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Roh S, Lee YS, Kenyon DB, Elliott AJ, Petereit DG, Gaba A, Lee HY. Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study. JMIR Form Res 2023; 7:e47851. [PMID: 37471115 PMCID: PMC10401399 DOI: 10.2196/47851] [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: 04/03/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. OBJECTIVE This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. METHODS Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants' satisfaction with and acceptance of the intervention. RESULTS A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=-5.22; P<.001), increase in knowledge (t120=-4.75; P<.001), and satisfaction with the intervention (t120=-3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. CONCLUSIONS This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. TRIAL REGISTRATION ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603.
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Affiliation(s)
- Soonhee Roh
- Department of Social Work, University of South Dakota, Sioux Falls, SD, United States
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, CA, United States
| | - DenYelle B Kenyon
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD, United States
| | - Amy J Elliott
- Avera Research Institute, Avera Health, Sioux Falls, SD, United States
| | - Daniel G Petereit
- Monument Health Cancer Care Institute, Rapid City, SD, United States
| | - Anu Gaba
- Sanford Roger Maris Cancer Center, University of North Dakota, Fargo, ND, United States
| | - Hee Yun Lee
- School of Social Work, University of Alabama, Tuscaloosa, AL, United States
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Premkumar K, Ramasamy R, Ramasamy M, Aiyer H. Little Doctors: Agents of change in Indian rural communities. MEDICAL TEACHER 2023; 45:784-788. [PMID: 37053445 DOI: 10.1080/0142159x.2023.2197134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The child-to-child approach to health advocacy is one that draws on the strengths and agency of children to make a positive impact within their communities. The approach has been popularly used for health education in low- and middle-income countries. This article describes the 'Little Doctors' program that implemented the child-to-child approach in the towns of KC Patty and Oddanchatram, located in remote hilly regions of Tamil Nadu, India starting in 1986 to train middle- and high school children to respond to diseases prevalent in their communities along with practices for preventative measures. The program involved sessions that used a combination of creative instructional methods to engage students and provided take-home messages for them to act on with their families and community. The program was successful in creating a creative learning environment for children, offering a shift from the traditional methods of classroom instruction. Students who successfully completed the program were awarded certificates as 'Little Doctors' in their communities. Although the program did not conduct formal evaluations of the program effectiveness, students reported successfully recalling complex topics such as early signs of diseases like tuberculosis and leprosy that were prevalent in the community during the time. The program experienced several challenges and had to be discontinued despite its continued benefits to the communities.
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Affiliation(s)
- Kalyani Premkumar
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | | | | | - Harini Aiyer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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Hodge FS, Line Itty T, Arbing RH, Samuel-Nakamura C. A window into pain: American Indian cancer survivors' drawings. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1031347. [PMID: 36341151 PMCID: PMC9634249 DOI: 10.3389/fpain.2022.1031347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/04/2022] [Indexed: 11/12/2022]
Abstract
In order to explore the cultural constructs of pain, a series of focus groups were held among adult American Indian (AI) cancer survivors and their caregivers in the Southwest USA. Thirteen focus groups held at four sites (reservation, urban setting, hospital and clinic) elicited information on the barriers to cancer pain management. In response to facilitator questions about cancer pain and existing measurement scales, participants drew pictures to better explain their pain type (i.e., "pounding"), intensity (i.e., "spider web-like"), and other more abstract aspects of their pain episodes. Noting this novel outlet, subsequent groups were prompted for illustrations of pain. A total of 17 drawings were collected from focus group participants. We discuss seven of the drawings that best opened a window into the lived experience of pain, reflected through the eyes of cancer survivors. This study provides evidence that self-expression through color, imagery and written personal accounts provides more accurate depictions of pain for Southwest AI cancer survivors than pain scales alone. It is hypothesized that cultural modes of communication (i.e., storytelling) and intergenerational influences of artwork led to the depiction of pain in drawings. Suggestions for further exploration of the use of the pain drawings for pain assessment in healthcare settings are included.
