Challenges to recruit and retain American Indian and Alaskan Natives into social work programs: the impact on the child welfare workforce

There is a shortage of professionally trained American Indian/Alaskan Native (AI/AN) social workers available to provide services including child welfare services to tribal communities. This study used a mixed-model survey design to examine the perceptions of 47 AI/AN BSW and MSW students enrolled in social work programs across the to determine the challenges associated with recruitment and retention. The findings are supported in the literature. Findings indicate that social work academic programs have not made substantial gains in the recruitment and retention of AI/AN students over several decades. Students identified the following seven major barriers to successful recruitment and retention: (1) a lack of AI/AN professors; (2) a shortage of field placement agencies that serve AI/AN clients; (3) conflicts between students' academic obligations and responsibilities to their families and tribal communities; (4) students' feelings of cultural isolation; (5) the need for AI/AN role models and mentors; (6) a lack of understanding by universities of cultural customs and traditional values; and (7) racism. Implications for policy and practice are offered.

Recruitment and retention of Alaska natives into nursing: elements enabling educational success

In response to the underrepresentation of Alaska Native/American Indian nurses, nursing programs have implemented recruitment and retention efforts to support undergraduate Alaska Native/American Indian nursing students. The objective of this project was to provide graduates from the Recruitment and Retention of Alaska Natives into Nursing (RRANN) program the opportunity to identify program elements important to achieving academic success, levels of satisfaction, and make recommendations for future program direction. Findings suggest RRANN graduates viewed the program as vital to academic success. Recommendations include utilizing former graduates in recruitment and retention efforts, as mentors, and extending the program to benefit graduate students.

Evaluation of Cancer 101: an educational program for native settings

This community-based intervention study examines the impact of Cancer 101, a cancer education resource developed in collaboration with American Indians/Alaska Natives to improve cancer knowledge, action regarding cancer control in tribal settings, and survival rates for members of their communities. Pre/post-surveys used to assess knowledge, attitudes, perceived benefits and future activities at baseline, immediately post-training, and at 4-6 months. Participants demonstrated significant change in knowledge, attitude, and cancer control activities. Cancer 101 provides a critical pathway to increase knowledge and promote action to reduce the burden and improve survival of cancer within tribal communities.

What dental schools can learn from college experiences of American Indian students

American Indians continue to be underrepresented in dental education. They also remain an understudied group. This qualitative study used interviews to explore the positive and negative experiences of thirty American Indian college students studying at a large public university; these students from eighteen tribal nations ranged from eighteen to forty-four years of age. The intent was to identify challenges they face and factors that contribute to their resilience and persistence in their education. Results show that these students deal with issues related to financing their education, absence from family, alienation from friends, large classes, and lack of guidance and direction. A desire for improvement in their personal lives, parental involvement and encouragement, integration into a community of fellow American Indian students, and having a place of meeting and support were reported as contributing to their persistence. Students expressed preferences for smaller classes and closer relations with faculty members, as well as the need for advisors and orientation at the start of college life. To improve their recruitment and retention programs for American Indian students, dental schools should utilize the high value these students place on education and learn to involve their parents and communities in their efforts.

Determinants of sexually transmitted infections among Canadian Inuit adolescent populations

The health status of Canadian Inuit is considerably lower than that of their ancestors. The introduction of previously unknown diseases (e.g., tuberculosis), substance abuse (e.g., alcohol), and Western customs have permanently altered this population. As a result of Western assimilation, many Inuit have distanced themselves from their land and severed their ancestral ties. Consequently, many are now mired in a state of widespread poverty and malnutrition and have severe health problems (e.g., addictions) and communicable diseases, such as sexually transmitted infections (STIs). The purpose of this case report is to provide an overview of the STI crisis that exists among Canadian Inuit. More specifically, this case study is intended to assist public health nurses working in Inuit communities in understanding how certain determinants (e.g., Westernization, culture) may influence STI transmission among Inuit youth and, how to incorporate these determinants into nursing practice. Inuit adolescents have been subjected to intense acculturation pressures that do not exist for other adolescent populations. These pressures are creating problems for youth in their transition from childhood and adulthood; they also impact on the struggle to establish their own identity, caught between two opposing cultures: their native culture and the wider Canadian one.

Meeting the needs of regional minority groups: the University of Washington's programs to increase the American Indian and Alaskan native physician workforce

Minority populations in the United States are growing rapidly, but physician workforce diversity has not kept pace with the needs of underserved communities. Minorities comprised 26.4% of the population in 1995; by 2050, these groups will comprise nearly half. Medical schools must enlist greater numbers of minority physicians and train all physicians to provide culturally responsive care. The University of Washington School of Medicine (UWSOM) is the nation's only medical school that serves a five-state region (Washington, Wyoming, Alaska, Montana, and Idaho). Its mission addresses the need to serve the region, rectify primary care shortages, and meet increasing regional demands for underserved populations. The UWSOM Native American Center of Excellence (NACOE) was established as one important way to respond to this charge. The authors describe pipeline and minority recruitment programs at UWSOM, focusing on the NACOE and other activities to recruit American Indian/Alaskan Native (AI/AN) applicants to medical schools. These programs have increased the numbers of AI/AN medical students; developed the Indian Health Pathway; worked to prepare students to provide culturally responsive care for AI/AN communities; researched health disparities specific to AI/AN populations; provided retention programs and services to ensure successful completion of medical training; developed mentorship networks; and provided faculty-development programs to increase entry of AI/AN physicians into academia. Challenges lie ahead. Barriers to the pipeline will continue to plague students, and inadequate federal funding will have a significant and negative impact on achieving needed physician-workforce diversity. Medical schools must play a larger role in resolving these, and continue to provide pipeline programs, retention programs, and minority faculty development that can make a difference.

