Adapting Western research methods to indigenous ways of knowing.

Indigenous communities have long experienced exploitation by researchers and increasingly require participatory and decolonizing research processes. We present a case study of an intervention research project to exemplify a clash between Western research methodologies and Indigenous methodologies and how we attempted reconciliation. We then provide implications for future research based on lessons learned from Native American community partners who voiced concern over methods of Western deductive qualitative analysis. Decolonizing research requires constant reflective attention and action, and there is an absence of published guidance for this process. Continued exploration is needed for implementing Indigenous methods alone or in conjunction with appropriate Western methods when conducting research in Indigenous communities. Currently, examples of Indigenous methods and theories are not widely available in academic texts or published articles, and are often not perceived as valid.

Applying indigenous community-based participatory research principles to partnership development in health disparities research.

This case study of community and university research partnerships utilizes previously developed principles for conducting research in the context of Native American communities to consider how partners understand and apply the principles in developing community-based participatory research partnerships to reduce health disparities. The 7 partnership projects are coordinated through a National Institutes of Health-funded center and involve a variety of tribal members, including both health care professionals and lay persons and native and nonnative university researchers. This article provides detailed examples of how these principles are applied to the projects and discusses the overarching and interrelated emergent themes of sharing power and building trust.

Building and maintaining trust in a community-based participatory research partnership.

Although intervention research is vital to eliminating health disparities, many groups with health disparities have had negative research experiences, leading to an understandable distrust of researchers and the research process. Community-based participatory research (CBPR) approaches seek to reverse this pattern by building trust between community members and researchers. We highlight strategies for building and maintaining trust from an American Indian CBPR project and focus on 2 levels of trust building and maintaining: (1) between university and community partners and (2) between the initial project team and the larger community. This article was cowritten by community and academic partners; by offering the voices of community partners, it provides a novel and distinctive contribution to the CBPR literature.

A cervical cancer community-based participatory research project in a Native American community.

The Messengers for Health on the Apsáalooke Reservation project uses a community-based participatory research (CBPR) approach and lay health advisors (LHAs) to generate knowledge and awareness about cervical cancer prevention among community members in a culturally competent manner. Northern Plains Native Americans, of whom Apsáalooke women are a part, continue to be disproportionately affected by cervical cancer. This article examines quantitative and qualitative changes that occurred in the community since the inception of the Messengers for Health program. Paired sample t tests are used to evaluate the one-group pretest and posttest interviews of 83 Apsáalooke women in knowledge, comfort, and cancer awareness levels. Results reveal cervical cancer knowledge gains, gains in participants' comfort discussing cancer issues, and gains in awareness of cervical cancer and the Messengers program. Field notes, meeting minutes, and community perceptions are used to qualitatively evaluate the effectiveness of the Messengers program. Practice implications are discussed.

Determining client need in a multi-state fetal alcohol syndrome consortium: from training to practice.

BACKGROUND: A multi-state consortium was developed in the US to conduct baseline data collection and intervention research on fetal alcohol syndrome. Each state employed support specialists whose job it was to reduce or eliminate alcohol consumption in women who were at high risk for drinking alcohol during their pregnancy. The purpose of this paper is to report how support specialists in three primarily rural/frontier states were trained to assess client need and how client need was actually assessed in the field. METHODS: A qualitative process evaluation was conducted using semi-structured interviews. Interviews were conducted with state staff involved in support specialist training and consortium activities and the support specialists themselves. Inductive analyses were conducted with interview data. RESULTS: Need determination varied by state and for one state within the state. How support specialists were trained to assess need and how need was assessed in the field was mostly congruent. CONCLUSION: Process evaluation is an effective method for providing practical and useful answers to questions that cannot be answered by outcome evaluation alone.

Rural community leaders' perceptions of environmental health risks: improving community health.

Qualitative description was used to explore how rural community leaders frame, interpret, and give meaning to environmental health issues affecting their constituents and communities. Six rural community leaders discussed growth, vulnerable families, and the action avoidance strategies they use or see used in lieu of adopting health-promoting behaviors. Findings suggest intervention strategies should be economical, use common sense, be sensitive to regional identity, and use local case studies and "inside leadership." Occupational health nurses addressing the disparate environmental health risks in rural communities are encouraged to use agenda-neutral, scientifically based risk communication efforts and foster collaborative relationships among nurses, planners, industry, and other community leaders.

