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Joseph G. The role of sovereignty in Indigenous community-based health interventions: A qualitative metasynthesis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2024; 73:216-233. [PMID: 37058286 DOI: 10.1002/ajcp.12670] [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: 10/01/2021] [Revised: 06/01/2022] [Accepted: 01/10/2023] [Indexed: 06/19/2023]
Abstract
Indigenous peoples around the world suffer from health disparities attributed to a plethora of risk factors and social determinants of health stemming from colonialism and systemic oppression. Community-based health interventions have been identified as a means for addressing and reducing Indigenous health disparities by allowing for Indigenous sovereignty to be respected and centered. However, sovereignty relating to Indigenous health and well-being is underresearched. The present article explores the role of sovereignty in Indigenous community-based health interventions. A qualitative metasynthesis was conducted among 14 primary research studies co-authored by Indigenous people describing and evaluating Indigenous community-based health interventions. Five conceptual themes emerged as aspects of sovereignty which benefit Indigenous health and well-being outcomes: integration of culture; relocation of knowledge; connectedness; self-actualization; and stewardship. Implications are discussed, with the goal of creating a decolonial framework rooted in Indigenous epistemologies and perspectives for how sovereignty impacts Indigenous health, as well as strengthening a clear need for further research on and praxis of sovereignty in Indigenous healthcare.
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Affiliation(s)
- Gillian Joseph
- Center for World Indigenous Studies, Olympia, Washington, USA
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Maudrie TL, Aulandez KMW, O'Keefe VM, Whitfield FR, Walls ML, Hautala DS. Food Stress and Diabetes-Related Psychosocial Outcomes in American Indian Communities: A Mixed Methods Approach. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:1051-1065. [PMID: 36244877 PMCID: PMC9742178 DOI: 10.1016/j.jneb.2022.06.004] [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: 10/22/2021] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Explore the relationship between diabetes-related psychosocial outcomes and food stress in American Indian communities. DESIGN Convergence model of a mixed methods triangulation study. SETTING Five American Indian reservation communities in the Midwest. PARTICIPANTS One-hundred ninety-two participants were randomly selected from tribal health centers using clinic patient records and were surveyed about diabetes distress, empowerment, and food stress across 4 different time points. Seventeen focus group discussions were conducted and transcribed, and a mix of purposive and convenience sampling was used. PHENOMENON OF INTEREST Psychosocial outcomes associated with (or related to) diabetes and food stress. ANALYSIS Quantitative: Multiple linear regression was performed to explore relationships between food stress and diabetes distress and empowerment. Qualitative: Open coding of data identified portions of the transcripts related to food followed by a deductive approach on the basis of the components of quantitative food stress. RESULTS Food stress in the forms of (1) not having enough money for food and not having enough time for cooking or shopping (P = 0.08) and (2) inadequate food access and being on a special diet (P = 0.032) were associated with increased diabetes distress. Lower diabetes empowerment was associated with not having enough money for food and being on a special diet (P = 0.030). Our qualitative data mirrored quantitative findings that experiencing multiple forms of food stress negatively impacted diabetes psychosocial outcomes and illuminated the cyclical role mental health can play in relationships to food. CONCLUSIONS AND IMPLICATIONS Our findings highlight that experiencing food stress negatively affects diabetes empowerment and diabetes distress. These findings emphasize the importance of improving community food environments and addressing individual food access for diabetes management and prevention initiatives in American Indian communities.
