2013 CRCAIH Pilot Grants Program Awardees
Is my healthcare making me sick? Microaggressions in American Indian healthcare
John Gonzalez, PhD (University of Minnesota Medical School, Duluth)
The long-term objective of this project is to understand the role that racial discrimination as a chronic stressor, in the form of microaggressions, has on American Indian health and health disparities. A substantial body of research demonstrates that chronic psychosocial stress significantly undermines physical, mental, and behavioral health. Recently, perceived racial discrimination as a stressor has been linked to increased rates of cardiovascular disease, breast cancer, and hypertension. Given this documented impact of racial discrimination stressors, to what extent are racial discrimination stressors experienced by AI’s in health care services delivery, and what are their impacts upon AI health care utilization, as part of explaining health disparities in this population? This proposed pilot study seeks to incubate a program of research addressing these important questions. A growing literature is documenting the types and ways microaggressions occur with many marginalized groups. However, AI’s are not sufficiently represented in these studies. In addition, the types of microaggressions AI’s experience in healthcare settings and how this affects health service access and utilization, and health outcomes is unknown. The proposed research focuses on the microaggression stressors AI’s experience in a regional healthcare setting where AI’s make-up 20% of the population. A focus on microaggressions is justified given preliminary data indicating widespread occurrence and concern in the AI community about health disparities and access to health services. The specific aims for this project are 1) Develop an interview protocol for assessing American Indian microaggression stressors in the healthcare system and 2) Identify and examine the most salient microaggressions stressors in relation to health care access and utilization, and general health and wellbeing. Focus groups will be conducted to identify the types and range of microaggression experiences of AI’s in the healthcare system. Qualitative analyses of the focus group discussions will be used to develop an interview protocol for assessing these experiences. Participants will then be recruited for semi-structured interviews using this resulting microaggressions interview protocol. Participants will also complete several previously validated self-report measures allowing exploration of the proportional unique variance in perceived wellness that is predicted through microaggressions, microaggressions in health care, overt racial discrimination, culturally significant stressors of historical loss and trauma, coping strategies, and cultural identity.
Click here to see Dr. Gonzalez's presentation in the 2015 Pilot Grant Seminar Series
Dr. Gonzalez Bio from 2015 CRCAIH Annual Summit program
Reliability and validity in a prevention program for American Indian women
Jessica D. Hanson, PhD (Sanford Research, Center for Health Outcomes and Prevention Research)
The long-term objective of this project is to enrich an existing tribal program, the OST CHOICES Program, which aims to prevent alcohol-exposed pregnancies in non-pregnant American Indian women. One challenge of the OST CHOICES Program is the lack of established validity and reliability of CHOICES measures with American Indian women, as OST CHOICES is the first of its kind. Therefore, the goal of the proposed study is to establish validity (accuracy in measurement) and reliability (reproducibility) of the CHOICES measurements with American Indian women. This will be accomplished by: 1) establishing content validity by soliciting input on the CHOICES measures from community members and content experts; 2) further establishing validity by implementing a “think aloud” methodology with non-pregnant American Indian women; and 3) determining reliability of the CHOICES measurements by conducting a test-retest, comparing the reliability of modified CHOICES measures— based on input from SA 1 and 2—with the original CHOICES measures. The expected outcomeof this study is to establish the reliability and validity of the key CHOICES measurements for American Indian women. While the CHOICES measurements have been previously validated with a variety of populations, there is still a great need for this type of study in American Indian communities. The OST CHOICES Program, whose aim is to prevent alcohol-exposed pregnancies with American Indian women, can only be enhanced through this study. The impact resultsof the proposed research include benefitting the women enrolled, impacting the evaluation of the OST CHOICES Program, and expanding scientific knowledge and clinical practice.
