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Hopkins I, Verlander M, Clarkson L, Jacobsen P. What Do We Know About Sharing Power in Co-Production in Mental Health Research? A Systematic Review and Thematic Synthesis. Health Expect 2024; 27:e70014. [PMID: 39235102 PMCID: PMC11375733 DOI: 10.1111/hex.70014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/18/2024] [Accepted: 08/18/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Guidance on co-production between researchers and people with lived experience was published in 2018 by the National Institute for Health and Care Research (NIHR) advisory group, previously known as INVOLVE. This guidance described sharing power as a key principle within co-production. Authentic sharing of power within co-produced mental health research does not always occur however and remains a challenge to achieve within many projects. OBJECTIVES To explore what has been learned about the sharing of power in co-production within mental health research since the publication of these guidelines, by synthesising qualitative literature relating to power within co-produced mental health research. METHODS We carried out a systematic review with thematic synthesis. We searched CINHAL, Embase and PubMed databases to identify qualitative or mixed-method studies relating to power within co-produced mental health research. Studies were independently screened by two reviewers for inclusion and appraised using the Critical Appraisal Skills Programme tool (CASP) for qualitative research. RESULTS We identified nine papers that met the criteria for inclusion and were included in the synthesis. Three themes were generated: (1) Battling to share power against a more powerful system, (2) Empowerment through relationships and (3) The journey is turbulent, but it is not supposed to be smooth. CONCLUSIONS Results highlight that power is pervasive, especially within the hierarchical systems research is often conducted within. Sharing power within co-produced mental health research is an ongoing complex process that is not intended to be easy. Respectful trusting relationships can help facilitate power sharing. However, ultimately meaningful change needs to come from research funders, universities and NHS providers. PATIENT OR PUBLIC CONTRIBUTION The study authors include a lived experience researcher who contributed to the review design, analysis and write-up.
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Affiliation(s)
- India Hopkins
- Department of Psychology, University of Bath, Bath, UK
| | - Max Verlander
- Department of Psychology, University of Bath, Bath, UK
| | - Lucy Clarkson
- Department of Psychology, University of Bath, Bath, UK
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Caughlan C, Kakuska A, Manthei J, Martinez A, DiBianco L, Craig Rushing S. Formative Research to Design and Evaluate Caring Text Messages for American Indian and Alaska Native Youth, College Students, and Veterans. Health Promot Pract 2024:15248399241275610. [PMID: 39230252 DOI: 10.1177/15248399241275610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Purpose. Caring Text Messages (CTM) is an evidence-based intervention, developed by the Northwest Portland Area Indian Health Board, modeled after the Caring Contacts (CC) intervention. CC has been shown to prevent suicide deaths, attempts, ideation, and hospitalizations in a variety of settings. Method. Three sets of CTM were developed by American Indian and Alaska Native (AI/AN) teens, college students, and veterans (tailored for each audience), which were reviewed by psychologists familiar with the intervention. To enroll in the service, participants texted a keyword to a text message short code and received two text messages per week with hopeful and encouraging messages. A robust multimedia social marketing campaign was designed to promote the service for each audience. Results. By September 2023, 387 participants enrolled in the Youth CTM intervention, 141 enrolled in the College CTM, and 31 enrolled in the Veterans CTM. Post surveys show elevated levels of user satisfaction. Conclusions. CTM can be tailored to reach populations at higher risk of suicide, including AI/AN youth, college students, and veterans, and connect them to culturally responsive peer and crisis support services. Continued monitoring and evaluation can guide next steps for marketing and outreach and will be useful to determine its impact on those who enroll.
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Affiliation(s)
- Colbie Caughlan
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Amanda Kakuska
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jane Manthei
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Aurora Martinez
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Lisa DiBianco
- Northwest Portland Area Indian Health Board, Portland, OR, USA
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Qeadan F, Madden EF, English K, Venner KL, Tingey B, Egbert J, Hipol FAS. Quantifying the Burden of Opioid Use Disorder and Non-fatal Opioid Overdose in American Indian and Alaskan Native Populations Using the Cerner Real-World Data™ Database. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02084-z. [PMID: 39143452 DOI: 10.1007/s40615-024-02084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/27/2024] [Accepted: 06/30/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE This study evaluated the prevalence and incidence of opioid use disorder (OUD), rates of opioid overdose (OD), and rates of non-fatal (NF) OD in American Indian/Alaskan Native (AI/AN) populations. METHODS We used de-identified patient data from Oracle Cerner Real-World Data™. Rates were estimated over time, and stratified by sex, age, marital status, insurance, and region. Mann-Kendall trend tests and Theil-Sen slopes assessed changes over time for each group while autoregressive modeling assessed differences between groups. RESULTS The study identified trends in OUD and OD among 700,225 AI/AN patients aged 12 and above. Between 2012 and 2022, there was a significant upward trend in both OUD and OD rates (p < 0.05) , with OUD diagnosed in 1.75% and OD in 0.38% of the population. The Western region of the US exhibited the highest rates of OUD and OD. The 35-49 age group showed the highest rates of OUD, while the 12-34 age group had the highest rates of OD. Marital status analysis revealed higher rates of OUD and OD among separated, widowed, or single patients. Additionally, individuals with Medicare or Medicaid insurance demonstrated the highest rates of OUD and OD. CONCLUSION Results show that rates of OUD, OD, and NF OD continue to rise among AI/AN individuals, with some regional and demographic variation. Our study provides foundational estimates of key AI/AN populations bearing greater burdens of opioid-related morbidity that federal, state, and tribal organizations can use to direct and develop targeted resources that can improve the health and well-being of AI/AN communities.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA.
| | - Erin F Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM, USA
| | - Kamilla L Venner
- Department of Psychology, Center On Alcohol, Substance Use, And Addiction (CASAA), University of New Mexico, Albuquerque, NM, USA
| | - Benjamin Tingey
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Jamie Egbert
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
| | - Feli Anne S Hipol
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
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Neikirk K. Adapting STEMM in Hawai'i: Necessary actions for one of the most diverse places in the United States. J Cell Physiol 2024; 239:e31336. [PMID: 39030924 DOI: 10.1002/jcp.31336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 07/22/2024]
Abstract
Hawai'i's diverse population prime it to be an exemplary environment to study representation in science, technology, engineering, mathematics, and medicine (STEMM). In actuality, Hawai'i has low STEMM enrollment and therefore, low representation in STEMM. What primarily inhibits Hawai'i from having a strong STEMM workforce is the lack of education in STEMM, resources allocated to STEMM, and mentorship to succeed in STEMM. Other factors such as cultural values, high costs of living, and geographical barriers also contribute to Hawai'i's low STEMM enrollment. To combat these issues, I offer suggestions to encourage STEMM enrollment, such as directing funds toward after-school education. I also suggest combatting the lack of resources by providing more online opportunities for students and workers. As for Hawai'i's low mentorship, I suggest that more programs be created within communities and universities to create a platform for mentors and mentees to network. This manuscript seeks to highlight these areas of improvement and recognize lessons to be learned from Hawai'i, thus serving as a resource for individuals internationally.
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Affiliation(s)
- Kit Neikirk
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, Tennessee, USA
- Department of Biology, University of Hawai'i at Hilo, Hilo, Hawaii, USA
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Largent EA, Joffe S, Dickert NW, Morain SR. The ethical value of consulting community members in non-emergency trials conducted with waivers of informed consent for research. Clin Trials 2024:17407745241259360. [PMID: 38916109 DOI: 10.1177/17407745241259360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
There is growing interest in using embedded research methods, particularly pragmatic clinical trials, to address well-known evidentiary shortcomings afflicting the health care system. Reviews of pragmatic clinical trials published between 2014 and 2019 found that 8.8% were conducted with waivers of informed consent; furthermore, the number of trials where consent is not obtained is increasing with time. From a regulatory perspective, waivers of informed consent are permissible when certain conditions are met, including that the study involves no more than minimal risk, that it could not practicably be carried out without a waiver, and that waiving consent does not violate participants' rights and welfare. Nevertheless, when research is conducted with a waiver of consent, several ethical challenges arise. We must consider how to: address empirical evidence showing that patients and members of the public generally prefer prospective consent, demonstrate respect for persons using tools other than consent, promote public trust and investigator integrity, and ensure an adequate level of participant protections. In this article, we use examples drawn from real pragmatic clinical trials to argue that prospective consultation with representatives of the target study population can address, or at least mitigate, many of the ethical challenges posed by waivers of informed consent. We also consider what consultation might involve to illustrate its feasibility and address potential objections.
