Guardians of the Living Water: Using a Health Literacy Framework to Evaluate a Child as Change Agent Intervention.

BACKGROUND: American Indian communities in the United States experience considerable health inequities, including increased exposure to environmental contaminants. Consequently, community members of the Apsáalooke (Crow) Nation identified the lack of water-related environmental knowledge among children as an area of concern. AIM: The purpose of this study was to provide a feasibility evaluation of an increasingly sophisticated environmental health literacy program for children. METHOD: A community-academic partnership developed and piloted the Guardians of the Living Water program to increase environmental health literacy among children and their families on the Crow reservation. Nutbeam's framework for health literacy, a schema based on functional, interactive, and critical literacy, shaped the program evaluation. We used a within-subjects, quasi-experimental design without a control group. Interviews with children and parents were used to assess the feasibility of the program, while pre-/posttests assessed changes in knowledge, skills, and behavior. RESULTS: Compared with preintervention responses, those from postintervention indicated significant increases for selected knowledge and attitude components. Based on qualitative interviews with children and caregivers, the camp was a valuable experience and increased knowledge of water quality science and reinforced cultural knowledge. DISCUSSION: This success of our program stems from the trust initially built between partners and then expanded throughout the community. The program and the evaluation benefited from both the health literacy framework and from our integration of Apsáalooke values. CONCLUSION: Our findings suggest that a community-based intervention designed to increase environmental health literacy among youth and their social networks is feasible and acceptable to this American Indian community.

Developing a Curriculum for Change: Water and Environmental Health Literacy in a Native American Community.

BACKGROUND: Knowing about risks of water contamination is the first step in making informed choices to protect our health and environment. Researchers were challenged with sharing water quality research this information with local communities. OBJECTIVES: The purpose of this article is to describe the formative evaluation used to develop and implement an Environmental Health Literacy (EHL) summer camp and afterschool water curriculum for Native American (NA) children in the fourth through sixth grades. METHODS: Community and university scientists, elders, and educators came together and co-developed a summer camp and afterschool program for local youth to address the issues of water and its importance to the tribal community. LESSONS LEARNED: Research partners must continually balance research needs with relationships and service to the community. The health literacy framework used to develop our curriculum also complemented our community-based participatory research (CBPR) approach and may benefit other partnerships. CBPR helped to build trust and culturally center the intervention. CONCLUSIONS: Project partners built on the mutual commitment to "do what we say we will do" within the community context. Using the CBPR approach provided a strong framework for the collaboration necessary for this project. Trust relationships were key to the successes experienced during the development, implementation, and multiple revisions of this intervention.

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.

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.