Dr. Hanson Bio from 2015 CRCAIH Annual Summit program
Using mindfulness to reduce risky behaviors among American Indian youth
Alicia Claire Mousseau, PhD (Little Wound School, Oglala Sioux Tribe)
Little Wound School (LWS) is an active organization in the Kyle area on the Pine Ridge Reservation and has been challenged with a number of issues plaguing their community including adverse environmental conditions, poverty, high suicide and health disparity rates. Two particular health issues that are having a significant influence on the students at LWS are risky sexual behaviors and substance use. More specifically, there has been an increase in students’ sexually transmitted infections and pregnancies within the last couple of years. Substance use rates have also increased. Both of these issues have influenced student attendance and retention, as well as overall academic performance.
LWS understands and recognizes theses issues in their school and the importance of a holistic education for their students. Thus, LWS has started a Therapeutic, Health, and Wellness Department with the goal of providing students with individual and interpersonal skills and a supportive environment to encourage and assist them in living a healthy and successful life. This goal will be met by providing the LWS students with a variety of programing and services to help them meet their individual and collective needs.
Although there are specific interventions and treatments for each area of concern, there is also high comorbidity, which would implore a more transdiagnostic and comprehensive approach. One fundamental skill that has been utilized in a variety of treatments and for a number of different issues is the practice of mindfulness, which has been described as awareness, acceptance, and nonjudgment of present moment experiences. Mindfulness has also been linked to emotion regulation and distress tolerance, which, in turn, has increased health and wellness outcomes. School-based implementation of mindfulness programs in both elementary and high school have shown benefits to students’ cognitive, social, and psychological realms including working memory, attention, academic skills, social skills, emotion regulation, and self-esteem.
The proposed pilot project will implement a mindfulness curriculum among high school freshmen at LWS and examine the influence on risky behaviors, including sexually transmitted diseases and substance use, and retention. To ensure that all students have the opportunity to receive the mindfulness training a randomized wait list control design will be used with half of the high school freshmen receiving the mindfulness curriculum during the first semester of school and the other half receiving it during the second semester of school. Data will be collected at three time points: pre-mindfulness curriculum (August/September 2013), mid-year after the first group receives the mindfulness curriculum (December 2013/January 2014), and post-mindfulness curriculum (April/May 2014). It is the hope that the mindfulness curriculum will reduce students’ risky sexual behaviors and substance use and increase students’ retention. If this program is successful future goals include implementing a Pine Ridge Reservation-wide mindfulness program for middle and high school students.
Click here to see Dr. Mousseau's presentation in the 2015 Pilot Grant Seminar Series
Dr. Mousseau Bio from 2015 CRCAIH Annual Summit program
Determinants of care and life quality in American Indian women with cancer
Soonhee Roh, PhD (University of South Dakota, School of Health Sciences)
Cervical cancer remains a significant cause of morbidity and mortality among women globally and impacts people of all races and ethnicities. Yet, cancer burden is not equally distributed among racial and ethnic groups and there are considerable regional variations in cancer incidence and mortality rates within the American Indian population. Cervical cancer mortality rates among American Indian women in South Dakota are five times the national average. American Indian women suffer from striking health disparities in relation to cervical cancer, including a higher prevalence, lower survival rate, and a rapidly increasing incidence. This disparity can be attributed to multiple factors including late-stage diagnosis, limited access to appropriate medical care, poor health literacy related to the disease, trust issues, hopelessness, logistical problems (e.g., transportation, finances, and child care) in terms of accessing cancer-related health care, and comorbidities specific to tribes in a geographic region. American Indian women’s health issues have reached crisis levels, raising a nationwide call to arms to improve the quality of cancer care and health outcomes.
Research has reliably demonstrated that both community-based participatory research and culturally appropriate cancer care can reduce disparities among cancer patients. These methods result in improved treatment compliance and recovery, better communication and social support for patients, lower rehospitalization rates, and improved family satisfaction with patient care. Using a mixed methodological community-based participatory research approach, we will investigate potential social determinants of the quality of cancer care and the quality of life among American Indian women with cervical cancer residing in South Dakota. Our long-term goal is to leverage our preliminary findings into the National Cancer Institute R01 or R21 grant so that we can begin to develop and refine a culturally competent psychosocial intervention aimed at improving the quality of cancer care and lives of American Indian women with cervical cancer.
