seeking to understand perspectives rooted in the family’s culture, are more likely to achieve positive outcomes (Foronda, 2020; Holyoak et al., 2020). Applied to EI, this theory underscores that providers working with Indigenous families must be genuinely open to learning from and deferring to the cultural knowledge of those families.

Navajo People and Early Intervention

The Navajo Nation spans approximately 25,351 square miles across northeastern Arizona, northwestern New Mexico, and southern Utah, with approximately 65% of enrolled Navajo members residing on Navajo tribal lands (Navajo Nation Department of Agriculture, n.d.). Like many AI/AN communities, the Navajo ¹ have experienced profound historical inequities through forced relocation, boarding school policies, and government oppression, with persistent socioeconomic disparities including an average household income of $8,240 and a 48.5% unemployment rate (Navajo Nation Department of Agriculture, n.d.). Many families live in rural, isolated areas with limited access to health care and transportation. Despite these challenges, Navajo communities maintain strong cultural values, traditional ceremonies, and a resurgent Navajo language (Navajo Nation Office of the President, 2026).

The Part C EI program on the Navajo Nation, called Growing in Beauty (GIB), serves children with developmental delays or disabilities from birth to age 5 (Navajo Nation Office of Special Education and Rehabilitation Services, n.d.). Because the Nation spans three states, GIB services are governed by each respective state’s EI program. In the Arizona GIB program, some, but not all, EI providers are Navajo. Accordingly, although Navajo traditions and beliefs are embedded in EI practices with GIB, there may be some variability in cultural knowledge influencing service provision. Research specific to EI on the Navajo Nation is limited. Applequist and Bailey (2000) found that Navajo caregiver satisfaction was most strongly associated with family-centered service delivery, while Billey et al. (2024) demonstrated the effectiveness of a parent coaching language intervention grounded in Navajo culture and tailored to individual family values. Together, these studies support the critical importance of centering Navajo cultural values in EI approaches.

Navajo and Baby Equipment: Cradleboards and Baby Walkers

Two pieces of baby equipment frequently observed among Navajo families—traditional cradleboards and modern baby walkers—have been a focus of EI providers due to their potential developmental implications through the lens of the Western medical model. Children receiving EI services may have additional vulnerabilities; those with physical disabilities such as cerebral palsy may present with asymmetries, hip dysplasia, or spasticity that can be exacerbated by positioning in baby equipment (Howard et al., 2023; Kawakami et al., 2013; Leung et al., 2018).

Traditional cradleboards have been used across many American Indian cultures for generations (James et al., 2021; Sabourin & Globensky, 2022). In Navajo culture, a cradleboard typically consists of a wooden backboard, a protective hoop over the infant’s head, a footplate, and straps securing the swaddled infant in a supine position with the legs straight and together (Beeshligai, 2018; Claw, 2018). From a Western medical perspective, this positioning carries potential risks: swaddling could cause overheating of the infant, pressure on the occiput may contribute to plagiocephaly, and restraint of the infant’s legs in extension may exacerbate problems of hip dysplasia, particularly for infants with physical disabilities (American Academy of Pediatrics [AAP], 2022; Clarke, 2013; Leung et al., 2018; Nelson, 2017). The AAP recommends swaddling of infants should be loose around the legs to minimize risks of hip dysplasia, and swaddled infants should be monitored for overheating from overbundling (Moon et al., 2022).

Indigenous frameworks, however, highlight significant benefits of cradleboard use that Western models often overlook. The cradleboard is understood to protect the infant’s spine and head, enhance sensory development, and provide a secure space from which the child begins to perceive and connect to the world (Barrie Kavash & Barr, 1999; Bédard, 2020). As emphasized in the Indigenous Ecological Systems Model, the cradleboard fosters interconnectedness and relationality: carried by adults throughout daily life, the infant develops bonds with family and community members. Through close swaddling, the child also begins to learn Indigenous values of restraint and endurance (Schoolcraft, 1848). The cradleboard is thus not merely a piece of equipment, but a culturally embedded practice that transmits values, identity, and relationship. In consideration of these values, although there are risks identified through the Western medical model, in a 2022 statement the AAP and the National Institute of Child Health and Human Development recognized the cradleboard as a culturally appropriate sleep surface (Moon et al., 2022).

