American Indian women experience health inequities within the physical, mental, and spiritual realms. Although the purpose of this study was to examine mammography decision-making processes among Native women in the northeastern United States, the role of Native identity in health-care decision-making in general was identified as significant and is therefore being reported independently. The findings of a grounded theory study with 20 American Indian women formed the basis for an examination of the complexities surrounding identity and health-care decision-making. The theme of Connecting to Nativeness reflects the individual and communal influences of Native identity on women's health and health-care decisions. Implications for researchers and clinicians, including the relationship between historical events and current constructions of identity, the fluid nature of identity, and the impact of racism on health-care decisions, are addressed.