Bridging traditions and prevention: Insights into implementing and sustaining substance use programs for urban AI/AN communities.

INTRODUCTION: Substance use prevention programs tailored to American Indian and Alaska Native (AI/AN) populations in the U.S. have shown promise, particularly when they center on cultural relevance and community engagement. However, limited research has been conducted to understand program implementation and sustainability in AI/AN organizations and communities. METHODS: This study explores implementation and sustainability using 20 virtual in-depth interviews with AI/AN service providers and administrators across the U.S. following a randomized control trial of the virtual TACUNA (Traditions and Connections for Urban Native Americans) program for AI/AN emerging adults living outside Tribal lands. RESULTS: Participants highlighted the importance of a culturally grounded workforce, funding, and collaborative partnerships for the successful implementation and sustainability of prevention efforts. Initial funding is crucial for launching programs, and collaborative partnerships with federal and state agencies can improve funding opportunities and sustainability. Many also highlighted that integrated care models that combine medical, behavioral, and cultural health services effectively address complex needs, while hybrid delivery methods can balance accessibility and relational engagement. Participants also noted that tailored interventions require a deep understanding of community values and trust-building through local stakeholder engagement. In addition, many said culturally appropriate evaluation methods, combining quantitative and qualitative metrics, are essential for measuring success and ensuring continuous improvement. Finally, participants argued that systemic policy changes are needed to rectify funding inequities, reduce regulatory barriers, and support culturally relevant practices, thereby enhancing the effectiveness of health services for urban and non-urban Indian health organizations and communities. CONCLUSION: These perspectives can help inform the implementation of TACUNA in communities across the U.S. Findings underscore the necessity of tailoring programs to cultural values and emphasize the need for systemic policy changes to address funding inequities and regulatory barriers. By addressing these gaps, stakeholders can consider how to enhance the effectiveness and sustainability of substance use prevention initiatives within AIAN communities.