Baby walkers are another piece of equipment commonly used by Navajo families. Baby walkers have been banned in Canada due to injury risks such as stair falls (Government of Canada, 2016), and the AAP (2022) has cautioned against their use for unsupervised infants. Evidence also indicates that contrary to common caregiver belief, baby walker use is associated with delays in motor development rather than promotion of walking (Badihian et al., 2017; Bezgin et al., 2021). However, as with cradleboards, Western risk-focused perspectives do not account for the cultural and practical reasons that may guide Navajo families in their use of this equipment.

Beyond cultural values, caregivers across cultures also use baby equipment for practical reasons, including parental convenience and the ability to safely contain an infant during household tasks (Birken et al., 2015; Dogan et al., 2009). EI providers must therefore be sensitive to both the cultural significance and the practical realities that inform caregiving decisions.

Purpose of the Study

EI practices rooted exclusively in the Western frameworks diverge from Indigenous worldviews and fail to honor the cultural traditions and practical considerations that guide Navajo caregiving. The historic inequities experienced by Navajo families, combined with non-Navajo providers’ limited knowledge of Navajo cultural values, create conditions for cultural conflict as described in Foronda’s (2020) Theory of Cultural Humility, undermining the delivery of culturally responsive care. To support both effective child outcomes and the honoring of cultural heritage, EI services for Navajo families cannot be based in Western evidence alone, but also must engage with Indigenous epistemology to learn of the beliefs and values guiding caregiving practices. Therefore, the purpose of this study was to understand the cultural and practical reasons guiding Navajo caregivers’ use of cradleboards and baby walkers, to inform culturally responsive collaborative care in EI through the frameworks of cultural humility and the Indigenous Ecological Systems Model. We hypothesized that both practical considerations and cultural values influence Navajo caregivers’ use of baby equipment. Our research aims were to: (a) understand the patterns of cradleboard and walker use among Navajo caregivers and (b) understand the reasons that guide caregivers in the use of these items.

Study Design

This study was conceptualized by EI providers who are non-Navajo based on their observations of baby equipment used by Navajo families, in recognition of the EI providers’ lack of cultural knowledge related to the reasons Navajo families use this equipment. In developing the study, these providers collaborated with a Navajo EI provider (the third author) and researched Indigenous methodologies for an understanding of cultural values to guide the study design. Therefore, this study used both Western and Indigenous research paradigms to inform the design and implementation.

The methodology followed a Western interpretive phenomenological approach for qualitative research based on a post-positivist research paradigm. Using this methodology, semi-structured interviews were conducted with Navajo parents and caregivers of infants and young children regarding their use of infant equipment. In addition to the interviews, relevant articles in the publication Leading the Way (n.d.) written by Navajo individuals were reviewed. Leading the Way is a newsletter publication available on the Navajo Nation with the purpose of preserving traditional wisdom for present and future generations of Navajo. Relevant articles about cradleboards and child development were identified through a search in a museum on the Navajo Nation housing newsletter archives. The articles included present and historical cultural photographs of Navajo children and caregivers using cradleboards as well as descriptions of traditional practices and spiritual values guiding the use of cradleboards. These rich details were used for triangulation of information to confirm study results based on data from interviews on traditional cradleboards and Navajo culture and parenting practices.

Indigenous epistemology also guided the study design and interpretation of results. Indigenous research paradigms typically have a different approach than those based on Western worldviews, with an emphasis on cultural traditions and values such as respect, responsibility, and benevolence, as well as principles such as resilience and restoration (Hickey, 2020). Researchers in this study strove to incorporate these principles into the methodology. Based on the Indigenous Ecological Systems Theory (Fish et al., 2022), the interviews were conducted using open-ended questions to gain in-depth information from participants about their practices for the use of infant equipment and the influences of the ecological systems of their family (immediate and extended), community, and Navajo culture.

