The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study

Background

Despite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms.

Objective

This exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic.

Methods

An exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis.

Results

Experts’ opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs.

Conclusions

Findings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth.

Plasmodium falciparum outbreak in native communities of Condorcanqui, Amazonas, Perú

Background

Malaria remains a serious health threat in the Amazonas Region of Peru and approximately 95% of the cases, mainly Plasmodium vivax, are found in native communities of The Rio Santiago District, Condorcanqui Province. In 2019, more than one thousand malaria cases were reported, with an unusual number of Plasmodium falciparum autochthonous cases. The present study aims to report this P. falciparum outbreak while describing the epidemiology of malaria and the risk factors associated in the native communities of Amazonas, Peru.

Methods

The DIRESA-Amazonas in collaboration with the Condorcanqui Health Network and the Institute of Tropical Diseases of the UNTRM carried out a malaria Active Case Detection (ACD III) between January 31st and February 10th of 2020. A total of 2718 (47.4%) individuals from 21 native communities grouped in eight sanitary districts, were screened for malaria infections. Each participant was screened for malaria using microscopy. Follow-up surveys were conducted for all malaria positive individuals to collect socio-demographic data. Spatial clustering of infection risk was calculated using a generalized linear model (GLM). Analysis of risk considered factors such as gender, age, type of infection, symptomatology, and parasitaemia.

Results

The study suggests that the P. falciparum index case was imported from Loreto and later spread to other communities of Rio Santiago during 2019. The ACD III reported 220 (8.1%) malaria cases, 46 P. falciparum, 168 P. vivax and 6 mixed infections. SaTScan analysis detected a cluster of high infection risk in Middle Rio Santiago and a particular high P. falciparum infection risk cluster in Upper Rio Santiago. Interestingly, the evaluation of different risk factors showed significant associations between low parasitaemia and P. falciparum asymptomatic cases.

Conclusion

This is the first report of a P. falciparum outbreak in native communities of Condorcanqui, Amazonas. Timely identification and treatment of symptomatic and asymptomatic cases are critical to achieve malaria control and possible elimination in this area. However, the current malaria situation in Condorcanqui is uncertain, given that malaria ACD activities have been postponed due to COVID-19.

A Systematic Review of Trauma Interventions in Native Communities

American Indian/Alaska Native and First Nations communities suffer from health disparities associated with multiple forms of trauma exposure. Culturally appropriate interventions are needed to heal current and historical trauma wounds. Although there are evidence-based trauma interventions for other populations, few have been implemented or evaluated with Native communities. Understanding the extant research on trauma interventions in Native communities is crucial for advancing science and filling gaps in the evidence base, and for meeting the needs of underserved people. In this systematic review of the literature on trauma interventions in Native communities in the United States, Canada, Australia, and New Zealand, we identified 15 studies representing 10 interventions for historical and/or current trauma. These studies involved the community to some extent in developing or culturally adapting the interventions and suggested positive outcomes with regard to historical and interpersonal trauma symptoms. However, notable limitations in study design and research methods limit both internal validity and external validity of these conclusions. Only one study attempted (but did not achieve) a quasi-experimental design, and small sample sizes were persistent limitations across studies. Recommendations for researchers include working in partnership with Native communities to overcome barriers to trauma intervention research and to increase the rigor of the studies so that ongoing efforts to treat trauma can yield publishable data and communities can secure funding for intervention research.

Place of Strength: Indigenous Artists and Indigenous Knowledge is Prevention Science

The Place of Strength (PoS) project represents an effort to Indigenize program evaluation with Indigenous communities by melding art with prevention science. We propose that Native artists as evaluators: (a) opens avenues of communication for Indigenous perspectives; (b) provides opportunities to capture spiritual, relational, and emotional impacts of prevention programming; and (c) maintains Indigenous processes, language, and values at the center of knowledge production. The New Mexico Tribal Prevention Project (NMTPP) funded seven Southwestern tribes to develop substance abuse prevention programs. In response to their expressed negative experiences with evaluation of prevention strategies, NMTPP piloted PoS. PoS shifted systematic knowledge paradigms to Tribal thought, values, and perspectives embodied in art. Art exists in Native communities as a way of documenting lifeways and historical experiences through various cultural forms. We share the process of collaborating with Native artists to document the impact of substance abuse prevention initiatives through their art within a community context. We offer concepts derived from this project as a community psychology model for re-conceptualizing evaluation utilizing Indigenous knowledge.

Ontogenetic variations in the diet of two invasive gobies, Neogobius melanostomus (Pallas, 1814) and Ponticola kessleri (Günther, 1861), from the middle Danube (Slovakia) with notice on their potential impact on benthic invertebrate communities

In this study, ontogenetic variations in diet of invasive bighead goby Ponticola kessleri and round goby Neogobius melanostomus from the middle Danube were analysed. Index of stomach fullness, Fulton's condition factor, index of food importance, frequency of occurrence, biomass, electivity, and proportions of invasive organisms in their diet were examined. Changes in the diet during ontogeny of both species emphasise the differences in their trophic niches. Our results combined with literary data suggest that bighead goby may threaten small native benthic fish species as a predator (especially in the invasion front), whereas round goby can potentially impact native fish species of all ontogenetic phases by competing for food. Round goby appear to have strong impact on bivalves, especially in the invasion front. High consumption of invasive organisms by bighead goby may help the native macroinvertebrate community. Thus, in contrast to round goby, bighead goby does not seem to be a hot candidate for being a nuisance invader.