Development of an interviewer training manual for a cervical health project on the Apsáalooke Reservation.

This article describes strategies used to develop a survey interview training manual for use on the Apsáalooke (Crow Indian) Reservation and delineates how this process and product differed from those discussed in the extant literature on survey interview training. Working to ensure cultural appropriateness is especially important due to past research improprieties with Native American populations. This manual was developed as a part of a cervical health intervention program, Messengers for Health. Areas covered include goals of survey research, recruitment and enrollment, manner of the interviewer, nonverbal behavior, beginning the interview, and language use. Limitations of this work and suggestions for conducting survey research with Native American populations are also included.

Determinants of alcohol use in pregnant women at risk for alcohol consumption.

The purpose of this investigation was to identify determinants of alcohol consumption based on a number of demographic and psychosocial variables in a group of pregnant women at risk for alcohol consumption. Data were collected on a sample of 232 pregnant females who agreed to participant in a multistate alcohol prevention intervention. The variables of interest included demographic measures of race, age, education, marital status, health status, employment status and if they had been involved in physical abuse during the past year. Additionally, psychosocial variables were collected on social support, family functioning, mental health and illicit drug use. The dependent variables of interest were any alcohol use during the pregnancy and an abuse measure that was based on a composite score generated from questions related to problems associated with alcohol behavior. Logistic regression analysis was conducted to see if the independent variables (demographic and psychosocial variables) were predictive of any alcohol use. Multiple linear regressions were conducted to ascertain if the independent measures were predictive of alcohol abuse. The results showed that race, age, physical abuse and to a lesser extent health were associated to any alcohol use and alcohol abuse. The findings with the psychosocial variables were not as robust. Nevertheless, problematic psychiatric and drug use composite scores were associated with alcohol abuse.

Formative evaluation of a multisite alcohol consumption intervention in pregnant women.

The purpose of this preliminary study was to conduct an analysis of the time spent in intervention activities designed to decrease alcohol consumption in high-risk pregnant women across three States. Based on the program's logic model an intervention dosage form was developed specifically for the process evaluation. The form enabled the researchers to generate six client measures of intervention dosage. Descriptive statistics of time spent in various intervention domains were generated for the three states. Also, logistic regression and Tobit estimations were used to see if at risk clients received more intervention dosage than their no risk counterparts. The data were collected on 109 pregnant women who had been involved with the intervention for 6 months or less. The results revealed dramatic differences in the amount of dosage given to clients across the three states in categories such as average time spent with each client and the distribution of time across the logic model domains. The detailed information generated through the analysis allowed the consortium members to identify how much and what type of intervention was being given to clients in the multisite FAS intervention. A number of important questions were generated that will be used to promote dialogue and discussion among the consortium members. Through this interaction it is hoped that the consortium members will be able to enhance the quality and effectiveness of the program's intervention.

Community-university Research Liaisons: Translating the Languages of Research and Culture.

This article describes the experiences of six individuals employed as community-university research liaisons in a grant-funded centre for health disparities research. The liaisons were located in Native American communities and bridged the communities and the university, providing information between these groups, expanding understanding and knowledge of how research can address health disparities, and assisting in the development and ongoing work of partnerships using CBPR approaches. While tribal communities within the state may face similar health disparities, the approach to solving these disparities must be based on an understanding of the context and environment of the specific tribal community. In this paper, the tribal liaisons share their stories of negotiating and navigating their unique positions. Suggestions for utilizing tribal community-university positions to support community and partnership development are offered.

Exploring patient-provider interactions in a Native American community.

Identifying and addressing barriers and facilitators to good patient-provider clinical interactions may enhance participation in health-promoting behaviors. We used the critical incident technique to elicit descriptions of positive and negative patient-provider interactions from both patients and providers in a rural Native American community. Using the interview data, we developed a model that illustrates the factors affecting patient-provider interactions. Trust emerged as the central theme in the determination of whether an interaction is considered good or bad. Trust was influenced by four higher-level themes: visit context, visit expectations, history, and time. These higher-level themes also affected the perceived barriers and facilitators to the clinical interaction, which were categorized as either actions or feelings/interpretations. Addressing and reducing barriers to positive clinical interactions on multiple levels is necessary for improving patient trust in the health care system, particularly among members of minority groups.