The study was approved by the Navajo Nation Human Research Review Board (NNHRRB) on February 19, 2019, study number NNR-19.331. To ensure that research on the Navajo Nation promotes and enhances the interests and vision of the Navajo people, approval of research requires community partnerships, letters of support, and resolutions or permissions from relevant organizations. Approval and letters of support were obtained from GIB and the Diné Department of Education. A resolution documenting local approval of the study was generated by the Western Agency Council and the Central Agency Council, which are the governmental departments of the Navajo Nation where the study took place. During the initial approval meeting as well as at annual report meetings, NNHRRB members (who were all Navajo) regularly reviewed study methods to ensure respect for Navajo people. Following approval of the study, the research team was required to provide quarterly updates to the Board. Changes in the study (i.e., addition of research staff, addition of a virtual option), annual reports, and annual continuation requests required Board approval. All dissemination activities and manuscripts reporting study results were reviewed and approved by the Board (Navajo Nation Human Research Review Board, 2025). The Institutional Review Board at Northern Arizona University (NAU) also provided initial approval of this study.

Researcher Positionality

Because research is influenced by the worldviews, experiences, and perspectives of the researchers, the positionality of the researchers is important to acknowledge (Holmes, 2020). This is especially significant in research with populations such as Indigenous groups who have been historically exploited and underrecognized in research. In this study, four of the investigators identify as White and one as Navajo. Although all the researchers who conducted interviews identify as non-Navajo, White females from the dominant Western culture who reside off the Navajo Nation in Flagstaff, Arizona, they each worked as an EI provider with Navajo families and had some familiarity with Navajo culture. However, using the model of cultural humility and in recognition of the power differential potentially present between non-Navajo researchers and Navajo families due to cultural differences and historic inequities, the non-Navajo researchers collaborated with the third author, who is Navajo, to ensure the research was conducted in a manner that was respectful of Navajo values. In addition, they consulted on multiple occasions with other Navajo members versed in Diné culture, including a medicine man and a medicine woman, on the study purpose, methods, and results.

Participants

Thirteen Navajo families participated in this study. All families were recruited from the GIB Navajo Early Intervention Program (IDEA, Part C) in the state of Arizona; accordingly, all families had a child with a significant developmental delay or disability that qualified them for EI services. Purposive sampling was used as GIB early intervention providers initially identified and recruited families enrolled in GIB who met eligibility criteria. The EI providers were all non-Navajo and had a professional relationship with the families for EI service provision. Providers recruited families by verbally informing them of the study purpose with a brief description of study procedures, including that participation was voluntary and data would be de-identified and kept confidential.

In recognition of the potential power differential between the EI provider and families they work with, every effort was made to ensure that families understood that their decision to participate or not would in no way influence the EI services they received. These efforts included providing families with contact information of the primary researchers (who did not work with the families as their provider) if they had any questions and scheduling interviews on a different date from when they were recruited to allow them time to consider and ask questions should they have any. In addition, all families were offered the opportunity to be interviewed by a researcher who was not their EI provider, although some families declined and indicated a preference to be interviewed by the researcher who was also their service provider.

Inclusion criteria for participants were current enrollment in the Arizona GIB program as a primary caregiver for a young child; identification as Navajo; English speaking; and written consent provided. In addition, during the COVID pandemic when in-person visits were restricted, families had to have a device with reliable internet access for a virtual interview. The Navajo Nation experienced significant challenges during the pandemic, with widespread health disparities causing some of the highest rates of deaths from COVID and technology inequities limiting internet access for many families (Clahchischiligi, 2021; Wallace, 2020). Because of disparities with internet services on the Navajo Nation, this biased the sample during COVID to primarily families who lived closer to towns on the Navajo Nation. Although efforts were made (separate from this study) by GIB staff to provide families with a device and a hotspot to connect to the internet to minimize disparities, in many cases there was no option available for connectivity due to lack of internet coverage. Some families were observed by providers to use cradleboards with their children prior to enrollment; however, the use of a cradleboard was not criteria for eligibility for study inclusion. Families who did not live on the Navajo Nation in the state of Arizona (the catchment area for GIB) and those who did not have internet access were excluded. No families who were recruited declined to participate in the study. Participating families were provided with a $15 gift card to compensate them for their time.

The primary participant in all cases was the mother. For several families, other family members, who self-identified their relationship to the child (grandparents, fathers), were also present for the interview and contributed information. All families self-identified as Navajo. Informal conversations with families suggested that only a few parents demonstrated fluency in the Navajo language; grandparents who participated were more likely to speak Navajo as well as English. Some families reported they had limited knowledge of cultural practices, while others reported significant knowledge of Navajo culture in general and historical knowledge for the use of cradleboards. Data were not collected on participants’ ages, gender identity, or socioeconomic status.

