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.

Determinants of Transgender Individuals' Well-Being, Mental Health, and Suicidality in a Rural State.

This project utilized a Community-Based Participatory Research (CBPR) approach to conduct qualitative interviews with 30 transgender adults living in a rural state. Participants' identities spanned from trans women and men to non-binary and Two-Spirit. The aim of this study was to better understand the experiences, needs, and priorities of the participants as well as to examine possible determinants of mental health, well-being, and suicidality for transgender individuals in Montana. These factors were investigated at individual, interpersonal, community, and societal levels using an ecological framework. Qualitative results indicate that participants experienced discrimination at all levels. Participants noted that discrimination contributed to mental health challenges and limited access to adequate general and transgender-specific healthcare services, both of which impacted overall well-being. This is reflected most notably in the elevated rate of past suicidal ideation attempts among the sample. Participants reported that the ability to transition, as well as other protective factors, played a role in reducing suicidality and improving mental and physical health. Our findings highlight the need to address transgender mental health through implementing changes at multiple ecological levels.

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.

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.

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.

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.