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Affiliation(s)
- Tara L Maudrie
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Kevalin M W Aulandez
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Victoria M O'Keefe
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Melissa L Walls
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Dane S Hautala
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Beans JA, Trinidad SB, Blacksher E, Hiratsuka VY, Spicer P, Woodahl EL, Boyer BB, Lewis CM, Gaffney PM, Garrison NA, Burke W. Communicating Precision Medicine Research: Multidisciplinary Teams and Diverse Communities. Public Health Genomics 2022; 25:1-9. [PMID: 35998578 PMCID: PMC9947193 DOI: 10.1159/000525684] [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: 01/20/2021] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Precision medicine research investigates the differences in individuals' genetics, environment, and lifestyle to tailor health prevention and treatment options as part of an emerging model of health care delivery. Advancing precision medicine research will require effective communication across a wide range of scientific and health care disciplines and with research participants who represent diverse segments of the population. METHODS A multidisciplinary group convened over the course of a year and developed precision medicine research case examples to facilitate precision medicine research discussions with communities. RESULTS A shared definition of precision medicine research as well as six case examples of precision medicine research involving genetic risk, pharmacogenetics, epigenetics, the microbiome, mobile health, and electronic health records were developed. DISCUSSION/CONCLUSION The precision medicine research definition and case examples can be used as planning tools to establish a shared understanding of the scope of precision medicine research across multidisciplinary teams and with the diverse communities in which precision medicine research will take place. This shared understanding is vital for successful and equitable progress in precision medicine.
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Affiliation(s)
- Julie A. Beans
- Southcentral Foundation Research Department, Anchorage, Alaska, United States of America
| | - Susan B. Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, United States of America
| | - Erika Blacksher
- Department of History and Philosophy of Medicine, University of Kansas City Medical Center, Kansas City, Kansas, United States of America Center for Practical Bioethics, Kansas City, Missouri, United States of America
| | - Vanessa Y. Hiratsuka
- Southcentral Foundation Research Department, Anchorage, Alaska, United States of America
- Center for Human Development, University of Alaska Anchorage, Anchorage, Alaska, United States of America
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Erica L. Woodahl
- Department of Biomedical and Pharmaceutical Sciences, University of Montana, Missoula, Montana, United States of America
| | - Bert B. Boyer
- Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, Oregon, United States of America
| | - Cecil M. Lewis
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, United States of America
- Laboratories of Molecular Anthropology and Microbiome Research, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Patrick M. Gaffney
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America
| | - Nanibaa’ A. Garrison
- Institute for Society and Genetics, University of California, Los Angeles, Los Angeles, California, United States of America
- Institute for Precision Health, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington, United States of America
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Walls M, Chambers R, Begay M, Masten K, Aulandez K, Richards J, Gonzalez M, Forsberg A, Nelson L, Larzelere F, McDougall C, Lhotka M, Grass R, Kellar S, Reid R, Barlow A. Centering the Strengths of American Indian Culture, Families and Communities to Overcome Type 2 Diabetes. Front Public Health 2022; 9:788285. [PMID: 35368509 PMCID: PMC8966038 DOI: 10.3389/fpubh.2021.788285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/03/2021] [Indexed: 11/13/2022] Open
Abstract
Type 2 diabetes (T2D) is a critical Indigenous health inequity rooted in experiences of colonization and marginalization including disproportionate exposure to stressors, disruption of traditional family and food systems, and attacks on cultural practices that have led to more sedentary lifestyles. Thus, an important step in redressing inequities is building awareness of and interventions attuned to unique Indigenous contexts influencing T2D and Indigenous culture as a pathway to community wellbeing. Using a dynamic, stage-based model of intervention development and evaluation, we detail the creation and evolution of a family-based, culturally centered T2D preventive intervention: Together on Diabetes (later Together Overcoming Diabetes) (TOD). The TOD program was built by and for Indigenous communities via community-based participatory research and has been implemented across diverse cultural contexts. The TOD curriculum approaches health through a holistic lens of spiritual, mental, physical and emotional wellness. Preliminary evidence suggests TOD is effective in reducing diabetes risk factors including lowering BMI and depressive symptoms, and the program is viewed favorably by participants and community members. We discuss lessons learned regarding collaborative intervention development and adaptation across Indigenous cultures, as well as future directions for TOD.
