From the start of the COVID-19 pandemic on the Navajo Nation, Diné (Navajo) traditional knowledge holders (TKHs), such as medicine men and women and traditional practitioners, contributed their services and healing practices. Although TKHs are not always fully acknowledged in the western health care system, they have an established role to protect and promote the health of Diné people. To date, their roles in mitigating the COVID-19 pandemic have not been fully explored. The purpose of this research was to understand the social and cultural contexts of the COVID-19 pandemic and vaccines based on the roles and perspectives of Diné TKHs. A multi-investigator consensus analysis was conducted by six American Indian researchers using interviews with TKHs collected between December 2021–January 2022. The Hózhó Resilience Model was used as a framework to analyze the data using four parent themes: COVID-19, harmony and relationships, spirituality, and respect for self and discipline. These parent themes were further organized into promoters and/or barriers for 12 sub-themes that emerged from the data, such as traditional knowledge, Diné identity, and vaccine. Overall, the analysis showed key factors that could be applied in pandemic planning and public health mitigation efforts based on the cultural perspective of TKHs.

The purpose of the Diné Teachings and Public Health Students Informing Peers and Relatives about Vaccine Education (RAVE) project was to develop strategies for health communication that addressed COVID-19 vaccine safety for residents of the Navajo Nation. The RAVE project developed a 16-week course using the Diné Educational Philosophy as a framework to train Diné College (DC) public health undergraduate students (n = 16) as health messengers to share COVID-19 vaccine safety information with unvaccinated peers and relatives. An online community survey (n = 50) was used to assess DC community vaccination perceptions to guide course development. The two primary reasons survey participants got vaccinated were to protect the health of others [82% (n = 41)] and to protect their own health [76% (n = 38)]. A pretest/post-test and a retrospective pretest (n = 13) were implemented to determine course effectiveness. A finding approaching significance was related to student confidence in being health messengers (9.1% increase). RAVE offers the first example in the published literature of successfully training American Indian undergraduate students in the context of a public health course to contribute to the response workforce during a public health crisis.