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Wilson DH, German D, Ricker A, Gourneau H, Hanson GC, Mayhew J, Brockie TN, Sarche M. Feasibility, acceptability and effectiveness of a culturally informed intervention to decrease stress and promote well-being in reservation-based Native American Head Start teachers. BMC Public Health 2023; 23:2088. [PMID: 37880677 PMCID: PMC10599064 DOI: 10.1186/s12889-023-16913-z] [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: 01/14/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND While benefiting from strong cultural ties to family, land and culture Native Americans residing on reservations experience psychological distress at rates 2.5 times that of the general population. Treatment utilization for psychological health in reservation-based communities is low with access to culturally appropriate care lacking. Evidence suggests that for mental health treatment, Native Americans prefer culturally informed care that respects Native perspectives on health and well-being. METHODS To decrease stress and promote well-being in tribal Head Start teachers we adapted and implemented a culturally focused intervention within a community-based participatory research framework using mixed methods. Feasibility and acceptability of the adapted 5-session curriculum was tested in a single arm intervention study with a sample of 18 teachers on the Fort Peck Reservation. Participants completed surveys at baseline and upon completion of the intervention. Within session observations and two post-intervention focus groups (n = 8, n = 10) were conducted to elaborate and explain the quantitative results eliciting participant experience of intervention effectiveness and feasibility, acceptably and appropriateness. Implementation outcomes were assessed quantitatively using the Acceptability of Intervention, Intervention Appropriateness, and Feasibility of Intervention measures. RESULTS Quantitively, attendance rate overall was 93% with no dropouts. Pretest/posttest surveys were analyzed using t-tests and Hedges g to measure effect size. Contrary to our hypothesis, self-perceived stress showed a small positive effect size, indicating that participants were more stressed post intervention. However, depression decreased, with tribal identity and resilience showing positive effect sizes. Content analysis for the qualitative data collected within session observations and post intervention focus groups revealed how lifetime traumas were affecting participants, providing some explanation for the increase in stress. Teachers reported that the sessions helped their psychological health and well-being, supporting feasibility of future interventions. Acceptability scored highest with a mean (SD) of 4.25 (.84) out of 5, appropriateness 4.18 (.86) and feasibility 4.06 (.96) supporting intervention to be acceptable, appropriate, and feasible. CONCLUSION Utilizing a culturally based intervention to buffer stress and support the well-being of reservation-based teachers showed promise in helping them recognize their cultural strengths, stress, and need for ongoing support. Implementation outcomes show that intervention scale-out is feasible.
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Affiliation(s)
- Deborah H Wilson
- School of Nursing, Johns Hopkins University, 525 N Wolfe St., Baltimore, MD, 21205, USA.
- Auckland University of Technology School of Clinical Sciences, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
| | - Danielle German
- Department of Health Behavior and Society, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 21205, USA
| | - Adrian Ricker
- School of Nursing, Johns Hopkins University, 525 N Wolfe St., Baltimore, MD, 21205, USA
| | - Hilary Gourneau
- Fort Peck Tribes Head Start, 409 G St, W Poplar, MT, 59255, USA
| | - Ginger C Hanson
- School of Nursing, Johns Hopkins University, 525 N Wolfe St., Baltimore, MD, 21205, USA
| | - Justin Mayhew
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Baltimore, MD, 21231, USA
| | - Teresa N Brockie
- School of Nursing, Johns Hopkins University, 525 N Wolfe St., Baltimore, MD, 21205, USA
| | - Michelle Sarche
- Colorado School of Public Health, Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Mail Stop, 13001 E 17th Pl B119, Aurora, CO, 80045, USA
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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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Ward EA, Iron Cloud-Two Dogs E, Gier EE, Littlefield L, Tandon SD. Cultural Adaptation of the Mothers and Babies Intervention for Use in Tribal Communities. Front Psychiatry 2022; 13:807432. [PMID: 35250665 PMCID: PMC8891558 DOI: 10.3389/fpsyt.2022.807432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE While one in five women may experience mood and anxiety disorders during pregnancy and postpartum, Indigenous identity increases that risk by 62%, especially among younger Indigenous women. The need for evidence-based perinatal mental health interventions that provide culturally relevant well-being perspectives and practices is critical to improving maternal, child, and community outcomes for Indigenous peoples, and reducing health inequities. METHODS Through a collaboration between community maternal and child health professionals, intervention researchers, and a cultural consultant, our workgroup developed cultural adaptations to Mothers and Babies, an evidence-based perinatal depression prevention intervention. Applying a cultural interface model, the workgroup identified existing intervention content for surface adaptations, as well as deep, conceptual adaptations to incorporate traditional teachings into this evidence-based intervention. RESULTS This collaboration developed a culturally adapted facilitator manual for intervention providers, including guidance for implementation and further adaptation to represent local tribal culture, and a culturally adapted participant workbook for Indigenous perinatal women that reflects cultural teachings and traditional practices to promote well-being for mother and baby. IMPLICATIONS Committing to a culturally respectful process to adapt Mothers and Babies is likely to increase the reach of the intervention into Indigenous communities, reengage communities with cultural practice, improve health outcomes among parents, children, and the next generation's elders, and reduce disparities among Indigenous groups. Replication of this community-engaged process can further the science and understanding of cultural adaptations to evidence-based interventions, while also further reducing health inequities. Future steps include evaluating implementation of the culturally adapted intervention among tribal home visiting organizations.