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Affiliation(s)
- Felicia S. Hodge
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States,Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States,Correspondence: Felicia S. Hodge
| | - Tracy Line Itty
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
| | - Rachel H.A. Arbing
- School of Nursing, University of California Los Angeles, Los Angeles, CA, United States
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Is Active Voice Enough? Community Discussions on Passive Voice, MMIWG2S, and Violence against Urban Indigenous Women in San José, California. GENEALOGY 2022. [DOI: 10.3390/genealogy6020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Men commit violence against Native American women at higher rates than other racial or ethnic groups. When violence against Indigenous women is discussed and written about, it is often in passive voice. Several scholars note the problem of using passive voice to talk about violence against women, but there is little research on how women themselves understand passive voice as connected to the violence perpetrated against them, and we found no literature on how Native women understand passive voice. This research asks how urban Native and Indigenous women understand passive language in relationship to violence. The authors, who are all members of the Red Earth Women’s Society (REWS), took up this conversation with urban Indigenous women in San José, California, in a year-long series of meetings that culminated in three focus-group discussions (FGD)/talking circles (TC) where Native women expressed their understanding of passive language and violence against Native women. From these exploratory talking circles, we found that Native women’s understanding of passive voice aligned with previous research on passive voice, but also contributed new insights.
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Comparison of Study Quality as Determined by Standard Research and Community Engagement Metrics: A Pilot Study on Breast Cancer Research in Urban, Rural, and Remote Indigenous Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095008. [PMID: 35564401 PMCID: PMC9102080 DOI: 10.3390/ijerph19095008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
The purpose of this review is to compare research evaluation tools to determine whether the tools typically used for assessing the quality of research adequately address issues of Indigenous health and culture, particularly when the studies are intended to benefit Indigenous peoples in urban, regional, rural, and remote settings. Our previously published systematic review evaluated studies about breast cancer using a modified Indigenous community engagement tool (CET). In this study, we evaluated the same studies using two commonly used tools: the Critical Appraisal Skills Programme (CASP) for qualitative research; and the Effective Public Health Practice Project (EPHPP) for quantitative research. The results were then compared to ascertain whether there was alignment between performances in terms of engagement and the CASP/EPHPP metrics. Of the 15 papers, 3 papers scored weakly on both metrics, and are therefore the least likely to offer reliable findings, while 2 papers scored strongly on both metrics, and are therefore the most likely to offer reliable findings. Beyond this summation, it was clear that the results did not align and, therefore, could not be used interchangeably when applied to research findings intended to benefit Indigenous peoples. There does not appear to be a pattern in the relationship between the reliability of the studies and the study settings. In order to address disparities in health outcomes, we must assess research through a typical research quality and cultural engagement and settings lens, ensuring that there is rigour in all aspects of the studies.
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Christie V, Green D, Amin J, Pyke C, Littlejohn K, Skinner J, McCowen D, Gwynne K. What Is the Evidence Globally for Culturally Safe Strategies to Improve Breast Cancer Outcomes for Indigenous Women in High Income Countries? A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116073. [PMID: 34199955 PMCID: PMC8200222 DOI: 10.3390/ijerph18116073] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
The aim was to systematically assess the evidence on whether cultural safety affects breast cancer outcomes with regards to care for Indigenous women in high income countries. We conducted a systematic review in accordance with PRISMA guidelines of peer-reviewed articles in Medline, EMBASE, CINAHL, Scopus, Web of Science, Proquest Sociology and Informit Rural health database and Indigenous collection databases. Key inclusion criteria were: adult female patients with breast cancer; high income country setting; outcome measure, including screening, diagnosis, treatment and follow up care. A total of 15 were selected. We developed a Community Engagement assessment tool in consultation with aboriginal researchers, based on the National Health and Medical Research Councils' community engagement guidelines, against which studies were appraised. This novel element allowed us to evaluate the literature from a new and highly relevant perspective. Thematic analysis of all 15 studies was also undertaken. Despite limited literature there are evidence-based strategies that are likely to improve outcomes for Indigenous women with breast cancer in high income countries and indicate that culture makes a positive difference. It is also clear that strong Indigenous community leadership and governance at all stages of the research including design is an imperative for feasibility.