Contextualizing CBPR: Key Principles of CBPR meet the Indigenous research context.

This paper addresses two questions regarding the use of Community-based Participatory Research (CBPR) approaches with tribal communities. First, how do "gold standard" CBPR principles hold up when applied to Native American communities and what additional contextual information is necessary to understand and work with these principles in this setting? Second, what additional principles or recommendations are helpful for researchers interested in conducting research using a CBPR approach with tribal communities? We studied a variety of literature sources on CBPR and Native health research to answer these questions. We are unaware of any publications that contextualize CBPR principles for working with specific populations. This information has direct application for conducting research with tribal communities, and confirms the importance of using CBPR approaches in this setting.

Apsáalooke women's experiences with Pap test screening.

BACKGROUND: Cervical cancer mortality rates are among the highest in the United States for Northern Plains Native American women compared with white and other Native American women. The aims of Messengers for Health, a community-based participatory research project based on the Apsáalooke (Crow Indian) Reservation, are to decrease cervical cancer screening barriers, improve knowledge regarding screening and prevention, and increase the proportion of women receiving Pap tests. This paper presents results from a survey assessing women's perceptions of the level of comfort and care received by health care providers in their most recent Pap test appointment. METHODS: A survey assessing patient communication and satisfaction with their health care providers was conducted with a random sample of 101 Apsáalooke women. Qualitative and quantitative methods were utilized to analyze the survey data. RESULTS: Women reported both positive and negative experiences with their provider regarding their Pap test appointments. They noted positive experiences when trust was established and when the provider offered information, reassured or encouraged them, was personable, was familiar or consistent, maintained confidentiality, and was a woman. The women reported negative experiences when the examination was too short, when they did not have a consistent or female provider, and when they did not feel comfortable with the provider's nonverbal communication. CONCLUSIONS: Continued work with both providers and patients is necessary to decrease communication barriers and increase satisfaction with Pap test appointments.

Recommendations for conducting successful research with Native Americans.

BACKGROUND: In this article, I discuss factors that may affect working relationships between non-Indian researchers and Native American individuals and communities and give recommendations for conducting successful research. METHODS: I describe 7 factors including Native American communities must receive information back from researchers and have access to data collected from them, researchers must address assets and broader social issues, and researchers must place the needs of the community ahead of their own interests. RESULTS AND CONCLUSIONS: Carrying through on the recommendations will make for more effective, culturally appropriate research.

Participatory development of a cervical health brochure for Apsáalooke women.

BACKGROUND: One challenge for eliminating health disparities is increasing the cultural sensitivity of educational systems including printed educational materials. These materials can be effective in changing health knowledge, attitudes, and behaviors. Participatory community-based processes are vital in creating culturally sensitive interventions. METHODS: We held community meetings in 4 communities on the Apsáalooke Reservation. We gave women examples of cervical health pamphlets and held modified focus groups to gather information on women's preferences. RESULTS: Women provided detailed feedback and we developed an Apsáalooke-specific educational pamphlet. CONCLUSION: These results support a participatory process for overall project guidance.

Lessons learned from community-based participatory research in Indian country.

The purpose of this article is to share lessons learned from implementing community-based participatory research (CBPR) in Indian Country that may be generalizable to other medically underserved communities. CBPR is currently included in multiple grant announcements by the National Institute of Health and Centers for Disease Control and Prevention, but information about this methodology vs traditional research methodology is often misleading. This article addresses some common mistakes made by academic research institutes by sharing what we have learned about how CBPR can be implemented in a respectful manner. The majority of tribal Nations prefer, if not mandate, that CBPR be used in most proposed studies involving their communities today.

Development and implementation of a culturally sensitive cervical health survey: a community-based participatory approach.

Cervical cancer mortality rates are higher for Great Plains Native American women than for Caucasian women and other Native women. Messengers for Health, a project based on the Apsáalooke (Crow Indian) reservation, utilizes a lay health advisor approach to decrease cervical cancer screening barriers, increase knowledge regarding screening and prevention, and increase the proportion of women receiving Pap tests among Apsáalooke women aged 18 and older. This project utilizes a community-based participatory research model, which emphasizes community member involvement in all phases of the project. The initial phase of this project was the development and implementation of a culturally sensitive survey used to guide the program and benefit the community. The process and preliminary results are presented.