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Affiliation(s)
- Emily A Largent
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Joffe
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie R Morain
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
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Jaramillo ET. Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol. BMJ Open 2024; 14:e088348. [PMID: 38844399 PMCID: PMC11163646 DOI: 10.1136/bmjopen-2024-088348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 05/24/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Severe inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality, presenting a growing public health concern as the United States (US) population ages. These inequities are often attributable to social and environmental factors, including economic insecurity, histories of trauma, gaps in transportation and safety-net services, and disparities in access to policy-making processes rooted in colonialism. This constellation of factors renders racial-minority and ethnic-minority older adults 'structurally vulnerable' to mental ill health. Fewer data exist on protective factors associated with social and environmental contexts, such as social support, community attachment and a meaningful sense of place. Scholarship on the social determinants of health widely recognises the importance of such place-based factors. However, little research has examined how they shape disparities in depression and treatment specifically, limiting the development of practical approaches addressing these factors and their effects on mental well-being for rural minority populations. METHODS AND ANALYSIS This community-driven mixed-method study uses quantitative surveys, qualitative interviews and ecological network research with 125 rural American Indian and Latinx older adults in New Mexico and 28 professional and non-professional social supporters to elucidate how place-based vulnerabilities and protective factors shape experiences of depression among older adults. Data will serve as the foundation of a community-driven plan for a multisystem intervention focused on the place-based causes of disparities in depression. Intervention Mapping will guide the intervention development process. ETHICS AND DISSEMINATION This study has been reviewed and approved by the University of New Mexico Health Sciences Center Institutional Review Board. All participants will provide informed consent. Study results will be disseminated within the community of study through community meetings and presentations, as well as broadly via peer-reviewed journals, conference presentations and social media.
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Affiliation(s)
- Elise Trott Jaramillo
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
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Park A, van Draanen J. Community-Partnered Research appraisal tool for conducting, reporting and assessing community-based research. BMJ Open 2024; 14:e081625. [PMID: 38670613 PMCID: PMC11057323 DOI: 10.1136/bmjopen-2023-081625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Objective The aim of this study was to develop an appraisal tool to support and promote clear, accurate and transparent standards and consistency when conducting, reporting and assessing community-based research. Design Current recommendations for developing reporting guidelines was used with three key differences: (1) an analysis of existing guides, principles and published literature about community engagement, involvement and participation in research using situational and relational maps; (2) feedback and pilot-testing by a community-based research team; and (3) testing the utility and usability of the appraisal tool. Results After a series of iterative revisions, the resulting Community-Partnered Research (CPR) appraisal tool emerged into three products: an elaborate prospective format, a basic retrospective format, and a supplemental checklist format. All three versions of the CPR appraisal tool consist of 11 main question items with corresponding prompts aimed to facilitate awareness, accountability, and transparency about processes and practices employed by professional researchers and community co-researchers throughout four phases of research: (1) partnership and planning, (2) methods, (3) results and (4) sustainment. Conclusion We hope that introducing this tool will contribute to shifting individual and systematic processes and practices towards equitable partnerships, mutual trustworthiness and empowerment among professional researchers and community co-researchers and, in turn, improving the quality of co-created knowledge that benefits communities and creates social change.
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Affiliation(s)
- Avery Park
- University of Washington - Seattle Campus, Seattle, Washington, USA
| | - Jenna van Draanen
- Child, Family, and Population Health Nursing; Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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Wakhlu N, Soto C, Duncan M, Titman A, Turner BJ. Wellness Tour for Tribal Communities During the COVID-19 Pandemic: Uniting Sacred Space with Western Medicine to Prevent Substance Use. J Community Health 2024; 49:248-256. [PMID: 37848654 PMCID: PMC10924718 DOI: 10.1007/s10900-023-01295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
Substance use disorders (SUD) and overdose deaths worsened further during the Covid-19 pandemic in American Indian and Alaska Native (AIAN) communities. The Native Dad's Network (NDN) delivered the Wellness Tour, offering cultural activities and SUD prevention education, from March 2021 to June 2022, to 11 AIAN tribal communities across California. The in-person program created a "sacred space" through culturally congruent song, dance, and prayer. SUD education included: a lecture about opioids and SUD; group talking circles; an educational skit led by adolescents; and training in naloxone and fentanyl testing strip use along with supplies. After the day-long program, 341 participants agreed strongly on a 5-point Likert type question that it improved their quality of life (mean = 4.7). Among 243 respondents, agreement was strong (mean = 4.8) to two Likert-type questions about cultural relevance and confidence in using naloxone. This AIAN-led program adopted safe practices during the pandemic to deliver culturally congruent SUD prevention education to severely affected AIAN communities.
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Affiliation(s)
- Nausheen Wakhlu
- Department of Medicine, Keck School of Medicine of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA, 90033, United States of America
| | - Claradina Soto
- Department of Medicine, Keck School of Medicine of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA, 90033, United States of America
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, 90032, United States of America
| | - Mike Duncan
- California Consortium for Urban Indian Health, 1016 Lincoln Blvd #111, San Francisco, CA, 94129, United States of America
| | - Albert Titman
- California Consortium for Urban Indian Health, 1016 Lincoln Blvd #111, San Francisco, CA, 94129, United States of America
| | - Barbara J Turner
- Department of Medicine, Keck School of Medicine of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA, 90033, United States of America.
- Gehr Center for Health Systems Science, Keck School of Medicine of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA, 90033, United States of America.
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Gooding DC, Mohrbacher DA, Umucu E, Van Hulle CA, Lewis JP, Carter FP, Gleason CE. Ethnoracialized group differences in attitudes and knowledge about schizophrenia and willingness to engage in biomarker research: The UBIGR Study. Psychiatry Res 2024; 334:115776. [PMID: 38377801 DOI: 10.1016/j.psychres.2024.115776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
Although there is renewed optimism in biomarker research in schizophrenia, there is also need for greater inclusion of historically underrepresented groups in the research. In the present study, we surveyed 599 African American, 352 American Indian/Alaska Native, and 725 NonHispanic White participants about their attitudes toward research, knowledge and attitudes about schizophrenia, and willingness to engage in biomarker testing. Attitudes toward research were examined using the standardized 7-item Research Attitudes Questionnaire (RAQ) measure. Using structural equation modeling (SEM), we tested our predictive model of the likelihood of willingness to engage in biomarker testing for schizophrenia risk. Members of historically underrepresented groups were less willing to engage in biomarker testing. Overall, attitudes toward research, particularly trust, influenced biomarker testing willingness. These findings suggest that factors influencing willingness to engage in schizophrenia biomarker testing may be modifiable by outreach engagement and education.
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Affiliation(s)
- Diane Carol Gooding
- Department of Psychology, UW-Madison, Madison, WI, USA; Department of Psychiatry, SMPH, UW-Madison, Madison, WI, USA; Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA.
| | - Denise A Mohrbacher
- Department of Population Health Sciences, SMPH, UW-Madison, Madison, WI, USA
| | - Emre Umucu
- Department of Public Health Sciences, University of Texas - El Paso, TX, USA
| | - Carol A Van Hulle
- Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA
| | - Jordan P Lewis
- Memory Keepers Medical Discovery Team, Dept of Family Medicine & Biobehavioral Health, University of Minnesota Medical School, Duluth campus, MN, USA
| | - Fabu P Carter
- Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA
| | - Carey E Gleason
- Geriatrics and Gerontology, Dept. of Medicine, SMPH, UW-Madison, Madison, WI, USA; Wisconsin Alzheimer's Disease Research Center, UW-Madison, Madison, WI, USA; Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial VA Hospital, UW-Madison, WI, USA
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Skewes MC, Gonzalez VM, Gameon JA, Ricker A, Martell S, Reum M, Holder S. Development and Feasibility Pilot Study of Indigenous Recovery Planning: A Community-Engaged Approach to Addressing Substance Use in a Native Community. Clin Psychol Sci 2024; 12:253-269. [PMID: 38736431 PMCID: PMC11086671 DOI: 10.1177/21677026221141662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Although Native (American Indian and Alaska Native [AI/AN]) populations have high rates of abstinence from alcohol, health problems associated with substance use remain a pressing concern in many AI/AN communities. As part of a longstanding community-based participatory research (CBPR) project involving five years of relationship building and three preliminary studies, our team of academic and community co-researchers developed a culturally grounded intervention to facilitate recovery from substance use disorders among tribal members from a rural AI reservation. Our Indigenous Recovery Planning (IRP) intervention consists of six weekly sessions and aims to provide inroads to existing resources in the community, affirm and enhance Native identity, address culturally relevant risk factors, and build upon strengths. Results from a feasibility pilot study (N = 15) suggest that IRP is feasible to implement and acceptable to the community. Although there was insufficient statistical power to conduct hypothesis testing, there were changes between pretest and posttest scores in the expected directions. Future directions and limitations of this research are discussed.
