The Associations Between Health-Related Knowledge and Health Beliefs Regarding Risk for Gestational Diabetes in American Indian and Alaska Native Female Adolescents and Young Adults at Risk for Gestational Diabetes and Their Female Caregivers: A Cross-Sectional Dyadic Analysis.

INTRODUCTION: Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs). METHODS: Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members. RESULTS: Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05). DISCUSSION: As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.

Weaving the Strands of Life (Iiná Bitl'ool): History of Genetic Research Involving Navajo People.

To date, some genetic studies offer medical benefits but lack a clear pathway to benefit for people from underrepresented backgrounds. Historically, Indigenous people, including the Diné (Navajo people), have raised concerns about the lack of benefits, misuse of DNA samples, lack of consultation, and ignoring of cultural and traditional ways of knowing. Shortly after the Navajo Nation Human Research Review Board was established in 1996, the Navajo Nation recognized growing concerns about genetic research, and in 2002 they established a moratorium on human genetic research studies. The moratorium effectively has protected their citizens from potential genetic research harms. Despite the placement of the moratorium, some genetic research studies have continued using blood and DNA samples from Navajo people. To understand the history of genetic research involving Navajo people, the authors conducted a literature review of genetic or genetics-related research publications that involved Navajo people, identifying 79 articles from the years 1926 to 2018. To their knowledge, no known literature review has comprehensively examined the history of genetic research in the Navajo community. This review divides the genetic research articles into the following general classifications: bacteria or virus genetics, blood and human leukocyte antigens, complex diseases, forensics, hereditary diseases, and population genetics and migration. The authors evaluated the methods reported in each article, described the number of Navajo individuals reported, recorded the academic and tribal approval statements, and noted whether the study considered Diné cultural values. Several studies focused on severe combined immunodeficiency disease, population history, neuropathy, albinism, and eye and skin disorders that affect Navajo people. The authors contextualize Diné ways of knowing related to genetics and health with Western scientific concepts to acknowledge the complex philosophy and belief system that guides Diné people and recognizes Indigenous science. They also encourage researchers to consider cultural perspectives and traditional knowledge that has the potential to create stronger conclusions and better-informed, ethical, and respectful science.

At the Bedside: Traditional Navajo practitioners in a patient-centered health care model.

The growing national racial and ethnic diversity has created a greater need for health care delivery systems and health care providers to be more responsive to unique patient needs, that goes beyond meeting the immediate health problems to include attention to other critical component of patient care that take into account cultural competency such as health literacy, health beliefs and behaviors, cultural practices, etc.

A collaborative case study: The Office of Native Medicine.

National concerns about reducing the persistent health disparities found among varying racial and ethnic populations have led to initiatives to improve health care delivery systems. Many of these initiatives also promote the cultural competence of health care providers as a way to meet unique patient needs that go beyond immediate health problems, and to account for other critical components of patient care, such as health literacy, health beliefs and behaviors, and cultural practices. This case study describes a patient-centered care model developed by the Chinle Comprehensive Health Care Facility on the Navajo Reservation in Arizona, a model that has added a cadre of traditional tribal practitioners as part of its hospital and other clinical service resources.

A view from inside Arizona and New Mexico Indian country: pursuing a health career path.

INTRODUCTION: The stories of individuals working within the health system in Arizona and New Mexico Indian Country were examined to discover interests and needs related to their health career goals and advancement. The aims were: to identify what would be helpful to support educational and career progress; and to determine the barriers to advancement. METHODS: Community action research methodology was used. A semi-structured interview schedule administered by two of the investigators made up the qualitative interview portion of a two-part survey research design. This qualitative portion of the larger study is reported. Interviewees were chosen from health workers in Arizona and New Mexico Indian country who returned workplace-distributed questionnaires that indicated they were interested in career advancement. The interviewees were selected to be representative of the occupational background, work site, age, and cultural identity of those who returned the questionnaire. Investigators took notes by hand independently during interviews and reviewed both sets of notes simultaneously; the agreed on responses were entered as text data within 2 hours of the interviews. QRS Nudist software (QRS Software; Melbourne, VIC, Australia) was used to sort interview responses to each question in a successive fashion using a constant comparative method to identify key themes within and across questions. RESULTS: Twenty-five personal interviews were conducted in community locations convenient to the interviewee between February and April 2003. The duration of the interviews was 30 min and 60 min. Eighty percent of interviewees were American Indian and 80% percent were women. Themes within interviewees' stories regarding barriers to advancement included: 'making ends meet', dealing with the educational system, uncertainty and inflexibility in the current work setting, and not wanting to disadvantage children by their career decision. Themes related to what participants said they needed included 'making sure the bills are paid', making sure their children were not negatively affected by their decision to further their education, and being sure of the worth of further education in the workplace. Several across-interview themes included pursuing many sequential incremental educational and career steps, many interruptions and failed attempts at pursuing advanced education, and informal, verbal information-gathering patterns when seeking career advancement information. CONCLUSION: Barriers to career advancement and education arise from multiple sources. Supporting career advancement of community-rooted health workers in Indian Country will require partnership and collaboration across the education, health services, and community sectors. Financial management supports, workplace policies designed to support career-oriented education, consistent and accurate information regarding the educational process, and making courses more accessible will be necessary to support these non-traditional students. Health professions schools should regard their community-based graduates as ambassadors and provide them with ongoing accurate information, because they will be sought after to provide information to others. Innovative programs to assist in loan consolidation and financial management are needed to allow native health workers to be able to provide for their families should they wish to advance their careers. Collaboration across disciplines and programs in the education sector to support a limited set of prerequisite courses would help eliminate unnecessary or redundant courses.