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Affiliation(s)
- Melissa Walls
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Maudrie TL, Nguyen CJ, Jernigan VBB, Lessard KH, Richardson D, Gittelsohn J, O’Keefe VM. Impacts of COVID-19 on a Food Security Study with the Baltimore Native Community. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2022; 29:8-31. [PMID: 35881979 PMCID: PMC9351982 DOI: 10.5820/aian.2902.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urban American Indian/Alaska Native peoples experience disproportionate levels of food insecurity when compared to the general US population. Through a collaborative research partnership between Native American Lifelines of Baltimore, an Urban Indian Health Program, and a Johns Hopkins Bloomberg School of Public Health student-led research team, food security was identified as a priority issue. A sequential explanatory mixed methods study was planned to explore food security and food sovereignty in the Baltimore Native community prior to the COVID-19 pandemic. Due to the local impact of COVID-19, a community-based participatory research approach guided the community-academic team to revise the original study and increase understanding of how the pandemic impacted food security in the community. This article highlights the lessons learned and strengths of using a community-based participatory approach to guide adaptations made due to COVID-19 to this research study. By utilizing a co-learning approach and emphasizing flexibility, we were able to collaboratively collect meaningful data to drive future community solutions to food insecurity while building an evidence base for policy changes to better support urban Native food security.
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Affiliation(s)
- Tara L. Maudrie
- Center for American Indian Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
| | - Cassandra J. Nguyen
- Institute for Research and Education to Advance Community Health in the Department of Medical Education and Clinical Sciences at Washington State University in Spokane, WA
| | | | | | | | - Joel Gittelsohn
- Center for Human Nutrition in the Department of International Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
| | - Victoria M. O’Keefe
- Center for American Indian Health at Johns Hopkins Bloomberg School of Public Health in Baltimore, MD
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Aulandez KMW, Walls ML, Weiss NM, Sittner KJ, Gillson SL, Tennessen EN, Maudrie TL, Leppi AM, Rothwell EJ, Bolton-Steiner AR, Gonzalez MB. Cultural Sources of Strength and Resilience: A Case Study of Holistic Wellness Boxes for COVID-19 Response in Indigenous Communities. FRONTIERS IN SOCIOLOGY 2021; 6:612637. [PMID: 33869563 PMCID: PMC8022692 DOI: 10.3389/fsoc.2021.612637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has had disproportionately severe impacts on Indigenous peoples in the United States compared to non-Indigenous populations. In addition to the threat of viral infection, COVID-19 poses increased risk for psychosocial stress that may widen already existing physical, mental, and behavioral health inequities experienced by Indigenous communities. In recognition of the impact of COVID-19 related psychosocial stressors on our tribal community partners, the Johns Hopkins Center for American Indian Health Great Lakes Hub began sending holistic wellness boxes to our community partners in 11 tribal communities in the Midwestern United States and Canada in summer of 2020. Designed specifically to draw on culturally relevant sources of strength and resilience, these boxes contained a variety of items to support mental, emotional, cultural, and physical wellbeing. Feedback from recipients suggest that these wellness boxes provided a unique form of COVID-19 relief. Additional Johns Hopkins Center for American Indian Health offices have begun to adapt wellness boxes for the cultural context of their regions. This case study describes the conceptualization, creation, and contents of these wellness boxes and orients this intervention within a reflection on foundations of community-based participatory research, holistic relief, and drawing on cultural strengths in responding to COVID-19.
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Affiliation(s)
- Kevalin M. W. Aulandez
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Melissa L. Walls
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Nicole M. Weiss
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Kelley J. Sittner
- Department of Sociology, Oklahoma State University, Stillwater, OK, United States
| | - Stefanie L. Gillson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Elizabeth N. Tennessen
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Tara L. Maudrie
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Ailee M. Leppi
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Emma J. Rothwell
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Athena R. Bolton-Steiner
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Miigis B. Gonzalez
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
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