Lessons Learned in Community Research Through The Native Proverbs 31 Health Project

Abstract

BackgroundAmerican Indian women have high rates of cardiovascular disease largely because of their high prevalence of hypertension, diabetes, and obesity. This population has high rates of cardiovascular disease-related behaviors, including physical inactivity, harmful tobacco use, and a diet that promotes heart disease. Culturally appropriate interventions are needed to establish health behavior change to reduce cardiovascular disease risk.Community ContextThis study was conducted in Robeson County, North Carolina, the traditional homeland of the Lumbee Indian tribe. The study’s goal was to develop, deliver, and evaluate a community-based, culturally appropriate cardiovascular disease program for American Indian women and girls.MethodsFormative research, including focus groups, church assessments, and literature reviews, were conducted for intervention development. Weekly classes during a 4-month period in 4 Lumbee churches (64 women and 11 girls in 2 primary intervention churches; 82 women and 8 girls in 2 delayed intervention churches) were led by community lay health educators. Topics included nutrition, physical activity, and tobacco use cessation and were coupled with messages from the Proverbs 31 passage, which describes the virtuous, godly woman. Surveys collected at the beginning and end of the program measured programmatic effects and change in body mass index.OutcomeChurches were very receptive to the program. However, limitations included slow rise in attendance, scheduling conflicts for individuals and church calendars, and resistance to change in cultural traditions.InterpretationChurches are resources in developing and implementing health promotion programs in Christian populations. Through church partnerships, interventions can be tailored to suit the needs of targeted groups.

Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives

“…22,25,27–31,35,38,39 As one example, Adams, et al 31 explained how their team used community-based participatory research, along with their history of university-tribal partnerships to jointly design Healthy Children, Strong Families.…”

“…20,22,24,29–31,35 The remaining two-thirds of the interventions were non-randomized trials (n=5; 25%) 25,28,32,38,40 or pilot/feasibility studies (n=8; 40%) 21,23,26,27,34,36,39,41 . Three of the non-randomized trials discussed why using a randomized controlled trial would not be appropriate within their community contexts.…”

“…20,25,31,39,42–46 Most of the formative assessments used a mixed methods approach including qualitative methods such as key informant interviews and focus groups. Pathways also conducted direct observations 42 while the Youth Wellness Program 43 used a school self-assessment and a locally generated environmental inventory.…”

Best Practices for Effective Clinical Partnerships with Indigenous Populations of North America (American Indian, Alaska Native, First Nations, Métis, and Inuit)

“…Along with communication with tribal leadership, communication with the community through regular presence, responsiveness to community requests, and learning to communicate within the cultural norms of that tribe are all the responsibility of Haozous & Neher clinicians and researchers. 14,[20][21][22] When working in or with an indigenous population, trusted clinicians can become part of the fabric of the community, and may be invited to ceremonial or community events. Malone 23 describes the phenomenon of boundary crossings, in which the clinician has established a trusting relationship, and remains aware of his or her role in the community to avoid crossing professional boundaries by going Native and inadvertently committing ethical violations.…”

Perceptions of Pharmacogenetic Research to Guide Tobacco Cessation by Patients, Providers and Leaders in a Tribal Healthcare Setting

“…Of the few culturally specific tobacco cessation interventions targeting AI/AN populations in existence, none incorporates pharmacogenetic testing [7][8][9][10][11]. Use of pharmacogenetic testing to guide or personalize tobacco cessation therapy may improve patient outcomes [12][13][14][15][16][17][18].…”