Data Collection Procedures

Interview questions were developed by the researchers to focus on understanding the reasons and the use of traditional cradleboards and baby walkers by Navajo families to address the research questions of this study. This interview guide was then reviewed by cultural experts, including a Navajo medicine man and Navajo early childhood experts. Suggestions for edits to questions based on their review were incorporated into the interview guide. Although some questions in the interview guide were closed-ended, these were followed up with open-ended probes to invite elaboration (see Appendix for interview guide questions).

Five researchers who were non-Navajo conducted interviews with families who provided consent. Two researchers were physical therapists and three researchers were occupational therapists who worked as providers for the Navajo EI program. Some of the interviewers had relationships with the families as their EI providers. Interviews took place from 2019 to 2023, with a pause in data collection because of the COVID-19 pandemic. Although initially interviews were conducted in person, due to COVID-19 restrictions some later interviews took place virtually over Zoom. Initial interviews were recorded and transcribed by the researchers and administrative personnel; audio transcripts of recordings on Zoom were used and reviewed by the interviewer for accuracy. Data saturation was determined when interviews revealed no new codes in post-interview review.

Audio recordings were stored on password-protected, cloud-based, FERPA-compliant Zoom accounts and then destroyed after the recording was transcribed and checked for accuracy. Transcriptions were stored on a secure password-protected cloud-based account during data analysis. In accordance with NNHRRB procedures for authentic and respectful research collaboration and Navajo Nation data sovereignty, data (interview transcriptions and results from analysis) were transferred to the NNHRRB at the conclusion of the study, as the Navajo people gave consent for the study and are recognized as the owners of the data.

In addition to interviews, researchers reviewed copies of the Navajo monthly newsletter Leading the Way: The Wisdom of the Navajo People to search for articles on cradleboards and cultural values related to childrearing. Eight articles with photos were retrieved with data extracted on Navajo traditions and practices for triangulation of sources (Beeshligai, 2018; Claw, 2018; Davis, 2005; Johnson, 2018; Manolescu & Noble, 2005; Salaybe & Manolscu, 2005; Walker, 2018; Yellowhorse, 2018).

Data Analysis

The purpose of this research was to generate new understanding concerning the use of baby equipment by Navajo families following generally the process outlined by Kiger and Varpio (2020) as interpreted through the lens of existing theories; therefore, both inductive and deductive approaches were used. Two primary investigators who are non-Navajo conducted data analysis, which was performed without the use of qualitative data analysis software; a third investigator who is Navajo reviewed the findings. One non-Navajo investigator (an occupational therapist) had extensive experience working with the Navajo since 1989, and the other non-Navajo investigator (a physical therapist) since 2017; both investigators also had extensive education in cultural responsiveness and research with crosscultural groups. Both of these investigators read transcripts of all interviews in detail, reflecting on their perspectives of the participants with discussions between researchers to guard against bias. One investigator completed initial coding of each interview without the use of qualitative data analysis software. The investigators then came together to review and come to an agreement on coding. Relevant patterns were identified in the codes and organized in initial themes through collaborative discussion. The researchers independently reviewed and reflected on themes for further refinement.

These themes were compared with data extracted from articles and photos in the Navajo publication Leading the Way to confirm consistencies in results for triangulation of data. Although member checking with participants was not performed due to challenges with follow-up communication, the initial themes were presented to other Navajo members to solicit feedback. These members included representatives from the Diné Department of Education; the Navajo Western and Chinle Agency Councils; the Navajo Nation Research Review Board; and Navajo Early Childhood Instructors who were part of the GIB Early Intervention team. These sources all provided confirmation of findings, with suggestions primarily related to organization for the presentation of results. Based on this feedback, the primary investigators further reflected and reorganized themes to more clearly address the study aims and selected representational quotations for final thematic description in alignment with the research questions and the study purpose. These final themes were additionally reviewed by the third author, who is Navajo, for confirmation of Navajo values related to the findings.

To enhance qualitative rigor, prior to data collection each researcher considered and reflected on their own worldview, personal interactions, and perspectives on working with the Navajo and how these may influence their expectations of findings. A collaborative discussion between the researchers was held about these reflections to help decrease potential bias during data collection and analysis.