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Affiliation(s)
- Vita Christie
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
- Poche Centre for Indigenous Health, The University of Sydney, Sydney 2006, Australia;
- Correspondence:
| | - Debbie Green
- Armajun Aboriginal Health Service, Armidale 2350, Australia; (D.G.); (D.M.)
| | - Janaki Amin
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
| | - Christopher Pyke
- Foundation for Breast Cancer Care, South Brisbane 4101, Australia; (C.P.); (K.L.)
| | - Karen Littlejohn
- Foundation for Breast Cancer Care, South Brisbane 4101, Australia; (C.P.); (K.L.)
| | - John Skinner
- Poche Centre for Indigenous Health, The University of Sydney, Sydney 2006, Australia;
| | - Deb McCowen
- Armajun Aboriginal Health Service, Armidale 2350, Australia; (D.G.); (D.M.)
| | - Kylie Gwynne
- Faculty of Medicine Health and Human Sciences, Macquarie University, Sydney 2109, Australia; (J.A.); (K.G.)
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Abstract
American Indians and Alaska Natives (AIANs) have been documented as a population with high rates of cancer mortality in comparison to other racial and ethnic groups in the United States. During a time when other populations in the United States are experiencing improvements in cancer outcomes, cancer disparities in AIANs persist. The disparities in cancer outcomes in this diverse population can be attributed to a complex constellation of factors, which include access-to-care, economic, medical, and individual barriers, and mistrust and disenfranchisement.
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Exploring the Term “Resilience” in Arctic Health and Well-Being Using a Sharing Circle as a Community-Centered Approach: Insights from a Conference Workshop. SOCIAL SCIENCES 2019. [DOI: 10.3390/socsci8020045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the field of Arctic health, “resilience” is a term and concept used to describe capacity to recover from difficulties. While the term is widely used in Arctic policy contexts, there is debate at the community level on whether “resilience” is an appropriate term to describe the human dimensions of health and wellness in the Arctic. Further, research methods used to investigate resilience have largely been limited to Western science research methodologies, which emphasize empirical quantitative studies and may not mirror the perspective of the Arctic communities under study. To explore conceptions of resilience in Arctic communities, a Sharing Circle was facilitated at the International Congress on Circumpolar Health in 2018. With participants engaging from seven of the eight Arctic countries, participants shared critiques of the term “resilience,” and their perspectives on key components of thriving communities. Upon reflection, this use of a Sharing Circle suggests that it may be a useful tool for deeper investigations into health-related issues affecting Arctic Peoples. The Sharing Circle may serve as a meaningful methodology for engaging communities using resonant research strategies to decolonize concepts of resilience and highlight new dimensions for promoting thriving communities in Arctic populations.
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Tolma EL, Stoner JA, Thomas C, Engelman K, Li J, Dichkov A, Neely N. Conducting a formative evaluation of an intervention promoting mammography screening in an American Indian community: The Native Women's Health Project. AMERICAN JOURNAL OF HEALTH EDUCATION 2018; 50:52-65. [PMID: 31289604 PMCID: PMC6615737 DOI: 10.1080/19325037.2018.1552216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women. However, there are very few published studies describing the evaluation of breast health promotion programs among AI/AN women. PURPOSE To describe the formative evaluation of a multi-component intervention to promote mammography screening in an AI community in rural Oklahoma. METHODS A comprehensive process evaluation plan with emphasis on context, reach, dose received, dose delivered, and fidelity was developed. Data collection included mixed research methodology and impact was assessed via one group pre/post research design. Data analysis consisted of descriptive statistical analysis and content analysis. The study utilized a community-based participatory research (CBPR) approach. RESULTS Process evaluation revealed a relatively high reach within the priority population for both components (clinic and community) and a moderate implementation. Focus group research showed that participants were overall satisfied with program implementation. The intervention was feasible to implement in real-world settings. TRANSLATION TO HEALTH EDUCATION PRACTICE Community-based evaluation of breast health promotion programs among AI communities is challenging, as one has to balance methodological rigor with practical constraints. The use of an evaluation plan, mixed methods and a collaborative approach are useful tools in conducting the evaluation.
