Process Evaluation: How It Works

Abstract

Despite increasing prevalence of asthma among American Indians and/or Alaska Natives, little is known about their use of traditional healing in its management. A convenience sample of 24 Navajo families with asthmatic members (n=35) was interviewed between June 1997 and September 1998. While 46% of families had previously used traditional healing, only 29% sought traditional healing for asthma. Use of traditional healing was unrelated to use of biomedical therapies, hospitalizations, or emergency services. Practical factors and questions about the nature and origins of asthma were the primary considerations determining use of traditional medicine. Little conflict between traditional healing and biomedical treatment was reported. The use of traditional healing for asthma is influenced by beliefs about the disease and factors specific to the individual, including their local social, economic, and cultural context.As evidence has accumulated that effective self-management reduces frequency of asthma exacerbations and costs of medical care (National Asthma Education and Prevention Program [NAEPP], 1997) asthma patients and their families have assumed an increasingly important and independent role in their own treatment. At the same time, the use of complementary or alternative medicine (CAM) has become widespread and more accepted, particularly for chronic conditions such as asthma (Andrews et al., 1998;Davis, Gold, Hackman, Stern, & Gershwin, 1998;Eisenberg et al., 1993;Elder, Gilchrist, & Minz, 1997; Hackman, Stern, & Gershwin, 1996). This trend has raised questions about the concurrent use of multiple medical systems and the extent to which they constitute competing alternatives to biomedical therapies. A lack of qualitative accounts, however, has limited American Indian and Alaska Native Mental Health Research Copyright: Centers for American Indian and Alaska Native Health Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh) 2 VOLUME 11, NUMBER 1 the extent to which patterns of use and any potential conflicts can be understood in their local social, cultural, and economic context. In addition, the use of traditional healing for asthma in populations characterized by the presence of both biomedicine and indigenous healing systems has been little studied.This study examines use of traditional or indigenous medicine among a population of American Indian asthmatics. In the United States, asthmarelated morbidity and mortality is increasing most rapidly among minority populations (Mannino et al., 1998). Although early studies found a low prevalence of asthma among American Indians and/or Alaska Natives, recent figures suggest that asthma is increasing among these populations as well. For example, asthma-related hospitalizations among the Navajo increased between 1979 and 1989, particularly in children aged 1-4 (Hisnanick, Coddington, & Gergen, 1994). Despite its growing importance in this population, little is known about how Navajos select among possible...

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