Background: Despite advances in digital health interventions to reduce health inequities in rural, minoritized populations, Native Americans continue to experience disproportionate behavioral health concerns and lack access to healthcare services. In addition to the lack of care, many digital health interventions for Native populations are not created with cultural relevancy or historical variables in mind, thereby decreasing the usability and effectiveness of these interventions.

Methods: Participants (n=13; Mage=40 years) completed an online survey about perceptions of culture, alcohol use, and resources in their communities. Participants also answered questions regarding the usability of a digital health application designed to monitor alcohol use.

Results: Regarding cultural perceptions and alcohol use, 84.6% of participants reported that loss of Native American culture in the US and historical trauma has contributed to problematic alcohol use in their community. The majority of participants (69.2%) also reported instances where they should have sought treatment and did not. The most common barriers to seeking treatment included 1) lack of health insurance coverage for services, 2) time constraints, 3) feelings of embarrassment, 4) lack of trust in services and/or providers, and 5) a desire to continue drinking. Regarding the usability of the digital health app, many participants indicated they would use it again in the future (46.2%) and found it easy to use (76.9%). Participants also reported that the application functions were well integrated (30.8%). Many participants reported that using the app daily (69.2%), answering questions about alcohol use (76.9%), and setting goals (61.5%) were helpful. Additionally, 53.8% reported that the app reduced their alcohol intake. Qualitative responses for improving the application included connecting people to resources in their community and the ability to review past entries to identify patterns in alcohol intake.

Conclusion: For rural Native American populations, digital health apps may offer a more usable and acceptable option for alcohol use interventions. Digital health apps can address barriers to seeking treatment, such as limited access to services and perceptions of help-seeking behaviors for this population. These results highlight the need for tailored digital health interventions that focus on addressing relevant cultural and historical factors addressing alcohol use among Native populations.