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Affiliation(s)
| | | | - Julie A. Gameon
- Trauma and Resilience Center, The University of Texas Health Science Center at Houston
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Shukla R, Turner BJ, Ramos GG, Love M, D'Isabella J, Soto C. American Indian and Alaska Native substance use treatment: Barriers and facilitators according to an implementation framework. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209095. [PMID: 37277023 DOI: 10.1016/j.josat.2023.209095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Substance use disorder (SUD) and overdose deaths are higher in the American Indian and Alaska Native (AIAN) population than in other racial/ethnic groups. Multi-level gaps hinder SUD treatment for AIAN patients. Few studies have engaged front-line clinicians and administrators of SUD treatment programs serving AIAN patients to identify barriers and facilitators to improve the implementation of effective treatment. METHODS We conducted key informant interviews with a diverse sample of providers and administrators of SUD treatment programs across California regarding barriers and facilitators to treatment for AIAN patients. An AIAN-majority community advisory board (CAB) guided the development of an interview guide and helped to recruit respondents from five types of SUD programs statewide. Using ATLAS.ti, the research team coded interviews and classified emergent themes as barriers and facilitators related to Outer, Inner, and Individual domains of the Consolidated Framework for Implementation Research (CFIR). RESULTS Representatives of 13 of 15 invited SUD treatment programs participated and 9 of the 13 interviewed self-identified as AIAN. Related to Outer Setting barriers from coded interviews, a dominant barrier was policies that defund or underfund SUD treatment, especially detoxification centers. Outer Setting facilitators included consistent Indian Health Service (IHS) eligibility criteria, judicial system connections for direct treatment access, and community programs advocating SUD treatment. Key themes related to barriers for the Inner Setting were limited bed capacity, poor coordination of intake and care, and lack of telehealth technology. Facilitators integrated mental health, linkage to external resources, and culturally centered care. Individual-level barriers were negative attitudes such as SUD stigma, distrust of governmental programs, and lack of transportation while individual engagement was facilitated by programs addressing negative attitudes and providing telemedicine for remote care. CONCLUSION The public health threat of SUD for the AIAN population mandates the implementation of interventions and policies that facilitate care. This qualitative study with primarily AIAN clinical leaders of SUD treatment highlights opportunities to improve care at multiple CFIR levels, focusing on capacity, coordination, culturally congruent care, and community initiatives to promote engagement.
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Affiliation(s)
- Rit Shukla
- University of Southern California Price School of Public Policy, 650 Childs Way, Los Angeles, CA 90089, United States of America
| | - Barbara J Turner
- Department of Medicine, Keck Medical Center of University of Southern California, 2020 Zonal Avenue, Los Angeles, CA 90033, United States of America.
| | - Guadalupe G Ramos
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
| | - Morgan Love
- California Consortium for Urban Indian Health, 1016 Lincoln Blvd #111, San Francisco, CA 94129, United States of America
| | - Julia D'Isabella
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
| | - Claradina Soto
- Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles 90032, United States of America
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Browder SE, Yohann A, Filipowicz TR, Freeman NLB, Marston WA, Heisler S, Farber MA, Patel SR, Wood JC, McGinigle KL. Differential impact of missed initial wound clinic visit on 6-month wound healing by race/ethnicity among patients with chronic limb-threatening ischemia. Wound Repair Regen 2023; 31:647-654. [PMID: 37534781 PMCID: PMC10878832 DOI: 10.1111/wrr.13116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/07/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Abstract
Chronic limb-threatening ischemia (CLTI) is associated with significant morbidity, including major limb amputation, and mortality. Healing ischemic wounds is necessary to optimise vascular outcomes and can be facilitated by dedicated appointments at a wound clinic. This study aimed to estimate the association between successful wound care initiation and 6-month wound healing, with specific attention to differences by race/ethnicity. This retrospective study included 398 patients with CLTI and at least one ischaemic wound who scheduled an appointment at our wound clinic between January 2015 and July 2020. The exposure was the completion status of patients' first scheduled wound care appointment (complete/not complete) and the primary outcome was 6-month wound healing (healed/not healed). The analysis focused on how this association was modified by race/ethnicity. We used Aalen-Johansen estimators to produce cumulative incidence curves and calculated risk ratios within strata of race/ethnicity. The final adjustment set included age, revascularization, and initial wound size. Patients had a mean age of 67 ± 14 years, were 41% female, 46% non-White and had 517 total wounds. In the overall cohort, 70% of patients completed their first visit and 34% of wounds healed within 6-months. There was no significant difference in 6-month healing based on first visit completion status for White/non-Hispanic individuals (RR [95% CI] = 1.18 [0.91, 1.45]; p-value = 0.130), while non-White individuals were roughly 3 times more likely to heal their wounds if they completed their first appointment (RR [95% CI] = 2.89 [2.66, 3.11]; p-value < 0.001). In conclusion, non-White patients were approximately three times more likely to heal their wound in 6 months if they completed their first scheduled wound care appointment while White/non-Hispanic individuals' risk of healing was similar regardless of first visit completion status. Future efforts should focus on providing additional resources to ensure minority groups with wounds have the support they need to access and successfully initiate wound care.
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Affiliation(s)
- Sydney E. Browder
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Avital Yohann
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Teresa R. Filipowicz
- Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Nikki L. B. Freeman
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A. Marston
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen Heisler
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark A. Farber
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shrunjay R. Patel
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jacob C. Wood
- Department of Surgery—Vascular, UNC-Chapel Hill, Chapel Hill, North Carolina, USA
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Bime C, Wang Y, Carr G, Swearingen D, Kou S, Thompson P, Kusupati V, Parthasarathy S. Disparities in outcomes of COVID-19 hospitalizations in native American individuals. Front Public Health 2023; 11:1220582. [PMID: 37649785 PMCID: PMC10465166 DOI: 10.3389/fpubh.2023.1220582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/17/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives This study aimed to investigate COVID-19-related disparities in clinical presentation and patient outcomes in hospitalized Native American individuals. Methods The study was performed within 30 hospitals of the Banner Health system in the Southwest United States and included 8,083 adult patients who tested positive for SARS-CoV-2 infection and were hospitalized between 1 March 2020 and 4 September 2020. Bivariate and multivariate analyses were used to assess racial and ethnic differences in clinical presentation and patient outcomes. Results COVID-19-related hospitalizations in Native American individuals were over-represented compared with non-Hispanic white individuals. Native American individuals had fewer symptoms at admission; greater prevalence of chronic lung disease in the older adult; two times greater risk for ICU admission despite being younger; and 20 times more rapid clinical deterioration warranting ICU admission. Compared with non-Hispanic white individuals, Native American individuals had a greater prevalence of sepsis, were more likely to require invasive mechanical ventilation, had a longer length of stay, and had higher in-hospital mortality. Conclusion Native American individuals manifested greater case-fatality rates following hospitalization than other races/ethnicities. Atypical symptom presentation of COVID-19 included a greater prevalence of chronic lung disease and a more rapid clinical deterioration, which may be responsible for the observed higher hospital mortality, thereby underscoring the role of pulmonologists in addressing such disparities.