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Affiliation(s)
- Erin A Ward
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | | | - Emma E Gier
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Linda Littlefield
- Great Plains Healthy Start, Great Plains Tribal Leaders' Health Board, Rapid City, SD, United States
| | - S Darius Tandon
- Center for Community Health, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Elm JHL, Handeland T. Momentum and Longevity for Tribally Driven Health Equity Science: Evidence from the Gathering for Health Project. Hum Biol 2021; 91:153-162. [PMID: 32549036 DOI: 10.13110/humanbiology.91.3.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 03/19/2020] [Indexed: 01/10/2023]
Abstract
American Indian health disparities have reached crisis levels, and there is a need to develop culturally congruent interventions through meaningful tribal involvement and ethical community-oriented approaches. Hence, it is imperative that researchers and university administrators better understand how research translation occurs for tribally driven health-equity research projects. Utilizing thematic analysis methods, the authors examined documents from a 12-year community-based participatory research partnership to elucidate factors that ignite momentum and support partnership longevity. The overarching finding was that trust and respect provide a foundation for momentum and longevity and are closely intertwined with other themes identified in analyses. Seven themes were extrapolated and classified into two domains: (1) investments, which are catalyzing factors that advance research, and (2) intermediate processes, which link investments to success. Investment themes include Indigenous scholar involvement, time and effort, establishing rapport, and clear and appropriate communication. Intermediate process themes include generative colearning, active participation, and recognition and celebration. Community-based participatory research principles were reflected in these findings. This study also upholds prior published work on Indigenous research methodologies, promotes the lived experiences of Indigenous people, and contributes to Indigenous theory building and science.
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Affiliation(s)
- Jessica H L Elm
- Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University, Great Lakes Hub, Duluth, Minnesota, USA, .,Citizen of the Oneida Nation, Descendant of the Stockbridge-Munsee Band of the Mohicans
| | - Tina Handeland
- Community Research Council Member, Gathering for Health study.,Citizen of the Lac du Flambeau Band of Lake Superior Chippewa Indians
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O'Keefe VM, Cwik MF, Haroz EE, Barlow A. Increasing culturally responsive care and mental health equity with indigenous community mental health workers. Psychol Serv 2021; 18:84-92. [PMID: 31045405 PMCID: PMC6824928 DOI: 10.1037/ser0000358] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There are 600 diverse American Indian/Alaska Native communities that represent strong and resilient nations throughout Indian Country. However, a history of genocidal practices, cultural assaults, and continuing oppression contribute to high rates of mental health and substance use disorders. Underresourced mental health care and numerous barriers to services maintain these disparities. Indigenous community mental health workers hold local understandings of history, culture, and traditional views of health and wellness and may reduce barriers to care while promoting tribal health and economic self-determination and sovereignty. The combination of Native community mental health workers alongside a growing workforce of Indigenous mental health professionals may create an ideal system in which tribal communities are empowered to restore balance and overall wellness, aligning with Native worldviews and healing traditions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Rioli G, Ferrari S, Henderson C, Vandelli R, Galli G, Minarini A, Galeazzi GM. Users' choice and change of allocated primary mental health professional in community-based mental health services: A scoping review. Int J Soc Psychiatry 2020; 66:373-381. [PMID: 32126868 DOI: 10.1177/0020764020910182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The recovery model in mental health care emphasizes users' right to be involved in key decisions of their care, including choice of one's primary mental health professional (PMHP). AIMS The aim of this article was to provide a scoping review of the literature on the topic of users' choice, request of change and preferences for the PMHP in community mental health services. METHOD A search of the PubMed, Cochrane Library, Web of Science and PsycINFO for papers in English was performed. Additional relevant research articles were identified through the authors' personal bibliography. RESULTS A total of 2,774 articles were screened and 38 papers were finally included. Four main aspects emerged: (1) the importance, for users, to be involved in the choice of their PMHP; (2) the importance, for users, of the continuity of care in the relationship with their PMHP; (3) factors of the user/PMHP dyad influencing users' preferences; and (4) the effect of choice on the treatment outcomes. CONCLUSION While it is generally agreed that it is important to consider users' preferences in choosing or requesting to change their PMHP, little research on this topic is available. PMHPs' and other stakeholders' views should also be explored in order to discuss ethical and practical issues.
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Affiliation(s)
- Giulia Rioli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Ferrari
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Claire Henderson
- Department of Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Riccardo Vandelli
- School of Medicine and Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Giacomo Galli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Minarini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
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Coser A, Sittner KJ, Walls ML, Handeland T. Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support. JOURNAL OF FAMILY NURSING 2018; 24:621-639. [PMID: 30497320 PMCID: PMC6510027 DOI: 10.1177/1074840718810550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals' connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.
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