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Affiliation(s)
- Eleni L Tolma
- Department of Social and Behavioral Sciences, Faculty of Public Health, Kuwait University Health Sciences Center, P.O. Box 24923, Safat, 13110 Kuwait
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 309, Oklahoma City, OK 73126, x 49480
| | - Cara Thomas
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Kimberly Engelman
- Preventive Medicine and Public Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS 66160
| | - Ji Li
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, CHB 203, Oklahoma City, OK 73104, x 30126
| | - Aleksandar Dichkov
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126
| | - Norma Neely
- American Indian Institute, University of Oklahoma, 1639 Cross Center Drive, Norman, OK 73019
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Campbell JE, Janitz AE, Teasdale TA, Dowers-Nichols C, Kleszynski K, Dentino AN, Rubenstein LZ. Assessing Statewide Need for Older Adult Health Promotion Services: The Oklahoma Experience. JOURNAL OF SOCIAL SERVICE RESEARCH 2018; 44:119-131. [PMID: 31592202 PMCID: PMC6779164 DOI: 10.1080/01488376.2018.1428922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The growing senior population and persistent poor health status of seniors in Oklahoma compels a fresh look at what health promotion services would be well received. Surveys were distributed to a list of registered voters age 65 and older in Oklahoma with a total of 1,248 surveys returned (19.8%). Survey items asked about interests in services, classes, and activities, plus current barriers to accessing and/or engaging in such programs. To account for survey weighting, Rao-Scott Chi-Square Tests were performed to determine differences by demographic characteristics. We identified services, classes, and activities that were (and were not) of interest to seniors in Oklahoma with legal assistance (52.1%), exercise classes (46.6%), internet classes (40.7%), and indoor exercise activities (45.5%) receiving the highest level of interest. Barriers to interest in participating in programs included not wanting to go and not knowing availability of such services. The results of this survey provide useful data on health promotion gaps for seniors, interests and barriers to engaging in such activities, and guidance for statewide program development. Future program development needs to be focused on areas of interest for older adults, including legal assistance, exercise classes, and internet classes.
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Affiliation(s)
- Janis E Campbell
- College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Oklahoma City, OK, 73104, USA
| | - Amanda E Janitz
- College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Oklahoma City, OK, 73104, USA
| | - Thomas A Teasdale
- College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13 St., Oklahoma City, OK, 73104, USA
| | - Claire Dowers-Nichols
- Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 1122 NE 13th St., Oklahoma City, OK, 73117, USA
| | - Keith Kleszynski
- Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 1122 NE 13th St., Oklahoma City, OK, 73117, USA
| | - Andrew N Dentino
- Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 1122 NE 13th St., Oklahoma City, OK, 73117, USA
| | - Laurence Z Rubenstein
- Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 1122 NE 13th St., Oklahoma City, OK, 73117, USA
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Tolma EL, Engelman K, Stoner JA, Thomas C, Joseph S, Li J, Blackwater C, Henderson JN, Carson LD, Neely N, Edwards T. The Design of a Multi-component Intervention to Promote Screening Mammography in an American Indian Community: The Native Women's Health Project. AIMS Public Health 2016; 3:933-955. [PMID: 29546205 PMCID: PMC5690415 DOI: 10.3934/publichealth.2016.4.933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breast cancer is an important public health issue among American Indian/Alaska Native (AI/AN) women in the US. This article describes the design and implementation of a culturally sensitive intervention to promote breast health among AI/AN women through a hybrid model that incorporates clinical and community-based approaches. This is one of the first studies using this model addressing breast cancer disparities among AI/AN populations in the US. METHODS The Theory of Planned Behavior was used as the guiding framework of the intervention and Community Based Participatory Research was the primary vehicle for the intervention planning and implementation. Three preliminary studies took place that aimed to identify qualitatively and quantitatively what deterred or encouraged AI women to get past or future mammograms. The research results were shared with community members who, through a prioritization process, identified the theoretical focus of the intervention and its corresponding activities. The priority population consisted of AI women ages 40-74, with no recent mammogram, and no breast cancer history. RESULTS The intervention centered on the promotion of social modeling and physician recommendation. The main corresponding activities included enhancing patient-physician communication about screening mammography through a structured dialogue, receipt of a breast cancer brochure, participation in an inter-generational discussion group, and a congratulatory bracelet upon receipt of a mammogram. Environmental and policy related changes also were developed. CONCLUSION Creating a theory-based, culturally-sensitive intervention through tribal participatory research is a challenging approach towards eliminating breast cancer disparities among hard-to-reach populations.