Theme 1: Practical Reasons Guide Navajo Caregivers in How and When to Use Baby Equipment

Caregivers spoke of their use patterns for the cradleboards and walkers that were based primarily in practices to help with caring for their infant, including when their infants first used the cradleboards and baby walkers, when use was discontinued and why, and when and how the equipment was typically used throughout the day. Caregivers also discussed adaptations that they made for the baby’s comfort and to prevent any adverse effects. Child comfort, sleep, and safety additionally guided caregiver use.

Theme 2: The Cradleboard Connects the Infant to Nature and Navajo Cultural Values, Providing a Strong Foundation for Life

Theme 3: Using Baby Equipment Helps the Infant’s Body to Become Strong

Theme 4: Using Baby Equipment Improves a Child’s Independence, Autonomy, and Opportunities for Social Interactions With Others

Participants commented about how the use of baby equipment allowed the baby to be more independent, and that they valued this autonomy at a young age. Some families reported that they used a baby walker because it helped the developing child to move around independently before they could walk on their own, which provided more opportunities for interactions with others. Cradleboards are used at times to position an infant propped upright so that they can observe those around them and be part of family activities without needing to be held:

(Cradleboard) “Sometimes parents put their boards up so the baby can look around and visualize.” (Participant 1)

(Walker) “ . . . he was just like, so powerful, just to try and move, and he actually made himself do a lot of things in the walker. . . . ” (Participant 6)

Triangulation with articles in Leading the Way provided confirmation that physical strength, independence, and harmony with others is valued in Navajo culture, as identified in Themes 3 and 4 (Claw, 2018; Salaybe & Manolscu, 2005; Walker, 2018; Yellowhorse, 2018).

Clinical Implications

In early intervention, the ability of a provider to approach parents with cultural humility and flexibility can foster trust and positive relationships (Foronda, 2020) that can lead to better developmental outcomes for the child (Bradshaw, 2013). In using an approach based in cultural humility and Indigenous frameworks to understand Navajo caregiving practices related to use of baby equipment, the results of this study indicate that EI providers should be respectful of both the practical issues and the cultural values that influence the use patterns and the reasons caregivers use this equipment. Providers additionally need to be aware that families have variations in acculturation influencing their parenting style and preferences (Muir et al., 2019), necessitating a flexible approach.

Effective collaboration with caregivers needs to additionally incorporate an understanding of the practical reasons behind caregiving practices to address caregivers’ needs. Results from this study show that Navajo families often use cradleboards and baby walkers as a safe place to secure the infant while the caregiver is attending to chores or other distracting activities. Although therapists may coach caregivers to minimize use of this equipment for safety and developmental reasons (as based in the Western medical model), they also need to consider the context of the family and the home environment. Some Navajo families live in traditional dwellings that have areas with dirt or gravel floors. If a home is small with limited safe floor space and multiple people and animals in it, the risk of plagiocephaly in a cradleboard where the infant is contained could be less than the risk of injury to an infant placed on a floor in an insecure environment. In this case, coaching should support the family in the use of the cradleboard to support their practical needs, but focus on practices to minimize plagiocephaly, such as frequent repositioning of the infant’s head while in the cradleboard, rather than a recommendation not to use a cradleboard at all. Collaborative practices need to consider the cultural and environmental context of the family and the child for decisions based on priorities and the impact of caregiving practices.

Although EI providers have a responsibility to coach parents on the risks and safety concerns related to the use of baby equipment, for culturally responsive care, the methods used should incorporate respect for cultural values such as through exploration with families of alternative recommendations that support these values. For example, in Navajo culture, physical strength and a “straight and strong” body are valued, and caregiving practices around the use of baby walkers are related to the belief that a walker helps the baby learn to walk and to grow strong. An EI provider displays respect for the family’s cultural value of physical strength for the baby by coaching the family that, although using a baby walker may be a safety hazard and has not been found to accelerate the development of walking (Badihian et al., 2017; Bezgin et al., 2021), activities such as floor play time allow the infant to develop strength and motor skills to help with the goal of walking independently (Adolph & Franchak, 2017). Similarly, although an infant placed in a cradleboard may be at risk of developing plagiocephaly from pressure on the back of the head (Ruggles, 2014), simple measures such as limiting the time the infant is in the cradleboard each day and encouraging play in the prone position when out of the cradleboard to limit pressure on the head can respect the family’s use of a cradleboard for spiritual grounding for the child while minimizing developmental impact. When collaborating with Navajo families for the safe use of baby equipment, the themes identified in this study can help the EI provider understand the Indigenous worldviews and practical issues that may influence the family and use this knowledge to focus the information provided so that it is respectful of Navajo values while still coaching caregivers on safe and appropriate use of equipment.