Research careers for American Indian/Alaska Native nurses: pathway to elimination of health disparities

The health status of American Indians/Alaska Natives lags behind that of the US population. American Indian/Alaska Native (AIAN) nurses are on the front lines of health services for AIAN people. They have the potential to make scientific contributions as well, but are under-represented among researchers working to understand health disparities. The AIAN MS-to-PhD Nursing Science Bridge, at the University of Minnesota, in partnership with the Universities of North Dakota and Oklahoma, provides support for AIAN nurses during the critical training transition from masters of science to doctoral programs. Partner schools collaborate with AIAN elders, medicine people/spiritual leaders, and academic consultants to (1) foster academic success and strengthen the AIAN identity of students during their research training and (2) bring about institutional change to optimize student experiences. Future research programs developed by this cadre of AIAN nurse scientists will contribute scientifically sound, culturally acceptable knowledge to effectively improve the health of AIAN people.

Stigma of mental illness among American Indian and Alaska Native nations: historical and contemporary perspectives

Among American Indian and Alaska Native (AIAN) people, the concept of mental illness has different meanings and is interpreted in various ways. This paper describes the realities of mental health care that confront AIAN people. Stigma is associated with mental illness, which can be a barrier for those individuals who are in need of mental health services. Within the context of the AIAN historical and contemporary experiences, the paper details domains that negatively influence the lives of AIAN people. Included are the failure of the U.S. government to fulfill its treaty agreements with AIAN people; the disparities in income and education, and the pervasiveness of poverty; and access to care issues. These domains help to set the stage for health disparities that frequently catapult AIAN people to early morbidity and mortality. Importantly, many of these conditions are preventable. The paper concludes with recommendations for a more diverse workforce that will include AIAN mental health professionals who are available to provide culturally competent care to AIAN people in a variety of settings.

Using theater to promote cancer education in Alaska

BACKGROUND

Cancer, a rare disease in the 1950s, is now the leading cause of death among Alaska Natives (AN).

METHODS

Building on AN rich traditions of storytelling to share knowledge and wisdom, a 45 minute play, Understanding, was developed to address cancer-related issues specific to AN.

RESULTS

Written audience evaluations assessed the impact of this theater-based education. After seeing the play, 327 (94.5%) people reported feeling more comfortable talking about cancer, 265 (66.1%) shared that they had learned about cancer, and 234 (61.7%) wrote healthy ways they intended to change their behavior.

CONCLUSION

A postplay discussion provided an opportunity for the audience to share their stories, concerns, beliefs, and feelings.

A review of effective strategies for native women's breast health outreach and education

BACKGROUND

This commentary provides a summary of a pilot study designed to assist the American Cancer Society in revising the Circle of Life breast health program for American Indians and Alaska Natives (AIANs).

METHODS

Included are analyses of a literature review focusing on breast health outreach strategies among AIANs and in-depth interviews with breast health focus group facilitators. Over 70 AIAN breast or cervix cancer screening articles were reviewed, and approximately 20 focus group facilitators were interviewed.

RESULTS AND CONCLUSIONS

A primary finding was that AIAN breast cancer outreach, education, and screening programs are most effective when community-driven and culturally relevant to local tribal nations and geographic regions.

The promise and the challenge of the spirit of E.A.G.L.E.S. program

BACKGROUND

The Spirit of E.A.G.L.E.S. is a National Cancer Institute funded Special Populations Network. Prior to its inception, there was limited infrastructure available to American Indian and Alaska Native populations to support cancer control activities.

METHODS

Awareness has been raised about the burden of cancer in this special population.

RESULTS AND CONCLUSIONS

Changes have started to support truly comprehensive cancer control across the cancer care continuum and will drive future community-based, participatory action research.

Healthy living in Nunavut: an on-line nutrition course for inuit communities in the Canadian arctic

OBJECTIVES

It is recognized that empowerment of Indigenous Peoples through training and education is a priority. The objective was to design a course that would provide an innovative training approach to targeted workers in remote communities and enhance learning related to the Nunavut Food Guide, traditional food and nutrition, and diabetes prevention.

STUDY DESIGN

A steering committee was established at the outset of the project with representation from McGill University and the Government of Nunavut (including nutritionists, community nurses and community health representatives (CHRs), as well as with members of the target audience. Course content and implementation, as well as recruitment of the target audience, were carried out with guidance from the steering committee.

METHODS

An 8-week long course was developed for delivery in January - March, 2004. Learning activities included presentation of the course content through stories, online self-assessment quizzes, time-independent online discussions and telephone-based discussions. Invitations were extended to all prenatal nutrition program workers, CHRs, CHR students, home-care workers, Aboriginal Diabetes Initiative workers and public health nurses in Nunavut.

RESULTS

Ninety-six health-care workers registered for Healthy Living in Nunavut, with 44 actively participating, 23 with less active participation and 29 who did not participate.

CONCLUSIONS

Despite having to overcome numerous technological, linguistic and cultural barriers, approximately 40% of registrants actively participated in the online nutrition course. The internet may be a useful medium for delivery of information to target audiences in the North.