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Affiliation(s)
- Eleni L. Tolma
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas, Kansas City, KS, USA
| | - Julie A. Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Cara Thomas
- Tecumseh Early Head Start, Tecumseh, OK, USA
| | - Stephanie Joseph
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ji Li
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - J. Neil Henderson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - L. D. Carson
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Norma Neely
- American Indian Institute, University of Oklahoma, Norman, OK, USA
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Saftner MA. Family and Friend Influence on Urban-Dwelling American Indian Adolescent Girl's Sexual Risk Behavior. QUALITATIVE HEALTH RESEARCH 2016; 26:1561-1573. [PMID: 26612887 PMCID: PMC4882274 DOI: 10.1177/1049732315616627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Previous research with American Indian (AI) adolescent sexual risk behavior primarily focused on reservation-dwelling youth despite 70% of AIs living off Native lands. Using grounded theory methodology, I sampled 20 adolescent AI girls via talking circles and interviews to explore the perceptions of AI adolescent girls living in an urban, Midwest area about the influence of family and friends on their sexual behavior. Similar to research with other racial groups, participants cited their family and friends as a major influence. Five unique themes emerged related to family and friend influence. Urban-dwelling AI girls rely on their female family members and peers for information related to sex and receive varying messages from their networks of family and friends, which often overlap. AI youth have unique family groups yet have some similarities to other ethnic groups with regard to family and friend relationships that may allow for enhanced intervention development.
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Jensen J, Baete Kenyon DY, Hanson JD. Preventing alcohol-exposed pregnancy among American-Indian youth. SEX EDUCATION 2015; 16:368-378. [PMID: 27429593 PMCID: PMC4942809 DOI: 10.1080/14681811.2015.1082070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Research has determined that the prevention of alcohol-exposed pregnancies (AEP) must occur pre-conceptually with women, either by reducing alcohol intake in women planning pregnancy or at-risk for becoming pregnant, or by preventing pregnancy in women drinking at risky levels. One such AEP prevention programme with non-pregnant American Indian women is the Oglala Sioux Tribe (OST) CHOICES (Changing High-risk alcohOl use and Increasing Contraception Effectiveness Study) Programme, which shows promise in reducing AEP risk in American Indian women aged 18 or older. A community needs assessment was conducted with key informant interviews and focus groups with an emphasis on how to expand OST CHOICES. To identify interconnected themes, a content analysis methodology was used on the qualitative feedback from the focus groups and interviews. Altogether, key informant interviews were completed with 25 health and social service professionals. Eight focus groups were held with 58 American Indian participants, including adult women of child-bearing age, elder women, and adult men. Several sub-themes regarding the prevention of AEP with youth were identified, expanding the OST CHOICES curriculum into the schools, and the role of family and culture within AEP prevention.