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Affiliation(s)
- Christian Bime
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Ying Wang
- Department of Informatics Technology, Banner Health, Phoenix, AZ, United States
| | - Gordon Carr
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, University of Arizona, Tucson, AZ, United States
- Department of Medicine, University of Arizona College of Medicine, Tucson, AZ, United States
| | - Dennis Swearingen
- Department of Biomedical Informatics, University of Arizona College of Medicine, Phoenix, AZ, United States
- Department of Medical Informatics, Banner Health, Phoenix, AZ, United States
| | - Sherri Kou
- Department of Informatics Technology, Banner Health, Phoenix, AZ, United States
| | - Pam Thompson
- Department of Academic and Facilities Research, Banner Health, Phoenix, AZ, United States
| | - Vinita Kusupati
- Division of General Internal Medicine, Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sairam Parthasarathy
- Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Department of Medicine, University of Arizona, Tucson, AZ, United States
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Gonzalez VM, Skewes MC. Association of racism and substance use treatment with belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2023; 29:339-347. [PMID: 37227852 PMCID: PMC10330333 DOI: 10.1037/cdp0000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Belief in an American Indian/Alaska Native (AIAN) specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIANs. Despite a notable lack of evidence that biogenetic factors play a greater role in the development of alcohol problems among AIANs than other groups, many people still believe this myth. Consistent with theory and evidence that greater experiences with discrimination leads to the internalization of stereotypes and oppression, we hypothesized that greater perceived racial discrimination (racism) would be associated with greater BV belief, but that having a stronger ethnic identity would weaken this association. We also examined whether previous substance use treatment as well as participation in Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) was associated with BV belief. METHOD Participants were 198 reservation-dwelling AI adults with a substance use problem who completed a survey as part of a larger community-based participatory study. RESULTS A multiple regression analysis revealed that greater systemic racism was associated with greater belief in a BV; this association was not moderated by ethnic identity. Greater interpersonal racism was also associated with greater BV belief-but only among those low in ethnic identity. A regression analysis revealed that previous treatment, AA, and NA participation were not associated with BV belief. CONCLUSIONS Greater systemic and interpersonal racism were associated with belief in a BV, and greater ethnic identity buffered the association between interpersonal racism and BV belief. This suggests that both combatting racism and fostering positive ethnic identity may help to lessen BV belief. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Vasquez Guzman CE, Taylor C, Harris A, Donald C, Carney PA, Rasmussen-Rehkopf S, Bruegl A, Empey A, Hoffmann LM, Brodt E. Enhancing American Indians'/Alaska Natives' Knowledge, Confidence, and Community During the Medical School Application Process: Findings From the Northwest Native American Center of Excellence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:473-479. [PMID: 36201468 DOI: 10.1097/acm.0000000000004951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To describe a Medical School Applicant Workshop (MSAW); present lessons learned about its impact on American Indian/Alaska Native (AIAN) participants' knowledge, confidence, and sense of community; and report on participants' medical school application progress 1 year after workshop completion. METHOD The Northwest Native American Center of Excellence at Oregon Health & Science University developed and implemented an annual 1-day AIAN MSAW in 2018. The main objectives of the workshop are for participants to gain insights into the medical school application process; learn strategies to competitively apply; receive feedback on their personal statement and mock interviews; and discuss the medical school application process with AIAN faculty, admissions deans, and peer-mentors. Recruitment of AIAN participants occurred via email; social media; text messaging; medical association contacts; and AIAN and science, technology, engineering, and mathematics organizations. Two surveys were administered: one immediately after and another 1-year after the workshop. RESULTS Forty AIAN MSAW participants were accepted in 2018-2020. Findings indicate statistically significant increases in participants' self-reported knowledge of the medical school application process and in their self-reported confidence. Participants reported meeting other AIAN students was highly beneficial and feeling connected to a community of AIAN health professionals after attending the workshop. Among the 25 participants who completed the 1-year follow-up survey, 12 (48.0%) indicated applying to medical school; all 12 of these participants were invited to interview, and 11 were offered acceptance to at least one medical school. CONCLUSIONS Completing the MSAW increased participants' knowledge, confidence, and sense of community. If other programs and institutions were to consider using the MSAW model to reduce barriers and provide supports specifically designed for AIANs before and during the medical school application process, medical schools may stand to further increase AIAN representation in the physician workforce and ultimately to decrease health inequities among AIANs.
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Affiliation(s)
- Cirila Estela Vasquez Guzman
- C.E. Vasquez Guzman is assistant professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; tribal affiliation: Mayan and Zapotec, Mexico
| | - Cynthia Taylor
- C. Taylor is research associate, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Anna Harris
- A. Harris is a medical student, Oregon Health & Science University School of Medicine, Portland, Oregon; tribal affiliation: Cayuse, Oregon, Nez Perce, Idaho, and Karuk, California
| | - Caitlin Donald
- C. Donald is assistant director, Northwest Native American Center of Excellence, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; tribal affiliation: Osage and Ponca, Oklahoma
| | - Patricia A Carney
- P.A. Carney is professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Sarah Rasmussen-Rehkopf
- S. Rasmussen-Rehkopf is a medical student, WWAMI Medical Educational Program, University of Washington, Anchorage, Alaska; tribal affiliation: Quileute and Makah, Washington
| | - Amanda Bruegl
- A. Bruegl is associate professor, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon; tribal affiliation: Oneida and Stockbridge-Munsee, Wisconsin
| | - Allison Empey
- A. Empey is assistant professor, Department of Pediatrics, and vice chair for equity, diversity and inclusion, Oregon Health & Science University, Portland, Oregon; tribal affiliation: Confederated Tribes of Grand Ronde, Oregon
| | - Laurel Murphy Hoffmann
- L.M. Hoffmann is assistant professor, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Erik Brodt
- E. Brodt is associate professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon; tribal affiliation: Ojibwe, Minnesota
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Passmore SR, Longhurst C, Gerbitz A, Green-Harris G, Norris N, Edwards DF. "I Want to Know Everything ... ": The Return of Research Results and the Importance of Transparency in the Acceptability of Lumbar Punctures for African American Older Adults. J Alzheimers Dis 2023; 95:663-675. [PMID: 37574732 PMCID: PMC10637283 DOI: 10.3233/jad-230275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Although African Americans experience the highest risk of Alzheimer's disease (AD), they are dramatically underrepresented in preclinical biomarker research. This is especially true for studies involving lumbar puncture as it may involve more perceived risk even for those participants who are otherwise supportive of research. OBJECTIVE To understand the unique concerns of African American participants regarding biomarker studies involving lumbar puncture who demonstrate support for AD research. METHODS Study participants were African American adults contacted through an AD research registry. We employed a novel method used to create hypothetical research studies varying on a set number of factors. The method is designed to collect potential patterns in decision making regarding research participation but differs from experimental vignette design in that the survey is administered with an accompanying qualitive interview to determine the meaning participants ascribe to factors independently and in conjunction with one another. RESULTS Sixty-one participants each reviewed three randomly selected research scenarios and created their "ideal" study involving lumbar puncture. Scenario variables included: disclosure of research results, racial and ethnic identity of the researcher, recruitment method, and amount of incentive. CONCLUSION Findings indicate that transparency in the return of AD research results to be the strongest driver of participation, followed by race of the researcher and amount of incentive. Recruitment method had limited impact on hypothetical decision making.
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Affiliation(s)
- Susan Racine Passmore
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- School of Nursing, University of Wisconsin, Madison, WI, USA
| | - Colin Longhurst
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Abigail Gerbitz
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gina Green-Harris
- Center for Community Engagement and Health Partnerships, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Nia Norris
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Dorothy Farrar Edwards
- Collaborative Center for Health Equity, Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
- Department of Kinesiology, School of Education, University of Wisconsin, Madison, WI, USA
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17
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Hanson JD, Sarche M, Buchwald D. Alcohol consumption and pregnancy in American Indian and Alaska Native women: A scoping review of the literature. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231175799. [PMID: 37218719 PMCID: PMC10214055 DOI: 10.1177/17455057231175799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/24/2023]
Abstract
American Indian and Alaska Native communities have diverse cultures, histories, and contemporary experiences. Grouping them together masks the differences in health and lifestyle behaviors, chronic disease rates, and health outcomes among them. This is particularly true for data on drinking during pregnancy among American Indian and Alaska Native women. The goal of this article is to describe how generalizing findings from data gathered from often small, geographically specific samples, combined with inferior research methodologies, has led to misunderstandings about drinking among preconceptual and pregnant American Indian and Alaska Native women. We conducted a scoping review using PubMed and the "PCC mnemonic" (population, concept, and context) as our guide. Our search terms included the population (American Indian and Alaska Native women), concept (alcohol), and context (immediately before or during pregnancy) and focused on PubMed articles in the United States. Using these search terms, we uncovered a total of 38 publications and eliminated 19, leaving 19 for review. Methodologically (i.e. how data were collected), we found most previous research on prenatal or preconceptual alcohol use with American Indian and Alaska Native women used retrospective data collection. We also assessed who data were collected from and noted two groups: studies that sampled higher-risk women and those that focused on American Indian and Alaska Native women in specific geographic areas. Restricting data collection to higher-risk American Indian and Alaska Native women or conducting small studies in specific geographic areas has generated an incomplete and inaccurate picture of American Indian and Alaska Native women as a whole as well as those who consume alcohol. Data from select groups of American Indian and Alaska Native women may overestimate the true prevalence of drinking during pregnancy among this population. Updated and accurate data on drinking during pregnancy are urgently needed to inform the development of interventions and prevention efforts.
