Abstract
This study aimed to understand facilitators and barriers to returning to in-person learning for youth, caregivers, and school staff from three communities in the Navajo Nation and the White Mountain Apache Tribe following the 2020 COVID-19-driven school closures. A safe and rapid return to school through effective and acceptable COVID-19 mitigation strategies was vital for students’ social and scholastic development and the resilience of staff and families. We interviewed school staff (
Plain Language Summary
This study surveyed native families and school staff in the American southwest regarding their decision to return to in-person schooling following COIVD-19 school closures. The analysis looks at the patterns of responses collected that suggest factors that increased or decreased the likelihood of a to return to in-person instruction.
Introduction
Significance of Study
To curb the spread of COVID-19, schools across the world, including in the United States (US), closed in early 2020, shifting from in-person to distance learning. By spring 2020, 83% of public teachers reported all or some classes had transitioned online (National Center for Education Statistics, 2022a). At the start of the 2020 to 2021 school year, only 40% of US public-school districts offered in-person learning, with teachers, parents, and children remaining hesitant to return. However, evidence shows closures negatively affected student and family wellbeing (Viner et al., 2022), highlighting the importance of maintaining in-person schooling in future pandemics (Hertz et al., 2022).
Virtual learning introduced challenges for Native American (NA) families. Limited internet access resulted in 45% of schools serving NA students offering only paper education packets and 25% completely shuttering, unable to provide remote learning (National Indian Education Association, 2020). Non-curricular resources were difficult to deliver during virtual learning. Notably, food security was profoundly disrupted (Hoover, 2020). Kinship networks with strong intergenerational bonds were strained in supporting youth and virtual learning (Schultz et al., 2023). Schools serving NA families were cautious about reopening. In mid-April 2021, 70% of Bureau of Indian Education (BIE) schools remained remote, compared to 48% of public schools (Dearman, 2021; National Center for Education Statistics, 2022b, 2022c). Many NA families hesitated to return to in-person classes because of the risk of COVID-19 transmission and the disproportionate pandemic-related loss of family members.
Despite challenges, many NA communities took innovative approaches to recovery and resilience during the COVID-19 pandemic. For example, some school districts created internet hotspots by equipping buses to visit remote locations. Students accessed hotspots from their cars, making digital learning possible. Buses also delivered food directly to students’ homes, ensuring nutritional needs were maintained despite physical closures. Though hesitant to return to large gatherings, NA communities leveraged a collective wellbeing mentality to promote high vaccination rates (Haroz et al., 2022) and universal masking when businesses and communal places reopened. These efforts helped to promote wellbeing and reduce the spread of a deadly disease.
However, the impact of school closures may be particularly long-lasting and profound among NA youth due to pre-COVID-19 educational and mental health inequities rooted in historical violence and injustice faced by NA communities (Office for Civil Rights, 2021; Pember, 2020). Before COVID-19, NA youth were approximately two to three grade levels behind their White counterparts in math and reading (The National Caucus of Native American Legislators, 2008). Similarly, NA youth face mental health disparities, presenting to emergency departments with greater than twice the rate of mental health diagnoses as their White counterparts (Zook et al., 2018). Evidence suggests that disparities have worsened since the pandemic began (Curtin et al., 2022). Understanding what facilitated the return to in-person learning for NA families and staff is critical to ensuring communities feel safe in returning to in-person learning during future pandemics.
Purpose
We studied the facilitators and barriers among NA youth, caregivers, and school staff to returning to in-person learning following the 2020 COVID-19 school shutdowns. By uplifting the experiences of NA families and school staff during COVID-19 school closures, we aimed to identify strategies to keep schools open in future pandemics. Maintaining safe in-person learning is critical the wellbeing and safety of NA youth. Study findings may inform policy makers, local public health agencies, and educators on ways to support NA communities, while mitigating the spread of infectious disease. While the findings in the study are highly contextualized, the findings may generalize to other NA communities or other groups who have faced historical maltreatment and ongoing injustices.
Methods
Participants and Study Setting
This qualitative study took place in the context of a larger cohort study, Project SafeSchools (PSS; Allison-Burbank et al., 2022). The cohort study aimed to understand the impact of the COVID-19 pandemic and associated school closures on Native American caregivers, youth, and school personnel. The study was completed in partnership with the White Mountain Apache Tribe (WMAT) and the Navajo Nation (NN). The WMAT is located on the Fort Apache Indian Reservation in Eastern Arizona. The reservation has 13 schools serving approximately 3,500 majority-Apache students (Bohl Gerke, 2023). The NN covers areas of Northern Arizona, Northwestern New Mexico, and Southeastern Utah (Biggs, 2023). Our study focused on three large agencies on NN: Chinle, Shiprock, and Western. These areas have 32 schools that serve approximately 7,000 students.