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Tolma EL, Stoner JA, Li J, Kim Y, Engelman KK. Predictors of regular mammography use among American Indian women in Oklahoma: a cross-sectional study. BMC WOMENS HEALTH 2014; 14:101. [PMID: 25169207 PMCID: PMC4237829 DOI: 10.1186/1472-6874-14-101] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 08/18/2014] [Indexed: 11/25/2022]
Abstract
Background There are significant disparities in breast cancer screening and survivorship between American Indian (AI) and non-Hispanic white women. This study aimed to identify the salient beliefs AI women from Oklahoma have on regular mammography screening, and to determine which beliefs and health- related practices are associated with past mammography screening behavior. Methods This study used an integrated model of the Theory of Planned Behavior as the guiding theoretical framework. Data were collected from 255 (mean age = 51 years, SD 7.64 years) AI women randomly selected from a rural Oklahoma medical clinic (response rate: 79%). Multivariate logistic regression was used to identify factors associated with self-reported past mammography within the last two years while controlling for demographic variables. Associations were summarized using odds ratios (OR), the ratio of the odds of past mammography per a 1-unit increase in continuous independent factor scales (subjective physician norm, cultural affiliation, fatalism, knowledge of mammography screening guidelines, and perceived behavior control barriers) or between groups defined by categorical variables, and 95% confidence intervals (CI). Results Of the participants, 65% (n = 167) reported a screening mammogram within the last two years. After adjustment for age and educational status, women with a higher total subjective-norm physician score (OR = 1.15, 95% CI: 1.06-1.24), a higher knowledge of mammography screening guidelines (OR = 1.52, 95% CI: 1.00-2.31), a family history of breast cancer (OR = 9.97, 95% CI: 3.05-32.62), or reporting an annual versus none or a single physician breast examination (OR = 5.57, 95% CI: 1.79-17.37) had a higher odds of past mammography. On the other hand, women who were more culturally affiliated (OR = 0.42, 95% CI: 0.24-0.74), perceived more barriers (OR = 0.86, 0.78-0.94), or had higher fatalistic attitudes toward breast cancer (OR = 0.90, 95% CI: 0.82-0.99) had lower odds of past mammography. Conclusion In the development of culturally-appropriate interventions promoting mammography among AI communities, emphasis could be put on the following: a) promoting clinic-related practices (e.g. physician recommendation, physician breast examination); b) promoting community-related practices (e.g. knowledge about mammography while eliminating fatalistic attitudes); and c) reducing environmental barriers.
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Affiliation(s)
- Eleni L Tolma
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, CHB Rm, 473, P,O, Box 26901, 73126 Oklahoma City, OK, USA.
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Saftner MA, Martyn KK, Momper SL. Urban Dwelling American Indian Adolescent Girls' Beliefs Regarding Health Care Access and Trust. JOURNAL OF INDIGENOUS SOCIAL DEVELOPMENT 2014; 3:1-15. [PMID: 25541597 PMCID: PMC4274642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Indigenous people, specifically American Indians (AI), have historically had a greater mistrust of the medical system compared to their White counterparts. The purpose of this paper is to explore the perceptions of AI adolescent girls living in an urban, Midwest area about health care providers, health care systems, and access to health care as related to sexual health care. Using grounded theory methodology, twenty 15-19 year old AI girls participated in talking circles and individual interviews. Two distinct themes emerged related to sexual health care: 1) AI adolescent girls trust their health care providers and the health care system; and 2) Access to health care is critical to practicing safe sex and obtaining information about healthy sexual practices. These findings are unique and may help health care providers and social workers providing care and support to the urban adolescent AI girl.
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Affiliation(s)
- Melissa A Saftner
- Clinical Associate Professor, The University of Minnesota School of Nursing, 308 Harvard Street SE, Minneapolis, MN 55455, USA; ; ;
| | - Kristy K Martyn
- Professor and Assistant Dean of Clinical Advancement, Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd NE, Atlanta, GA 30322; ; ;
| | - Sandra L Momper
- Assistant Professor, The University of Michigan School of Social Work, 1080 S. University, Ann Arbor, MI 48109; ; ;
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Saftner MA, Martyn KK, Momper SL, Loveland-Cherry CJ, Low LK. Urban American Indian Adolescent Girls: Framing Sexual Risk Behavior. J Transcult Nurs 2014; 26:365-75. [PMID: 24803532 DOI: 10.1177/1043659614524789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The purpose of this study was to explore factors that influence urban adolescent American Indian (AI) girls' sexual risk behavior. DESIGN A qualitative study was conducted with grounded theory methodology to reveal factors and processes that influence sexual risk behavior. METHOD Talking circles, individual interviews, and event history calendars were used with 20 urban AI 15- to 19-year-old girls to explore influences on sexual risk behavior. RESULTS The generated theory-framing sexual risk behavior-describes social and structural factors and processes that influenced the girls' sexual risk behavior. The theory extends Bronfenbrenner's ecological model by identifying microsystem, mesosystem, and macrosystem influences on sexual risk behavior. DISCUSSION Urban AI girls reported similar social and structural influences on sexual risk behavior as urban adolescents from other racial and ethnic groups. However, differences were noted in the family structure, cultural heritage, and unique history of AIs. IMPLICATIONS This theory can be used in culturally responsive practice with urban AI girls.
