Culture, Experience, and the Will to Screen: Adrd Screening Intention In an American Indian Community

Background and Purpose Alzheimer's disease and related dementias (ADRD) pose a growing public health challenge, yet early detection remains underutilized among American Indian (AI) adults. Screening intention is a well-established proximal predictor of health behavior, yet limited research has examined how cultural identity and personal experience with ADRD jointly shape this intention in AI communities. This study examined whether ADRD exposure and cultural identity were independently associated with ADRD screening intention, and whether ADRD exposure moderated the relationship between cultural identity and screening intention.

Methods Using a community-based participatory research (CBPR) approach, a cross-sectional survey was conducted with AI adults (N = 248) in a Northern Plains community in September 2024. Recruitment occurred through community-based avenues including a tribal powwow, referrals, and word of mouth. Screening intention was measured using four items assessing plans to seek memory loss screening. Cultural identity was assessed with a single item measuring identification with traditional practices, dichotomized into weak/none vs. moderate/strong. ADRD exposure was assessed by whether participants had known someone with dementia. Multiple linear regression models examined main effects and the interaction between cultural identity and ADRD exposure, controlling for demographics, dementia knowledge, self-confidence, chronic conditions, food security, and health beliefs.

Results The sample was predominantly female (52%), with a mean age of 44.78 years (SD = 15.46). Most participants reported low household income (89% earning less than $3,000/month) and low food security. The majority identified with their cultural traditions at a moderate-to-strong level (79%), and approximately 41% had known someone with dementia. ADRD exposure was the strongest predictor of screening intention (B = 0.63, p < .001), followed by moderate-to-strong cultural identity (B = 0.41, p < .05). A significant interaction was found (B = -0.85, p < .05): among participants without ADRD exposure, stronger cultural identity was positively associated with screening intention (B = 0.68, p = .002). However, this effect was not significant among those with ADRD exposure (B = -0.16, p = .614), suggesting that direct experience with ADRD may override the motivating role of cultural identity.

Conclusions and Implications Findings highlight the interplay between lived experience and cultural context in shaping ADRD screening motivation among AI adults. Cultural identity promotes screening intention in the absence of direct ADRD experience, but this effect is attenuated when individuals have personally known someone with dementia. These results underscore the need for culturally grounded, experience-sensitive outreach strategies. Interventions targeting AI communities should leverage cultural strengths while also addressing the distinct needs of those already touched by dementia. This CBPR-based study contributes to a growing evidence base on culturally informed approaches to dementia prevention and early detection among underserved Indigenous populations.