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Affiliation(s)
- Jessica D Hanson
- Department of Applied Human Sciences,
University of Minnesota Duluth, Duluth, MN, USA
| | - Michelle Sarche
- Centers for American Indian & Alaska
Native Health, Colorado School of Public Health, University of Colorado Denver Anschutz
Medical Campus, Aurora, CO, USA
| | - Dedra Buchwald
- Institute for Research and Education to
Advance Community Health, Washington State University, Seattle, WA, USA
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18
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Wark K, Woodbury RB, LaBrie S, Trainor J, Freeman M, Avey JP. Engaging Stakeholders in Social Determinants of Health Quality Improvement Efforts. Perm J 2022; 26:28-38. [PMID: 36154895 PMCID: PMC9761288 DOI: 10.7812/tpp/22.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Social determinants of health (SDOH) affect around 70% of health outcomes. However, it is not clear how to integrate SDOH into clinical practice and health care policy. This quality improvement project engaged stakeholders to identify SDOH factors relevant in an Alaska Native/American Indian health system and how to integrate SDOH data into electronic health records (EHRs). Methods The authors utilized an internal steering committee of clinical leadership; conducted focus groups with patients, practitioners, administrative staff, and clinical leaders; developed programmatic workgroups to engage with the health system; and coordinated with allied health systems. Results The Steering Committee members prioritized uses of SDOH data. Focus groups grounded work in local community values and refined SDOH subdomains. Workgroups developed data visualizations, such as EHR dashboards, to automate data collection for reporting and assess performance metrics. External stakeholders helped innovate ways to utilize SDOH data through community partnerships and advocacy work. Stakeholders liked how the holistic approach of SDOH looks at whole-person wellness and how it can improve patient-practitioner relationships and reduce health disparities. They were concerned about outdated SDOH data and how some sensitive SDOH could lead to unanticipated harms. Leaders emphasized developing an actionable, strengths-based SDOH framework. Conclusions Many initiatives call for integrating SDOH into health care and EHRs. Engaging diverse audiences helps guide the work. This engagement may be particularly helpful for minority-serving health systems. SDOH data collection can be stigmatizing for patients. Stakeholder engagement can mitigate that by identifying which SDOH data elements to prioritize, and how to utilize them.
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Affiliation(s)
- Kyle Wark
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - R Brian Woodbury
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Scott LaBrie
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - John Trainor
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Michele Freeman
- Research Department, Southcentral Foundation, Anchorage, AK, USA
| | - Jaedon P Avey
- Data Services Department, Southcentral Foundation, Anchorage, AK, USA
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19
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Han HR, Lee JW, Saylor MA, Parisi JM, Hornstein E, Agarwalla V, Jajodia A, Li Q, Weikert M, Davidson PM, Szanton SL. Methods and operational aspects of human-centred design into research processes for individuals with multiple chronic conditions: A survey study. Nurs Open 2022; 10:3075-3083. [PMID: 36515006 PMCID: PMC10077392 DOI: 10.1002/nop2.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/22/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
AIM To examine ways in which human-centred design was integrated into a nursing school's research processes involving individuals with multiple chronic conditions. DESIGN Cross-sectional survey study. METHODS Three surveys were sent out, with surveys 1 and 2 involving faculty who had worked closely with design strategists and survey 3 as a school-wide survey eliciting experience with human-centred design, respectively. RESULTS Survey respondents (n = 7 for surveys 1 and 2 and n = 36 for survey 3) had no or minimal experience with human-centred design. Faculty respondents indicated it helped engaging various stakeholders, particularly in intervention development. Key lessons learned included: (1) the importance of designer involvement from study conception, (2) distinguishing a design strategist's skillset from strictly visual design, (3) challenges during the ethical review processes, and (4) sustainability of resources. The dynamic approach of human-centred design has benefited our efforts to advance the science of caring for individuals with multiple chronic conditions.
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Affiliation(s)
- Hae-Ra Han
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins School of Public Health, Baltimore, Maryland, USA.,Center for Community Programs, Innovation and Scholarship, Baltimore, Maryland, USA
| | - Ji Won Lee
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | | | | | | | | | - Anushka Jajodia
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Center for Community Programs, Innovation and Scholarship, Baltimore, Maryland, USA
| | - Qiwei Li
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Mike Weikert
- Center for Social Design & Master of Arts in Social Design, MICA, Baltimore, Maryland, USA
| | | | - Sarah L Szanton
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins School of Public Health, Baltimore, Maryland, USA
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20
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Mangal S, Park L, Reading Turchioe M, Choi J, Niño de Rivera S, Myers A, Goyal P, Dugdale L, Masterson Creber R. Building trust in research through information and intent transparency with health information: representative cross-sectional survey of 502 US adults. J Am Med Inform Assoc 2022; 29:1535-1545. [PMID: 35699571 DOI: 10.1093/jamia/ocac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/22/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Participation in healthcare research shapes health policy and practice; however, low trust is a barrier to participation. We evaluated whether returning health information (information transparency) and disclosing intent of data use (intent transparency) impacts trust in research. MATERIALS AND METHODS We conducted an online survey with a representative sample of 502 US adults. We assessed baseline trust and change in trust using 6 use cases representing the Social-Ecological Model. We assessed descriptive statistics and associations between trust and sociodemographic variables using logistic and multinomial regression. RESULTS Most participants (84%) want their health research information returned. Black/African American participants were more likely to increase trust in research with individual information transparency (odds ratio (OR) 2.06 [95% confidence interval (CI): 1.06-4.34]) and with intent transparency when sharing with chosen friends and family (3.66 [1.98-6.77]), doctors and nurses (1.96 [1.10-3.65]), or health tech companies (1.87 [1.02-3.40]). Asian, Native American or Alaska Native, Native Hawaiian or Pacific Islander, Multirace, and individuals with a race not listed, were more likely to increase trust when sharing with health policy makers (1.88 [1.09-3.30]). Women were less likely to increase trust when sharing with friends and family (0.55 [0.35-0.87]) or health tech companies (0.46 [0.31-0.70]). DISCUSSION Participants wanted their health information returned and would increase their trust in research with transparency when sharing health information. CONCLUSION Trust in research is influenced by interrelated factors. Future research should recruit diverse samples with lower baseline trust levels to explore changes in trust, with variation on the type of information shared.
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Affiliation(s)
- Sabrina Mangal
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Leslie Park
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | | | - Jacky Choi
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | | | - Annie Myers
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lydia Dugdale
- Department of Medicine, Columbia University, New York, New York, USA
| | - Ruth Masterson Creber
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
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21
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Lim S, Dominianni C, Alroy KA, Baquero M, Crossa A, Gould LH. Racial and Ethnic Disparities in COVID-19-Like Illness and Impacts of Social Distancing and Working from Home. Ethn Dis 2022; 32:123-130. [PMID: 35497392 DOI: 10.18865/ed.32.2.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives To examine racial and ethnic disparities in COVID-19-like illness (CLI) during March - August 2020 in New York City, and to test effect modification by age, nativity, and working from home vs outside the home, and mediation via social distancing behavior. Design Analysis of the monthly Community Health Survey datasets. Setting New York City. Participants 5,305 adults living in New York City. Main Outcome Measures A binary indicator of having new onset of CLI in the past 30 days. Methods Prevalence of having CLI was compared among racial and ethnic groups using multivariable log-linear regression. Stratified and causal mediation analyses were conducted to test effect modification and mediation, respectively. Results Overall percentage of CLI decreased from 25% during March-May to 14% during June-August. In both periods, there was no increased prevalence of CLI among Black or Latino New Yorkers compared with White New Yorkers. However, in stratified analyses, Latino vs White New Yorkers had 2.05 times (95%CI=1.09, 3.83) higher prevalence of CLI among adults working outside the home. Mediation via social distancing was not statistically significant. Conclusions Excess burden of CLI among Latino adults working outside the home underscores inequitable impacts of COVID-19 in New York City.