For the PSS cohort study, participants included primary caregivers and school personnel at least 18 years old, who either worked at or had a child (4–16 years old) eligible to attend a school that serves tribal members. Caregivers reported on one “index child” who was selected randomly if multiple children in the household met the age criteria. Before participating in any study activities, adults (age > 18) completed informed consent, caregivers provided permission for their youth to participate, and minors assented to the study. Full details for the PSS Cohort study. can be found in the protocol paper (Allison-Burbank et al., 2022) For this analysis, we focused on a subset of caregivers, school staff, and of index children (ages 11–16), who were approached to participate in qualitative interviews.
Theoretical Framework
We used the Theoretical Domains Framework (TDF) (Atkins et al., 2017) to guide our coding process. The TDF frames the factors determining current and desired behaviors (Atkins et al., 2017). We selected this framework as a basis to try and better understand what influences stakeholders desire to return to in-person learning and uptake of COVID-19 mitigation strategies. The TDF includes domains of capability, opportunity, and motivation as determinants of behavior and decision-making (Atkins et al., 2017). The TDF was applied in this context to help guide our understanding of what drove stakeholders participation in COVID-19 mitigation strategies and returning to in person learning. The study investigators developed a TDF-informed semi-structured interview guide. Questions were developed for each of the main domains of the TDF. The final guide included two questions related to opportunity, three related to motivation, and one related to capability. All guides were refined with the input of Diné (Navajo) and WMAT-affiliated study team members.
Recruitment and Data Collection
Caregivers, youth, and school staff were purposively selected from the parent cohort study sample. Purposive sampling was used to balance perspectives across Tribe, participant type, and families enrolled in virtual-only or in-person learning. Interviews were designed to take 45 to 60 min and conducted in-person or over the phone by local Apache and Diné study staff using the interview guide. Interviews were audio recorded and professionally transcribed. Enrollment continued until saturation was met within TDF domains among youth, caregiver and staff subcategories. Saturation was defined by consensus across the research team that no new information was emerging from interviews for the TDF codes or agreed-upon emergent codes.
Quality Assurance
Study investigators outside of the interviewing team, conducted quality assurance. The investigators reviewed the first three interviews conducted by staff and provided written feedback regarding fidelity to the interview guide and overall framework model. Investigators hosted biweekly calls with the coding team to provide ongoing support and facilitate discussion of saturation. Ongoing discussions with local staff increased the cultural and contextual validity of coded themes and, in many cases, introduced unique nuances to code interpretation.
Data Analysis
We developed an initial codebook using the TDF framework and interview guide. Three independent coders reviewed the same transcripts of two caregivers, two youth and two staff interviews. These independent coders then discussed discrepancies in coding and further refined the codebook. Themes that were unique to the TDF and agreed upon through discussion by the coders were added to the final codebook. The team then completed coding of an additional two transcripts per participant category until text selection and code application were analogous in compared manuscripts with 90% agreement among interview quotes cited. Once agreement was reached, we completed independent coding of all transcripts by a single coder.
The coding team aggregated code segments using TDF and emergent codes. We then reviewed the coded excerpts within each TDF category, including capability, opportunity, and motivation, and summarized crosscutting themes. The team then chose example quotes to represent each TDF category as well as crosscutting themes. To establish credibility, we reviewed key findings with the study PIs and additional local NA staff working on the project.
Results
Participants
A total of
Participant Demographics.
Tribal affiliation was asked only of care-giver participants.
Qualitative Findings
Overall, district administration’s decision to reopen schools was heavily dependent upon state and local governmental guidelines. Most caregivers and staff felt the decision to reopen was made without consideration of staff or family preference. Families weighed the health risks of COVID-19 transmission and perceived improvement in instructional opportunities, when deciding to return to in-person learning. Detailed findings below are presented via the TDF domains (Table 2).
TDF Framework Domains and Definitions.
Opportunity
Technological Difficulties of Virtual Learning
Participants’ perspectives on virtual learning highlighted the challenges of insufficient technology and connectivity facing NA families. Although students were provided with school laptops, many had inadequate wireless connections at home. Caregivers stated they were unfamiliar with virtual platforms and could not adequately support virtual learning. Implementation of Wi-Fi-enabled buses was seen as helpful but inadequate for those living in remote locations. Difficult internet and technological accessibility were seen as barriers to virtual learning and motivators in returning to in-person learning.