We propose the following study aims: (1) To investigate the subjective experience of American Indian women diagnosed with l cancer within the past ten years and its meaning in the lives of American Indian women and their families and tribes; (2) To explore the cultural aspect of their cancer diagnosis and its impact on the delivery of cancer treatment; (3) To uncover the role, if any, that religion/spirituality and social supports play in American Indian cancer coping strategies, and (4) To examine the prevalence of depression, the level of quality of life and the related social determinants among American Indian women with cancer. In order to achieve our aims, we will employ qualitative and quantitative research methodologies so that we can generate subjective and objective data regarding the lived experiences of American Indian women with cervical cancer by building up a research partnership with the American Indian communities in South Dakota. We will recruit 30 American Indian women aged 18 or older with a diagnosis of first primary cervical cancer.
Assessing the impact of lay patient advocate training in tribal communities
H. Bruce Vogt, MD, FAAP (University of South Dakota, Sanford School of Medicine);
Jay Memmott, PhD, MSW (University of South Dakota, School of Health Sciences)
The project’s long-term goal is to enhance health outcomes by removing barriers to effective patient self advocacy.We hypothesize that laypersons in American Indian (AI) communities participating in health literacy and self-advocacy training will demonstrate increased levels of patient activation over the baseline. This proposal will test our hypothesis through the following Aims: Aim 1. Develop Health Literacy/Self-Advocacy Training Curriculum for Laypersons in AI Communities: We will create a modular curriculum designed to provide laypersons in AI communities with enhanced knowledge and understanding of the patient’s role in healthcare. The curriculum will include elements such as an overview of the healthcare system, the provider/patient relationship, and skill-building modules in literacy, numeracy, and
communication within the healthcare context. Participants will also receive training on methods for utilizing their self-advocacy skills to advocate for other members of their family. A coordinating patient toolkit will be developed to support the curriculum as deemed appropriate by the Curriculum Committee. Aim 2. Deliver Training Curriculum Via Classroom Integration in Pilot Community Adult Education Programs: Through a partnership with the South Dakota Association for Lifelong Learning (SD ALL), the training curriculum will be delivered via classroom integration in the adult education program in each of the four pilot communities. Instructors from these local programs will be trained in curriculum delivery by the Lead Trainer and will receive any necessary materials and instructional support from the research team. These instructors will also aid the Project Manager and Project Evaluator in administering assessments and collecting data. Aim 3. Deploy Novel Evaluation Model to Assess Training Curriculum Impact on Patient Activation: We will employ a novel evaluation model combining a modified version of the Technology Acceptance Model (TAM), to project behavioral intention of participants, with the short form of the Patient Activation Measure (PAM), to assess change in activation among participants. Bootstrap resampling procedures will also be employed to estimate the reliability of our parametric models and improve the overall accuracy and power of our findings.
The approach used by this project will invest resources in capacity-building activities aimed at equipping individuals to more effectively advocate for themselves during a healthcare encounter. By placing the locus of this investment in local laypersons and adding a training module focused on advocating for family members, the project seeks to begin addressing health disparities at the grassroots level and within the base unit of AI society (the family). Rather than creating another centralized service organization within the community, this project will invest in the individuals of the community. Rather than providing local residents with another centralized resource, local residents will become the resource. The societal impact of this project will be multiphased and sustained in nature as the presence of laypersons trained in health literacy and advocacy in a family unit – and the extended family unit of an American Indian community – holds the potential for a significant positive impact on long-term individual and group health outcomes.
Drs. Vogt and Memmott Bios from 2015 CRCAIH Annual Summit program.