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Affiliation(s)
- Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Queens, NY
| | | | - Karen A Alroy
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - María Baquero
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Aldo Crossa
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - L Hannah Gould
- New York City Department of Health and Mental Hygiene, Queens, NY
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22
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Dari T, Fox C, Laux JM, Speedlin Gonzalez S. The Development and Validation of the Community-Based Participatory Research Knowledge Self-Assessment Scale (CBPR-KSAS): A Rasch Analysis. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2022. [DOI: 10.1080/07481756.2022.2034478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Trinidad SB, Blacksher E, Woodbury RB, Hopkins SE, Burke W, Woodahl EL, Boyer BB, Hiratsuka VY. Precision medicine research with American Indian and Alaska Native communities: Results of a deliberative engagement with tribal leaders. Genet Med 2022; 24:622-630. [PMID: 34906504 PMCID: PMC9754657 DOI: 10.1016/j.gim.2021.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/15/2021] [Accepted: 11/03/2021] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Amid calls for greater diversity in precision medicine research, the perspectives of Indigenous people have been underexplored. Our goals were to understand tribal leaders' views regarding the potential benefits and risks of such research, explore its priority for their communities, and identify the policies and safeguards they consider essential. This article reports on the participants' perspectives regarding governance and policy, stewardship and sharing of information and biospecimens, and informed consent. METHODS After informal local dialogs with 21 tribal leaders, we convened a 2.5-day deliberation with tribal leaders (N = 10) in Anchorage, Alaska, in June 2019 using a combination of small group and plenary discussion, ranking, and voting exercises to explore the perspectives on precision medicine research. RESULTS Tribal sovereignty was central to participants' ideas about precision medicine research. Although views were generally positive, provided that the appropriate controls were in place, some kinds of research were deemed unacceptable, and the collection of certain biospecimens was rejected by some participants. Differences were observed regarding the acceptability of broad consent. CONCLUSION Tribal leaders in this study were generally supportive of precision medicine research, with the caveat that tribal oversight is essential for the establishment of research repositories and the conduct of research involving Indigenous participants.
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Affiliation(s)
| | - Erika Blacksher
- Department of Bioethics and Humanities, UW School of Medicine, Seattle, WA
| | | | - Scarlett E Hopkins
- Department of Obstetrics and Gynecology and The Moore Institute for Nutrition and Wellness, Oregon Health & Science University, Portland, OR
| | - Wylie Burke
- Department of Bioethics and Humanities, UW School of Medicine, Seattle, WA
| | - Erica L Woodahl
- Department of Biomedical & Pharmaceutical Sciences, University of Montana, Missoula, MT
| | - Bert B Boyer
- Department of Obstetrics and Gynecology and The Moore Institute for Nutrition and Wellness, Oregon Health & Science University, Portland, OR
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McGrew S, Raskoff S, Berkman BE. When Not to Ask: A Defense of Choice-Masking Nudges in Medical Research. JOURNAL OF HEALTH CARE LAW & POLICY 2022; 25:1-48. [PMID: 37034557 PMCID: PMC10078241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
In this article, we examine the legality and ethics of a controversial but widespread practice in clinical research: choice-masking nudges. A choice-masking nudge (CMN) exists when a research team explicitly obscures a meaningful choice from participants by presenting a default decision as the standard way forward. Even though an easy-to-use opt-out mechanism is available for participants who independently express concerns with the standard default, the fact that a default has been pre-selected is not made obvious to research participants. To opt out of the nudge, a participant must overtly request non-standard treatment. We argue that use of such nudges in medical research can be justified by their individual, collective, and social benefits, provided that they respect autonomy and satisfy our four further acceptability conditions. The structure of this Article is as follows. In Part II, we describe three controversial cases of CMNs in medical research. In Part III, we provide background on nudging and explain how our proposed CMNs fit into the existing literature on nudging and libertarian paternalism. In Part IV, we explain how the reasonable person standard as employed by United States research regulations can be used to support CMNs. In Part IV, we anticipate some of the strongest objections to CMNs by explaining how CMNs are compatible with a wide range of plausible accounts of autonomy. Finally, in Part VI, we discuss four additional core considerations an acceptable CMN must meet: legitimate policy goals; benefits outweighing harms; burdens distributed fairly; and absence of ethically superior feasible alternatives. We also analyze the three existing controversies explored in Part II and show how each would benefit from the conceptual clarity offered by our analytic framework. Medical research is complicated and can be difficult for participants to understand; thoughtfully designed CMNs can play an important role in gently guiding large numbers of research participants toward decision outcomes that really are best for them and their communities.
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Affiliation(s)
- Susanna McGrew
- in the Department of Bioethics at the National Institutes of Health
| | - Sarah Raskoff
- in the Department of Bioethics at the National Institutes of Health
| | - Benjamin E Berkman
- Department of Bioethics at the National Institutes of Health, where he is the head of the section on the ethics of genetics and emerging technologies. He has a joint appointment in the National Human Genome Research Institute, where he serves as the Deputy Director of the NHGRI Bioethics Core
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Brockie TN, Hill K, Davidson PM, Decker E, Koh Krienke L, Nelson KE, Nicholson N, Werk AM, Wilson D, Around Him D. Strategies for culturally safe research with Native American communities: An integrative review. Contemp Nurse 2021; 58:8-32. [PMID: 34907854 PMCID: PMC9596189 DOI: 10.1080/10376178.2021.2015414] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: A history of unethical research and deficit-based paradigms have contributed to profound mistrust of research among Native Americans, serving as an important call to action. Lack of cultural safety in research with Native Americans limits integration of cultural and contextual knowledge that is valuable for understanding challenges and making progress toward sustainable change.
Aim: To identify strategies for promoting cultural safety, accountability, and sustainability in research with Native American communities. Method: Using an integrative review approach, three distinct processes were carried out: (1) appraisal of peer-reviewed literature (Scopus, PubMed, and ProQuest), (2) review of grey literature (e.g. policy documents and guidelines), and (3) synthesis of recommendations for promoting cultural safety. Results: A total of 378 articles were screened for inclusion, with 55 peer-reviewed and grey literature articles extracted for full review. Recommendations from included articles were synthesised into strategies aligned with eight thematic areas for improving cultural safety in research with Native American communities. Conclusions: Research aiming to understand, respect, and acknowledge tribal sovereignty, address historical trauma, and endorse Indigenous methods is essential. Culturally appropriate, community-based and -engaged research collaborations with Native American communities can signal a reparative effort, re-establish trust, and inform pragmatic solutions. Rigorous research led by Native American people is critical to address common and complex health challenges faced by Native American communities. Impact statement: Respect and rigorous methods ensure cultural safety, accountability, and sustainability in research with Native Americans.