School District Decision to Return to In-Person Learning
District superintendents reopened schools based on the Centers for Disease Control and Prevention (CDC) recommendations or state and Tribal government guidelines. Staff often stated they were left out of the decision-making process. One staff member stated, “We were just left out of the loop. That was the… superintendent’s decision.”
Many schools continued offering virtual learning when classrooms reopened, giving caregivers the choice to remain virtual. Caregivers lamented a lack of clear, consistent communication from the administration about schooling options among rapidly changing school policies. One parent stated, “Maybe if they gave us weekly updates about the students…” Another explained, “I just think better communication would [have made it] a lot smoother.” Staff echoed concerns about disorganized communication. When transitioning between virtual and in-person learning, staff and caregivers wanted clearer communication about return-to-school logistics and safety protocols.
Social Influence
Some staff and caregivers described their decision to return to in-person learning as independent of “social influence” or the effect of one person on another’s beliefs or behaviors. Others acknowledged the influence of peers and coworkers. One staff member explained, “I haven’t spoken to anybody…I just made the decision on my own to make sure that my daughter is safe.” Youth spoke of contrasting experiences; in response to “Has that conversation that you’ve had with [peers] influenced your thoughts about being back in school?” one student commented, “Yeah,” while another student said, “No.”
For caregivers and staff influenced by peers, some peers encouraged while others inhibited decisions to return to in-person learning. Disagreements among families created challenges; one mother commented: I told my husband [I wanted to send my children to in-person learning], and my husband was upset. He was mad. He didn’t want his kids to go, then I’m over here like, Okay. We need to try; we need to try, let them deal with it.
Caregivers and staff often referenced how safety influenced students’ return to in-person learning. Staff deferred to caregivers’ decisions to engage in safety protocols. One staff member stated, “For me personally, it’s whatever their caregiver decide [sic] to have their child vaccinated or not vaccinated; that’s their call, not mine.”
COVID-19 transmission risk among families impacted caregivers’ decision to return to in-person learning. Caregivers and students described concern for COVID-19 transmission within multi-generational families and recognized the dangers of COVID-19 infection. One staff member explained: There’s a lot more intergenerational homes in our community … So, that was kind of a concern that I had early on, because we have so many high schoolers that live with their 70-year-old grand-… Great-grandfather or great-grandmother or whatever.
Staff also cited the risk of COVID-19 to their relatives: I had some anxiety about, um, coming back to school just because, um, I am high risk with my past … medical history, so that was one thing, and I, I’ve got a newborn son living with us, or, we have a newborn, so all those things and my wife has some medical history concerns, so that was the biggest thing that was, um, my anxiety was just trying to keep my family safe.
Risks to family members with complex medical problems were cited as a reason not to return to in-person learning.
Motivation
Motivation in Virtual Learning
The majority of caregivers did not see the benefit of virtual learning. One parent stated, “he missed being with friends, … I think just the school environment.” However, a few families with medically vulnerable members said they welcomed the ability to continue coursework in isolation, “Knowing that some students at school might be living with the elders or their parents, or siblings, I wouldn’t want them have to be having to be sick on COVID,” said one student. While families chose whether to return to school, many staff were not offered that choice.
The flexible schedule of virtual learning was both a facilitator and a barrier among families and staff. One student stated: “In-person school is difficult because you have to wake up early in the morning, going to class and everything; [virtual] you just have to wake up and your computer is right there.” Others found that virtual learning lacked accountability, “She did not like the schedule, waking up early, and there was really no authority online,” noted one caregiver. One staff member commented that virtual learning “interferes the education process,” elaborating, “You don’t get as much attention and information exchange when you’re at home compared to being in class … you have more initiative to learn more when you’re there in person.”
Emotion
Respondents stated social connection was beneficial and motivated a return to in-person learning. One staff highlighted, “I think students missed out on a lot, but the social, emotional part of being around their friends … I see that being the most positive thing [about] being back in person.” Caregivers found a social connection through in-person sports important to students’ physical and social wellbeing, along with sanitization and distancing protocols. Beyond peer relationships, mentorship and the relational community fostered by school staff were lost during virtual learning.
Despite a desire to return to pre-COVID-19 social interactions, respondents’ actions were tempered with anxiety about COVID-19 transmission. After describing the positive social benefits of in-person learning, one caregiver explained: [COVID-19 is] mutating and it’s changing, and it’s what scares me … it’s out there, and you don’t know; people are asymptomatic, they don’t know they have it and [could] be standing in front of you and have it and pass it to you.