Limitations

Participants in this study were all families who had children enrolled in the GIB Early Intervention program. By definition, all of these children have developmental delays or disabilities, which may have influenced the interview responses and the study results as these families may have a unique perspective from raising a child with a disability. Because of this and the limited sample size, results may not be representative of all Navajo families, which could limit generalizability. In addition, most of the researchers performing the interviews with families worked with the families as their early intervention provider. The relationship with the interviewer and provision of a gift card for participation could have influenced participants in socially desirable responses (Bispo, 2022). No families were included who did not use cradleboards; inclusion of these families may have strengthened the findings.

No specific information was collected from families related to demographics such as age, gender identity, or socioeconomic status, which limits transferability of results. Participants all lived in the region of the Navajo Nation within the state of Arizona which may not be representative of Navajo families living in regions of the Navajo Nation within New Mexico or Utah.

Member checking with the results of the data analysis was not performed due to difficulties with locating participants related to COVID shutdowns on the Navajo Nation. There was a significant time lag for some participants between the interview and data analysis, so that families were difficult to contact in follow-up. This could be a limitation for the confirmability of results. In addition, confirmation of results with other Navajo stakeholders could have introduced some bias as to representation of participants and Navajo culture. Triangulation of sources from consultation with articles from Navajo publications and information from Navajo websites were used to minimize the potential bias as a result of limitations in the sample used for this study.

The COVID pandemic occurred during data collection, resulting in a need to pause and prolong the study while obtaining additional NNHRRB approval to transition to remote interviews through a virtual platform. This also resulted in a requirement that participants have a reliable internet connection. These issues may also have impacted the sample and results.

Future Research

This study did not seek to explore differences in beliefs for Navajo families with different levels of acculturation, language fluency, or traditional knowledge; further research could focus on comparing these groups’ knowledge of the cultural significance of cradleboards and any differences in their use. As all participating families in this study resided on the Navajo Nation, future research should also seek to compare the experiences of Navajo families living off the Navajo Nation to determine whether there are any differences.

The findings of this study were used to create culturally appropriate education materials for Navajo families on child development and safe and appropriate use of infant equipment. Research could be conducted on the acceptability of these materials by Navajo community members as compared to education materials based on mainstream culture to analyze the effectiveness of a culturally responsive approach to education.

The methodology used in this study through the lens of cultural humility can be used to learn values and beliefs guiding behaviors of other unique cultural groups to enhance culturally responsive care practices. In addition, the findings of this study can be used to educate other professions working with the Navajo and research the impact of improved crosscultural understanding for non-Navajo health care and education providers. Understanding the cultural beliefs guiding families’ parenting practices can contribute to healthy, trusting provider–client relationships and emphasize a strengths-based approach to support families and enhance outcomes for Navajo children.

Since the beginning of our study, further guidance on ethical research practices with Indigenous populations and data governance has emerged that is imperative to follow for future research practices with these populations. To engage in ethical practices with Indigenous populations, it is critical for more researchers to be well versed in these practices. The CARE Principles for Indigenous Data Governance (Carroll et al., 2020) were developed in recognition of the importance of Indigenous People’s rights and interests that differ from those in mainstream research practices. These principles include Collective benefit; Authority to control; Responsibility; and Ethics. Research with Indigenous populations such as the Navajo needs to recognize and respect the traditions and autonomy of participants for the benefit of the participants as well as the researchers. Through this lens, as was important in the current study, Indigenous cultural values are woven into the foundation of the research, and Indigenous communities are granted ownership and control of data produced from the research (Carroll et al., 2020). In addition, the TRUST principles (Transparency, Responsibility, User focus, Sustainability and Technology) regarding management of digital data are important for researchers to adhere to for safeguarding of data in the digital age (Lin et al., 2020). In consideration of the historic inequities and unethical research practices with Indigenous communities in the past, adherence to these principles is crucial to future research and management of data usage and storage from studies with these communities to ensure responsible and ethical research practices that do not further erode trust.