A Comparative Analysis of Telephone and In-Person Survey Administration for Public Health Surveillance in Rural American Indian Communities.

OBJECTIVE: Public health surveillance systems suffer from insufficient inclusion of American Indian/Alaska Native (AI/AN) populations. These health surveys have also gravitated to telephone administration because of the rising cost of face-to-face interviewing. Several studies have demonstrated that telephone surveys underrepresent people with low incomes, less educational attainment, and minorities. This study assessed the impact of administration mode upon survey participation in rural AI/AN tribes. DESIGN: Using a modified Behavioral Risk Factor Surveillance System instrument, the Albuquerque Area Southwest Tribal Epidemiology Center partnered with 3 tribes to administer the survey to a target population of 900 AI/AN adults. Half of the sample was assigned to telephone survey administration and the other half was surveyed in-person by trained community interviewers. Significance testing was performed to assess differences in response rates, demographic characteristics, and costs by survey administration type. RESULTS: Several notable differences between the survey administration modes were observed. In-person administration yielded a higher response rate (68.8%) than the telephone survey (35.7%). Likewise, in-person participants were, on average, younger and had lower household incomes and educational attainment than those who completed the survey via telephone. In-person survey administration was also slightly more cost-effective than telephone administration ($192 vs $211 per completed survey) due to the low response rate of telephone administration. CONCLUSIONS: The findings from this study have important implications for public health surveillance with rural AI/AN populations, where telephone survey administration is unlikely to yield sufficient coverage of this underserved population. This discovery is particularly disconcerting, given the fact that face-to-face interviewing has largely been replaced by telephone interviewing (and increasingly mobile phones) for public health surveillance in the United States. Without change and innovation, the AI/AN population will continue to lack meaningful health data, further challenging capacity to document and address persistent disparities and inequities witnessed among AI/ANs nationwide.

Translating public health knowledge into practice: development of a lay health advisor perinatal tobacco cessation program.

The value of lay health advisor (LHA) interventions as an effective approach toward ameliorating racial, ethnic and/socioeconomic health disparities has been noted by researchers and policy makers. Translating scientific knowledge to bring state-of-the-art health promotion/disease prevention innovation to underserved populations is critical for addressing these health disparities. This article examines the experiences of a community-academic partnership in designing, developing, and implementing an evidence-based, LHA-driven perinatal tobacco cessation program for low-income, predominately African American and Hispanic women. A multimethod process evaluation was conducted to analyze three essential domains of program implementation: (1) fit of the tobacco cessation program into the broader project context, (2) feasibility of program implementation, and (3) fidelity to program implementation protocols. Findings indicate that project partners have largely succeeded in integrating an evidence-based tobacco cessation program into a community-based maternal and infant health project. The successful implementation of this intervention appears to be attributable to the following two predominant factors: (1) the utilization of a scientifically validated tobacco cessation intervention model and (2) the emphasis on continuous LHA training and capacity development.

A socioecological approach to improving mammography rates in a tribal community.

This article highlights the processes and intermediate outcomes of a pilot project to increase mammography rates of women in an American Indian tribe in New Mexico. Using a socioecological framework and principles of community-based participatory research, a community coalition was able to (a) bolster local infrastructure to increase access to mammography services; (b) build public health knowledge and skills among tribal health providers; (c) identify community-specific knowledge, attitudes, and beliefs related to breast cancer; (d) establish interdependent partnerships among community health programs and between the tribe and outside organizations; and (e) adopt local policy initiatives to bolster tribal cancer control. These findings demonstrate the value of targeting a combination of individual, community, and environmental factors, which affect community breast cancer screening rates and incorporating cultural strengths and resources into all facets of a tribal health promotion intervention.

Intermediate outcomes of a tribal community public health infrastructure assessment.

The purpose of this collaborative participatory project was to assess the strengths and needs of a tribal community as part of a larger public health capacity building program. Key project partners included: the Ramah Band of Navajo Indians, the Albuquerque Area Indian Health Board, the University of New Mexico Masters in Public Health Program, and the University of Nevada, Las Vegas, American Indian Research and Education Center. Principal intervention steps entailed: 1) relationship-building activities among tribal programs and between the Tribe and the scientific community; 2) an orientation to public health; 3) a comprehensive public health infrastructure assessment, utilizing a standardized CDC instrument; and 4) a prioritization of identified needs. The direct outcome was the development and beginning implementation of a community specific public health strategic action plan. Broader results included: 1) increased comprehension of public health within the Tribe; 2) the creation of a community public health task force; 3) the design of a tribally applicable assessment instrument; and 4) improved collaboration between the Tribe and the scientific community. This project demonstrated that public health assessment in tribal communities is feasible and valuable. Further, the development of a tribally applicable instrument highlights a significant tribal contribution to research and assessment.