Social and Professional Role
Staff felt a professional obligation to prevent the spread of COVID-19 upon returning to in-person learning and favored testing and vaccination in the interest of safety. One staff member explained, “I have to make sure that I’m not a risk to somebody here because I think that’s the most respectful thing to do … I worry about bringing [COVID-19] here and exposing somebody.”
During virtual learning, teachers saw expanded curricular workloads with new virtual platforms. Caregivers also took on new roles as educators alongside their existing jobs or duties. This extra workload was often cited as a catalyst for returning youth to in-person learning. One caregiver stated, “A lot of parents were okay with sending their kids to school. They struggled with the virtual school when everybody went virtual last year.” Staff stated concerns about burdensome testing protocols, describing their expanded role in ensuring testing and other mitigation strategies were completed. Sometimes, caregivers did not follow school protocols. One staff member observed, “I had a parent that brought in her kid… And, they were positive; they were supposed to be quarantined at home, but they were at this school.” In-person learning helped caregivers focus on their professional and family lives; however, it increased their anxiety about whether youth would be exposed to or test positive for COVID-19. Concerns were related to youth health and the burden of children quarantining at home. Caregivers bemoaned work conflicts, stating, “The inconvenience is having to leave work a lot to do that [student testing].”
Motivation in Mitigation Strategies
Familial influence impacted mitigation strategies such as masking, testing, and vaccination. One staff member noted the mandatory quarantine after COVID-19 exposure was difficult for families: I know that discourages a lot of parents when kids have to stay home because they’re not feeling well. But I’d rather them stay home for a day and find out that it’s nothing instead of coming to class and exposing their classmates, the staff, or whoever.
Fear also played a role in resistance to testing: “I think the kids are scared. They think it’s a regular [PCR] test, the really invasive one that goes to your brain,” one staff explained. Both staff and caregivers expressed enthusiasm to vaccinate to lessen disease severity. Vulnerable health status increased willingness to engage in masking, symptom screening, and testing. A student commented, “I think they should [mandate vaccination] because kids that don’t have their vaccination can get it [and] be safe.” Another student explained, “My mom at first didn’t want me to [get vaccinated] …my grandparents influenced me to get it because they’re the ones I was staying with out here, so I thought of them and got it.”
Capability
Capability in Virtual Learning
Virtual learning engagement was challenging; a staff member explained, “… for some kids, it’s better for them to be in person than virtual because of the distractions. And they just don’t pay attention when they’re doing it virtually.” In-person interactions were described as irreplaceable in providing adequate student coaching and curricular participation. Staff reported students’ virtual contributions were not incentivized by the permissiveness of assessments during virtual learning. One staff commented, “The kids sort of picked up on that sense, like, ‘Oh, we’re going to pass anyway,’ so they just stopped [participating].” This frustrated one staff member, who “considered leaving teaching last year” due to student apathy.
Academic supports were difficult to implement in the virtual setting. A staff member highlighted: I think the students really needed to be in school to get a lot of their support and services… like being able to talk to another individual, mental health, and tutoring; actually interacting with the teachers in the class, asking questions, and getting feedback.
A few staff stated material supports were also difficult to deliver, “It’s hard to get supplies to them. A lot of them come from a low-income family. So, that’s the hard part.”
Maintaining Safe Return-to-School Conditions
Implementation of COVID-19 safety measures while transitioning to in-person learning was encouraging to staff and families. Staff felt strongly that sanitation, masking, and distancing protocols would create a safe environment for in-person instruction facilitated by student engagement in protocols. However, staff struggled with consistently implementing mitigation strategies such as social distancing: “When there’s a lineup to go to the cafeteria or to transition to another building, there tends to be a clutter of students not keeping their distance. It’s hard to enforce.” Students also suggested better social distancing measures would make schools feel safer.
Vaccination and Testing
Caregivers’ ability to get their students tested and vaccinated influenced decisions to return to school. Caregivers found vaccination a useful mitigation strategy and hesitated when sending young children back to school who could not be vaccinated. Regarding testing, positivity rates from school-based pool testing provided caregivers with timely feedback on local rates of COVID-19. Students and staff agreed that COVID-19 testing improved safety by allowing one to “tell which [student] is sick or not.”“[Testing] gives a sense of security that if someone is going to be positive, at least we’re going to know,” explained a staff member. Caregiver consent for pool testing remained a barrier to implementation. Regarding vaccination, staff commented, “You really can’t ask a student to disclose if they’re vaccinated or not.”
Summary of Findings
Our findings suggest several unifying themes. First, logistical challenges were highly motivating – virtual learning with limited internet access was a major facilitator in returning to in-person learning. Second, a strong sense of communal wellbeing and worry about spreading the virus led to hesitation in return to in-person learning, but also motivated acceptance and participation in COVID-19 risk mitigation strategies. The lack of peer interactions and social connectedness while staying home was felt profoundly and encouraged the return to in-person learning.