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Affiliation(s)
- Teresa N Brockie
- Johns Hopkins School of Nursing; 525 North Wolfe St. Room 455 Baltimore, MD 21205, E: P: +1 (410) 955-1730 Twitter: @TeresaBrockie
| | - Kyle Hill
- Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Great Lakes Hub; 1915 South St. Duluth, MN 55812, E: P: +1 (410) 955-6931
| | - Patricia M Davidson
- University of Wollongong; Northfields Ave. Wollongong NSW 2522, Australia, E: P: +61 2 4221 3555 Twitter: @UOW_VC
| | - Ellie Decker
- Johns Hopkins School of Nursing; 525 North Wolfe St. Baltimore, MD, 21205 E: P: +1 (507) 469-4746
| | - Lydia Koh Krienke
- Johns Hopkins School of Nursing; 525 North Wolfe St. Baltimore, MD 21205 E: P: +1 (734) 660-6770
| | - Katie E Nelson
- Johns Hopkins School of Nursing; 525 North Wolfe St. Baltimore, MD 21205 E: P: +1 (507) 696-3902 Twitter: @itsnursekatie
| | - Natalie Nicholson
- Johns Hopkins School of Nursing; 525 North Wolfe St. Baltimore, MD, 21205 E: P: +1 (218) 444-4323 Twitter: @NNicholson10
| | - Alicia M Werk
- Aaniiih Nakoda College; 269 Blackfeet Ave. Harlem, MT, 59526 E: P: +1 (406) 654-4534
| | - Deborah Wilson
- Johns Hopkins School of Nursing; 525 North Wolfe St. Baltimore, MD 21205 E: P: +1 (413) 822-3632 Twitter: @DeborahWilsonRN
| | - Deana Around Him
- Child Trends; 7315 Wisconsin Avenue, Suite 1200W Bethesda, MD 20814 E: P: +1 (240) 223-9213 Twitter: @aroundhim_d
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Skewes MC, Gameon JA, Hallum-Montes R, Ricker A. Determinants of Relapse and Opportunities for Growth: Perspectives on Substance Use among American Indian Community Members. J Psychoactive Drugs 2021; 53:474-482. [PMID: 34706631 PMCID: PMC8692388 DOI: 10.1080/02791072.2021.1986241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 01/25/2023]
Abstract
Resulting from generations of historical oppression and systemic racism, American Indian and Alaska Native (AI/AN) communities experience serious health disparities associated with substance use disorders (SUDs). As part of a longstanding community-based participatory research intervention development project, our partnership of academic and community co-researchers conducted seven focus groups (N = 35) to understand community stakeholders' perspectives on substance use, relapse, and recovery on a rural AI reservation. Participants included cultural leaders (n = 10), SUD treatment providers (n = 5), people with SUD (n = 10), and affected family members (n = 10). Cultural leaders viewed relapse as symptomatic of historical oppression, whereas other stakeholder groups attributed relapse to individual and interpersonal risk factors such as peer influence, lack of family support, and traumatic stress. All participant groups recognized relapse as a normative aspect of recovering from SUD that presents new opportunities for learning and growth. Specifically, regaining humility, learning to ask for help, recognizing one's triggers, and strengthening commitment to change were identified as learning outcomes for people with SUD. For family members, relapse provided the opportunity to practice forgiveness and compassion, two important cultural values. All groups emphasized the importance of grounding interventions in cultural values and traditions.
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Egid BR, Roura M, Aktar B, Amegee Quach J, Chumo I, Dias S, Hegel G, Jones L, Karuga R, Lar L, López Y, Pandya A, Norton TC, Sheikhattari P, Tancred T, Wallerstein N, Zimmerman E, Ozano K. 'You want to deal with power while riding on power': global perspectives on power in participatory health research and co-production approaches. BMJ Glob Health 2021; 6:e006978. [PMID: 34764147 PMCID: PMC8587355 DOI: 10.1136/bmjgh-2021-006978] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/23/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Power relations permeate research partnerships and compromise the ability of participatory research approaches to bring about transformational and sustainable change. This study aimed to explore how participatory health researchers engaged in co-production research perceive and experience 'power', and how it is discussed and addressed within the context of research partnerships. METHODS Five online workshops were carried out with participatory health researchers working in different global contexts. Transcripts of the workshops were analysed thematically against the 'Social Ecology of Power' framework and mapped at the micro (individual), meso (interpersonal) or macro (structural) level. RESULTS A total of 59 participants, with participatory experience in 24 different countries, attended the workshops. At the micro level, key findings included the rarity of explicit discussions on the meaning and impact of power, the use of reflexivity for examining assumptions and power differentials, and the perceived importance of strengthening co-researcher capacity to shift power. At the meso level, participants emphasised the need to manage co-researcher expectations, create spaces for trusted dialogue, and consider the potential risks faced by empowered community partners. Participants were divided over whether gatekeeper engagement aided the research process or acted to exclude marginalised groups from participating. At the macro level, colonial and 'traditional' research legacies were acknowledged to have generated and maintained power inequities within research partnerships. CONCLUSIONS The 'Social Ecology of Power' framework is a useful tool for engaging with power inequities that cut across the social ecology, highlighting how they can operate at the micro, meso and macro level. This study reiterates that power is pervasive, and that while many researchers are intentional about engaging with power, actions and available tools must be used more systematically to identify and address power imbalances in participatory research partnerships, in order to contribute to improved equity and social justice outcomes.
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Affiliation(s)
- Beatrice R Egid
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - María Roura
- School of Public Health, University College Cork, Cork, Ireland
| | - Bachera Aktar
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Jessica Amegee Quach
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ivy Chumo
- Urbanisation and Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade Nova de Lisboa and Comprehensive Health Research Centre, Lisboa, Portugal
| | - Guillermo Hegel
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Laundette Jones
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Luret Lar
- Department of Community Medicine, University of Jos, Jos, Nigeria
| | - Yaimie López
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Apurvakumar Pandya
- Parul Institute of Public Health, Faculty of Medicine, Parul University, Vadodara, Gujarat, India
| | | | - Payam Sheikhattari
- School of Community Health and Policy, Prevention Sciences Research Center, Morgan State University, Baltimore, Maryland, USA
| | - Tara Tancred
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nina Wallerstein
- Center for Participatory Research, College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| | - Emily Zimmerman
- Center on Society and Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kim Ozano
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Gonzalez VM, Skewes MC. Belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems among reservation-dwelling participants with a substance use problem. Alcohol Clin Exp Res 2021; 45:2309-2321. [PMID: 34837658 PMCID: PMC8642279 DOI: 10.1111/acer.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Belief in the myth of an American Indian/Alaska Native (AIAN)-specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIAN college students who drink, despite also being associated with greater attempts to reduce drinking. This study examined the association of belief in a BV with alcohol use among reservation-dwelling AI adults with a substance use problem. METHODS Participants (n = 141) who drank alcohol in the past 90 days were selected from a larger AI sample who self-identified as having a substance use problem. Moderated-mediation analyses examined whether belief in a BV was positively associated with alcohol- and substance use-related consequences and whether self-efficacy and craving mediated the association of belief in a BV with alcohol use. RESULTS Among participants who reported using alcohol but not hard drugs (e.g., methamphetamine, opioids), greater belief in a BV was associated with more drinking days, which in turn was associated with greater alcohol-related consequences. Among participants who used alcohol only, belief in a BV was also significantly associated with greater craving, and in turn with more drinking days. Among individuals who used both alcohol and hard drugs, greater belief in a BV was associated with fewer drinking days, but was not significantly associated with substance use-related consequences. No association was found between belief in a BV and self-efficacy to avoid alcohol or drug use. CONCLUSIONS Among individuals who use only alcohol, belief in a BV may contribute to more drinking days and greater alcohol-related consequences through its association with greater craving. This study provides further evidence of the potential harm of internalizing the belief that being AIAN contributes to the risk for alcohol problems, a notion that lacks scientific evidence despite decades of research. The findings highlight the importance of combating societal myths regarding AIAN peoples and the internalization of these stereotypes.
