Objectives To evaluate urinary incontinence and pelvic organ prolapse knowledge among elder Southwestern American Indian women and to assess barriers to care for pelvic floor disorders through Community Engaged Research. Methods Our group was invited to provide an educational talk on urinary incontinence and pelvic organ prolapse at an annual meeting of American Indian Elders. Female attendees ≥55 years anonymously completed demographic information and two validated questionnaires; the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) and Barriers to Incontinence Care Seeking Questionnaire (BICS-Q). Questionnaire results were compared to historical controls from the original PIKQ and BICS-Q validation study. Results 144 women completed questionnaires. The mean age was 77.7 ± 9.1 years. The mean PIKQ UI score was 6.6 ± 3.0 (similar to historic gynecology controls 6.8 ± 3.3, p=0.49) and the mean PIKQ POP score was 5.4 ± 2.9 (better than historic gynecology controls 3.6 ± 3.2, p<0.01). Barriers to care seeking reported by the elder women were highest on the BICS-Q subscales of “Cost” and “Inconvenience”. Conclusions Urinary incontinence knowledge is similar to historic gynecology controls and pelvic organ prolapse knowledge is higher than historic gynecology controls among elder Southwestern American Indian women. American Indian elder women report high levels of barriers to care. The greatest barriers to care seeking for this population were related to cost and inconvenience, reflecting the importance of assessing socioeconomic status when investigating barriers to care. Addressing these barriers may enhance care seeking Southwestern American Indian women.

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The circle of tribal society is "experienced from the inside.... When forced from the center, one is "alienated, irritable, and lonely" (Deloria, 1970, p. 13). Social workers, as service providers and researchers in collaboration with the American Indian women they are privileged to serve, have a distinct opportunity for working toward health--the integration of the physical, the emotional, the spiritual--in the lives of women who seek help in treatment facilities for substance abuse. A genuine contribution to the health of the communities to which the women return and to the generations which follow is central to this opportunity and lies deep within the circle.

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Native American cultures have, over thousands of years, identified cultural practices from which other cultural entities, behavior analysis included, may benefit. In this paper, the authors discuss confluences between the principle of shared power in Native American (particularly Pueblo) philosophy and contemporary behavior analysis. Intriguing and useful convergences were identified in the definition of power, recognition of connectedness and definitions of "the person," the importance of constructional as opposed to coercive processes, lack of hierarchy (related to equivalence relations), and the utility of diverse voices. A behavior analysis of practices that instantiate the sharing of power in Native American cultures provides valuable guidance for work with problems of social importance, particularly for applied work at a cultural level. Examples of current and emerging work consistent with this analysis are also briefly considered.In 1995, Sato discussed Zen Buddhist practices from a behavior analytic perspective, examining confluences of Zen and behavior analytic understandings of phenomena. In a somewhat similar vein, in this paper we identify points of convergence between American Indian thought and behavior analysis. Our purpose, however, is not so much philosophical as practical. As behavior analysis becomes increasingly interested in the cultural level of analysis (e.g., Malott, 1988;Glenn, 1991;Lamal, 1991Lamal, , 1997 and in the practical applications of such analysis, behavior analysts have begun to examine ways, for example, to improve child-rearing and decrease child maltreatment through community-level interventions