Discussion
This paper described the behavioral determinants of returning to in-person learning and COVID-19 mitigation efforts among caregivers, staff and youth in several NA communities in the Southwest. Iterative discussion with staff from participant communities allowed us to faithfully apply the TDF framework and understand the opportunities, motivations, and capabilities among stakeholders in return to in-person learning.
Challenges with virtual learning was a major driver of returning to in-person learning. Families with knowledge of online platforms and the ability to support students at home adapted to virtual learning. In contrast, families with difficulty in managing laptops, online portals and discipline in completing curricular objectives found virtual learning overwhelming. Caregivers and staff echoed recent literature describing the strain of expanding responsibility in facilitating virtual learning (Fontenelle-Tereshchuk, 2021; Krishnaratne et al., 2022). Furthermore, staff struggled without the in-person engagement of students during virtual learning as students’ academic performance lagged.
Both youth and staff were strongly motivated to return to in-person learning although actions were tempered by the risks of COVID-19 spread. Return to in-person learning caused anxiety around youth spreading COVID-19 to household contacts. This is similar to what was found in a study of Canadian adolescents describing the risk of COVID-19 transmission as a stressor when returning to school (Schwartz et al., 2021). Importantly, students reported thoughtful use of mitigation strategies to protect their families. This is consistent with other findings of NA communities that suggest protecting others is a strong motivator for uptake and sustained use of mitigation strategies (Foxworth et al., 2021)
Effective mitigation measures were key in balancing the risks and benefits of in-person learning. Respondents suggested COVID-19 transmission was mediated most effectively with testing and vaccination while sanitization, masking, and social distancing was limited by available materials and physical space. The majority of respondents spoke positively about testing strategies to reduce the spread of COVID-19. Most of the respondents also appreciated less invasive forms of testing, such as the lower nasal swab. This reflects literature supporting the use of testing that is easily performed with minimal discomfort (Bruening et al., 2022) to improve participation.
While staff and caregivers felt largely left out of return to school planning, information about positivity rates were seen as reinforcing a safe return to school. Clear and transparent communication regarding this data is key to building trust (Zimmerman & Benjamin, 2023). Our findings demonstrate that stakeholders want to be consulted when planning responses to public health challenges. Continued engagement of stakeholders during development and implementation of any response to emerging diseases are critical to ensure uptake and buy-in of planned strategies (Goldman et al., 2023).
Limitations
We aimed to characterize the experiences of NA youth, caregivers, and staff during the COVID-19 school closures and transition back to in-person learning, among two tribal nations. As such, our findings may not be generalizable to other communities given their unique social, cultural, and political structures. However, given parallels with the study community and other NA communities or communities that have faced structural discrimination, the findings presented here may be relevant to inform practice and policy in similar settings. While we purposively sampled families who opted into virtual learning, only a few participated. Our findings may not fully represent the perspective of these families. It is worth noting that most participants were interviewed in the first 4 months of school re-openings and prior to mandates to return to in-person learning.
Conclusion and Implications
Virtual learning undercut social interaction and material supports, providing logistical barriers for NA youth, caregivers and staff. This, alongside concerns about others in the community, motivated a return to in-person school and acceptability of additional COVID-19 risk mitigation strategies. Most native communities’ value the collective good and health and wellbeing of relatives (i.e., others in the community). The importance of relations and this focus on others motivated behaviors and mitigated the impact of COVID-19 (Haroz et al., 2022). Health communication efforts and other public health interventions aimed to support NA communities should call on the strengths of the intergenerational community and highlight their resilience as it relates to mitigating any health burden (Foxworth et al., 2021). While native communities were disproportionately affected by COVID-19, their cultural appreciation of interconnectedness, may be leveraged to guide responses to future public health emergencies.
Footnotes
Acknowledgements
We respectfully acknowledge the tribal communities engaged in this work for their leadership in public health policy and research. We would like to thank all community members and families who helped to guide and those who participated in this study. A special thanks to research staff Benjamin Harvey, BS1, Anna Olson1, Allison Ingalls, MPH1, and Lauren Tingey, PhD, MSW, MPH1.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this RADx® Underserved Populations (RADx-UP), publication was supported by the National Institutes of Health under Award Number OT2HD107543.
Ethical Approval
This study was approved by the Johns Hopkins Bloomberg School of Public Health Institutional Review Board (IRB # 149111) and the Navajo Nation Human Subject Research Review Board.
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request in accordance with institutional review board requirements for participant safety and privacy.