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Haapanen KA, Christens BD. Community-engaged Research Approaches: Multiple Pathways To Health Equity. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:331-337. [PMID: 34312882 DOI: 10.1002/ajcp.12529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Gameon JA, Skewes MC. Historical trauma and substance use among American Indian people with current substance use problems. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:295-309. [PMID: 33829816 PMCID: PMC8084991 DOI: 10.1037/adb0000729] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the United States, American Indian and Alaska Native (AI/AN) people suffer health inequities associated with alcohol and other drug use and also experience historical trauma symptoms resulting from colonization. Research suggests that historical trauma may be associated with substance use among AI/ANs. METHOD As part of a Community-Based Participatory Research project with tribal partners from a rural AI reservation, our team collected cross-sectional survey data from 198 tribal members who self-identified as having substance use problems. We examined associations between historical trauma thoughts, historical trauma symptoms, and substance use outcomes. We also examined historical trauma symptoms, current trauma symptoms, awareness of systemic discrimination, and ethnic identity as moderators of the associations between historical trauma thoughts and substance use variables. RESULTS Historical trauma thoughts, controlling for symptoms, were associated with greater abstinent days, fewer heavy alcohol use days, fewer drinks per drinking day, and fewer drug use days; historical trauma symptoms, controlling for thoughts, were associated only with fewer abstinent days. Moderation analyses showed that historical trauma thoughts were associated with better substance use outcomes when historical trauma symptoms were low, current trauma symptoms were low, awareness of systemic discrimination was high, and ethnic identity was high. CONCLUSION When distressing trauma symptoms are low, historical trauma thoughts may act as a protective factor or as a marker for other factors associated with better substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Skewes MC. Commentary on Venner et al. : Community-based participatory research opens doors to rigorous addiction treatment research with Indigenous communities. Addiction 2021; 116:961-962. [PMID: 33181862 DOI: 10.1111/add.15299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Monica C Skewes
- Department of Psychology and Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
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Harry ML, Coley RY, Waring SC, Simon GE. Evaluating the Cross-Cultural Measurement Invariance of the PHQ-9 between American Indian/Alaska Native Adults and Diverse Racial and Ethnic Groups. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:100121. [PMID: 34142103 PMCID: PMC8208497 DOI: 10.1016/j.jadr.2021.100121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Patient Health Questionnaire-9 (PHQ-9), a self-reported depression screening instrument for measurement-based care (MBC), may have cross-cultural measurement invariance (MI) with a regional group of American Indian/Alaska Native (AI/AN) and non-Hispanic White adults. However, to ensure health equity, research was needed on the cross-cultural MI of the PHQ-9 between other groups of AI/AN peoples and diverse populations. METHODS We assessed the MI of the one-factor PHQ-9 model and five previously identified two-factor models between non-Hispanic AI/AN adults (ages 18-64) from healthcare systems A (n=1,759) and B (n=2,701) using secondary data and robust maximum likelihood estimation. We then tested either fully or partially invariant models for MI between either combined or separate AI/AN groups, respectively, and Hispanic (n=7,974), White (n=7,974), Asian (n=6,988), Black (n=6,213), and Native Hawaiian/Pacific Islander (n=1,370) adults from healthcare system B. All had mental health or substance use disorder diagnoses and were seen in behavioral health or primary care from 1/1/2009-9/30/2017. RESULTS The one-factor PHQ-9 model was partially invariant, with two-factor models partially, or in one case fully, invariant between AI/AN groups. The one-factor model and three two-factor models were partially invariant between all seven groups, while a two-factor model was fully invariant and another partially invariant between a combined AI/AN group and other racial and ethnic groups. CONCLUSIONS Achieving health equity in MBC requires ensuring the cross-cultural validity of measurement tools. Before comparing mean scores, PHQ-9 models should be assessed for individual racial and ethnic group fit for adults with mental health or substance use disorders.
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Affiliation(s)
- Melissa L. Harry
- Essentia Health, Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN 55805
| | - R. Yates Coley
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466
| | - Stephen C. Waring
- Essentia Health, Essentia Institute of Rural Health, 502 East Second Street, Duluth, MN 55805
| | - Gregory E. Simon
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466
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Vivekanandarajah A, Nelson ME, Kinney HC, Elliott AJ, Folkerth RD, Tran H, Cotton J, Jacobs P, Minter M, McMillan K, Duncan JR, Broadbelt KG, Schissler K, Odendaal HJ, Angal J, Brink L, Burger EH, Coldrey JA, Dempers J, Boyd TK, Fifer WP, Geldenhuys E, Groenewald C, Holm IA, Myers MM, Randall B, Schubert P, Sens MA, Wright CA, Roberts DJ, Nelsen L, Wadee S, Zaharie D, Haynes RL. Nicotinic Receptors in the Brainstem Ascending Arousal System in SIDS With Analysis of Pre-natal Exposures to Maternal Smoking and Alcohol in High-Risk Populations of the Safe Passage Study. Front Neurol 2021; 12:636668. [PMID: 33776893 PMCID: PMC7988476 DOI: 10.3389/fneur.2021.636668] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/29/2021] [Indexed: 11/13/2022] Open
Abstract
Pre-natal exposures to nicotine and alcohol are known risk factors for sudden infant death syndrome (SIDS), the leading cause of post-neonatal infant mortality. Here, we present data on nicotinic receptor binding, as determined by 125I-epibatidine receptor autoradiography, in the brainstems of infants dying of SIDS and of other known causes of death collected from the Safe Passage Study, a prospective, multicenter study with clinical sites in Cape Town, South Africa and 5 United States sites, including 2 American Indian Reservations. We examined 15 pons and medulla regions related to cardiovascular control and arousal in infants dying of SIDS (n = 12) and infants dying from known causes (n = 20, 10 pre-discharge from time of birth, 10 post-discharge). Overall, there was a developmental decrease in 125I-epibatidine binding with increasing postconceptional age in 5 medullary sites [raphe obscurus, gigantocellularis, paragigantocellularis, centralis, and dorsal accessory olive (p = 0.0002-0.03)], three of which are nuclei containing serotonin cells. Comparing SIDS with post-discharge known cause of death (post-KCOD) controls, we found significant decreased binding in SIDS in the nucleus pontis oralis (p = 0.02), a critical component of the cholinergic ascending arousal system of the rostral pons (post-KCOD, 12.1 ± 0.9 fmol/mg and SIDS, 9.1 ± 0.78 fmol/mg). In addition, we found an effect of maternal smoking in SIDS (n = 11) combined with post-KCOD controls (n = 8) on the raphe obscurus (p = 0.01), gigantocellularis (p = 0.02), and the paragigantocellularis (p = 0.002), three medullary sites found in this study to have decreased binding with age and found in previous studies to have abnormal indices of serotonin neurotransmission in SIDS infants. At these sites, 125I-epibatidine binding increased with increasing cigarettes per week. We found no effect of maternal drinking on 125I-epibatidine binding at any site measured. Taken together, these data support changes in nicotinic receptor binding related to development, cause of death, and exposure to maternal cigarette smoking. These data present new evidence in a prospective study supporting the roles of developmental factors, as well as adverse exposure on nicotinic receptors, in serotonergic nuclei of the rostral medulla-a finding that highlights the interwoven and complex relationship between acetylcholine (via nicotinic receptors) and serotonergic neurotransmission in the medulla.
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Affiliation(s)
- Arunnjah Vivekanandarajah
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Morgan E. Nelson
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Hannah C. Kinney
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Rebecca D. Folkerth
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Forensic Medicine, New York University School of Medicine, New York City, NY, United States
| | - Hoa Tran
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jacob Cotton
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Perri Jacobs
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Megan Minter
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kristin McMillan
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Jhodie R. Duncan
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kevin G. Broadbelt
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kathryn Schissler
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Hein J. Odendaal
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Jyoti Angal
- Avera Research Institute, Sioux Falls, SD, United States
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD, United States
| | - Lucy Brink
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Elsie H. Burger
- Division of Forensic Pathology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University & Western Cape Forensic Pathology Service, Tygerberg, South Africa
| | - Jean A. Coldrey
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Johan Dempers
- Division of Forensic Pathology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University & Western Cape Forensic Pathology Service, Tygerberg, South Africa
| | - Theonia K. Boyd
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
| | - William P. Fifer
- Department of Psychiatry and Pediatrics, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Elaine Geldenhuys
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Coen Groenewald
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Ingrid A. Holm
- Division of Genetics and Genomics and the Manton Center for Orphan Diseases Research, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Michael M. Myers
- Department of Psychiatry and Pediatrics, Columbia University Medical Center, New York State Psychiatric Institute, New York, NY, United States
| | - Bradley Randall
- Department of Pathology, University of South Dakota Sanford School of Medicine, Sioux Falls, SD, United States
| | - Pawel Schubert
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Mary Ann Sens
- Department of Pathology, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Colleen A. Wright
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
- Lancet Laboratories, Johannesburg, South Africa
| | - Drucilla J. Roberts
- Department of Pathology, Massachusetts General Hospital, Boston, MA, United States
| | | | - Shabbir Wadee
- Division of Forensic Pathology, Department of Pathology, Faculty of Health Sciences, Stellenbosch University & Western Cape Forensic Pathology Service, Tygerberg, South Africa
| | - Dan Zaharie
- Division of Anatomical Pathology, Department of Pathology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, South Africa
| | - Robin L. Haynes
- Department of Pathology, Harvard School of Medicine, Boston Children's Hospital, Boston, MA, United States
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