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Affiliation(s)
| | - Kristy K Martyn
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
| | - Sandra L Momper
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | | | - Lisa Kane Low
- University of Michigan School of Nursing, Ann Arbor, MI, USA
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Eschiti V, Lauderdale J, Burhansstipanov L, Weryackwe-Sanford S, Weryackwe L, Flores Y. Developing cancer-related educational content and goals tailored to the Comanche Nation. Clin J Oncol Nurs 2014; 18:E26-31. [PMID: 24675267 DOI: 10.1188/14.cjon.e26-e31] [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: 11/17/2022]
Abstract
Cancer-related educational content and goals should be modified to the needs of Native Americans to ensure adherence to healthy lifestyles. The current article describes the development of cancer-related educational modules that include creating behavioral goals specific to the people of the Comanche Nation. A community-based participatory research approach was used to conduct focus groups in the Comanche Nation and obtain feedback related to cancer-related educational modules and behavioral goals. Content analysis, verbatim transcriptions, field notes, and observations were used to analyze data and create five major themes. Comanche people need cancer educational modules and goals tailored to their culture to become engaged and maintain interest, thereby improving the likelihood of increasing cancer-related knowledge. Oncology nurses should respect guidance provided by Comanche community members to adapt cancer-related education materials and processes, as well as goal development, to address cultural concepts. When Comanche community members become knowledgeable and work toward healthy behavioral change, cancer health disparities may decrease.
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Affiliation(s)
| | - Jana Lauderdale
- Office of Diversity and Inclusion in the School of Nursing, Vanderbilt University, Nashville, TN
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James RD, Gold DE, St John-BlackBird A, Brown Trinidad S. Factors that influence mammography use among older American Indian and Alaska Native women. J Transcult Nurs 2014; 26:137-45. [PMID: 24626283 DOI: 10.1177/1043659614523994] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION American Indian and Alaska Native (AIAN) women have relatively high breast cancer mortality rates despite the availability of free or low-cost screening. PURPOSE This qualitative study explored issues that influence the participation of older AIAN women in mammography screening through tribally directed National Breast and Cervical Cancer Early Detection Programs (NBCCEDPs). METHODS We interviewed staff (n = 12) representing five tribal NBCCEDPs and conducted four focus groups with AIAN women ages 50 to 80 years (n = 33). RESULTS Our analysis identified four main areas of factors that predispose, enable, or reinforce decisions around mammography: financial issues and personal investments, program characteristics including direct services and education, access issues such as transportation, and comfort zone topics that include cultural or community-wide norms regarding cancer prevention. CONCLUSION This study has implications for nurse education and training on delivering effective mammography services and preventive cancer outreach and education programs in AIAN communities.
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Vogel O, Cowens-Alvarado R, Eschiti V, Samos M, Wiener D, Ohlander K, Royals D. Circle Of Life cancer education: giving voice to American Indian and Alaska Native communities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:565-72. [PMID: 23842983 DOI: 10.1007/s13187-013-0504-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The Circle Of Life (COL) was first developed in 1991 as a breast health program through a partnership between the American Cancer Society and a committee of lay and professional volunteers in Oklahoma, with representation from Oklahoma American Indian tribal communities. In 2008, The Society was awarded funding from the Centers for Disease Control and Prevention to expand and enhance COL. Since then, The Society has engaged a variety of tribal health and education leaders and Society staff to comprise a COL advisory workgroup. The workgroup's mission was to make recommendations and provide guidance in the revision of COL. Four cultural values emerged from the engagement of the workgroup: (1) the value of visual communication, (2) the value of interconnected generations, (3) the value of storytelling, and (4) the value of experiential learning. These four concepts greatly shaped the revision of the COL educational tools and resources.
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Affiliation(s)
- Octavia Vogel
- Corporate Center, Health Promotions Department, American Cancer Society, Atlanta, GA 30303, USA.
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MILLER J, KNOTT V, WILSON C, RODER D. A review of community engagement in cancer control studies among Indigenous people of Australia, New Zealand, Canada and the USA. Eur J Cancer Care (Engl) 2012; 21:283-95. [DOI: 10.1111/j.1365-2354.2012.01325.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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