A Community-Based Health Risk Assessment Following the Gold King Mine Spill: Results from the Gold King Mine Spill Diné Exposure Project

The Gold King Mine Spill (GKMS) disaster resulted in three million gallons of acid mine drainage-containing arsenic and lead being released into a tributary of the San Juan River. The San Juan River flows through the Navajo Nation and the Diné (Navajo) rely on this river for a variety of purposes lending to unique exposure pathways. We administered questionnaires in three Navajo communities in collaboration with the Navajo Nation Community Health Representatives to obtain frequency and duration data on 43 activities (e.g., praying with river water, fishing from the river). These activities were utilized to conduct a community-based probabilistic risk assessment from exposure to arsenic (As) and lead at three different time points (i.e., pre-GKMS, peak-GKMS, and post-GKMS) for four different exposure scenarios: (1) recreational, (2) cultural, (3) dietary, and (4) aggregate. The aggregate scenario combines exposure from engaging in recreational, cultural, and dietary related activities. Utilizing the Lifeline Community-Based Assessment Software ™ distributions were incorporated for different exposure factors (e.g., hand-to-mouth contacts, transfer efficiency) along with Diné-specific activities (e.g., using the sediment as sunscreen) to estimate dose. The estimated lead and arsenic (As) hazard quotients (HQs) for the recreational, cultural, and dietary scenario for all time points were less than one, indicating no excess non-cancer risks. Only the dietary scenario resulted in an excess cancer risk, with less than 1% of the simulated estimates exceeding the 1 × 10–04 cancer risk guideline from exposure to arsenic through the dietary scenario (e.g., consuming fish from the San Juan River) at all time points. This risk assessment is the first to incorporate the unique exposure pathways of the Diné people following the GKMS and highlights the need to incorporate community-specific pathways during the risk analysis process.National Institute of Environmental Health Sciences12 month embargo; first published 06 July 2023This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Cultural elements underlying the community health representative \u2013 client relationship on Navajo Nation

Abstract Background Navajo Nation Community Health Representatives (CHR) are trained community health workers (CHWs) who provide crucial services for patients and families. The success of the CHRs\u2019 interventions depends on the interactions between the CHRs and their clients. This research investigates the culturally specific factors that build and sustain the CHR-client interaction. Methods In-depth interviews were conducted with 16 CHRs on Navajo Nation. Interviews were transcribed and coded according to relevant themes. Code summaries were organized into a narrative using grounded theory techniques. Results The analysis revealed four findings critical to the development of a CHR-client relationship. Trust is essential to this relationship and provides a basis for providing quality services to the client. The ability to build and maintain trust is defined by tradition and culture. CHRs must be respectful of the diverse traditional and social practices. Lastly, the passing of clients brings together the CHR, the client\u2019s family, and the community. Conclusion Understanding the cultural elements of the CHR-client relationship will inform the work of community partners, clinical providers, and other indigenous communities working to strengthen CHR programs and obtain positive health outcomes among marginalized communities

Cultural elements underlying the community health representative – client relationship on Navajo Nation

Background: Navajo Nation Community Health Representatives (CHR) are trained community health workers (CHWs) who provide crucial services for patients and families. The success of the CHRs’ interventions depends on the interactions between the CHRs and their clients. This research investigates the culturally specific factors that build and sustain the CHR-client interaction. Methods: In-depth interviews were conducted with 16 CHRs on Navajo Nation. Interviews were transcribed and coded according to relevant themes. Code summaries were organized into a narrative using grounded theory techniques. Results: The analysis revealed four findings critical to the development of a CHR-client relationship. Trust is essential to this relationship and provides a basis for providing quality services to the client. The ability to build and maintain trust is defined by tradition and culture. CHRs must be respectful of the diverse traditional and social practices. Lastly, the passing of clients brings together the CHR, the client’s family, and the community. Conclusion: Understanding the cultural elements of the CHR-client relationship will inform the work of community partners, clinical providers, and other indigenous communities working to strengthen CHR programs and obtain positive health outcomes among marginalized communities. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1956-7) contains supplementary material, which is available to authorized users

Using environmental health dialogue in a Diné-centered approach for individualized results reporting in an environmental exposure study following the Gold King Mine Spill

Background: On August 5, 2015, the Gold King Mine Spill (GKMS) resulted in 3 million gallons of acid mine drainage spilling into the San Juan River impacting the Diné Bikeyah (traditional homelands of the Navajo people). The Gold King Mine Spill Diné Exposure Project was formed to understand the impacts of the GKMS on the Diné (Navajo). Reporting individualized household results in an exposure study is becoming more common; however, materials are often developed with limited community input with knowledge flowing in one direction - from researcher to participant. In this study we examined the development, dissemination, and evaluation of individualized results materials. Methods: In August 2016, Navajo Nation Community Health Representatives (Navajo CHRs) sampled household water, dust, and soil, and resident blood and urine for lead and arsenic, respectively. From May–July 2017, iterative dialogue with a wide range of community partners and a community focus groups guided the development of a culturally-based dissemination process. In August 2017, Navajo CHRs reported individualized results and they surveyed the participants on the report-back process at that time. Results: All of the 63 Diné adults (100%) who participated in the exposure study received their results by a CHR in person and 42 (67%) completed an evaluation. Most of those participants (83%) were satisfied with the result packets. Respondents ranked the individual and overall household results as the most important information they received (69% and 57%, respectively), while information on metals exposures and their health effects were the least helpful. Conclusions: Our project illustrates how a model of environmental health dialogue, defined by iterative, multidirectional communication among Indigenous community members, trusted Indigenous leaders, Indigenous researchers, non-Indigenous researchers, can improve reporting individualized study results. Findings can inform future research to encourage multi-directional environmental health dialogue to craft more culturally responsive and effective dissemination and communication materials.24 month embargo; first published 19 May 2023This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Strengthening the role of Community Health Representatives in the Navajo Nation

Abstract Background Strengthening Community Health Worker systems has been recognized to improve access to chronic disease prevention and management efforts in low-resource communities. The Community Outreach and Patient Empowerment (COPE) Program is a Native non-profit organization with formal partnerships with both the Navajo Nation Community Health Representative (CHR) Program and the clinical facilities serving the Navajo Nation. COPE works to better integrate CHRs into the local health care system through training, strengthening care coordination, and a standardized culturally appropriate suite of health promotion materials for CHRs to deliver to high-risk individuals in their homes. Methods The objective of this mixed methods, cross sectional evaluation of a longitudinal cohort study was to explore how the COPE Program has effected CHR teams over the past 6 years. COPE staff surveyed CHRs in concurrent years (2014 and 2015) about their perceptions of and experience working with COPE, including potential effects COPE may have had on communication among patients, CHRs, and hospital-based providers. COPE staff also conducted focus groups with all eight Navajo Nation CHR teams. Results CHRs and other stakeholders who viewed our results agree that COPE has improved clinic-community linkages, primarily through strengthened collaborations between Public Health Nurses and CHRs, and access to the Electronic Health Records. CHRs perceived that COPE’s programmatic support has strengthened their validity and reputation with providers and clients, and has enhanced their ability to positively effect health outcomes among their clients. CHRs report an improved ability to deliver health coaching to their clients. Survey results show that 80.2% of CHRs feel strongly positive that COPE trainings are useful, while 44.6% of CHRs felt that communication and teamwork had improved because of COPE. Conclusions These findings suggest that CHRs have experienced positive benefits from COPE through training. COPE may provide a useful programmatic model on how best to support other Community Health Workers through strengthening clinic-community linkages, standardizing competencies and training support, and structuring home-based interventions for high-risk individuals

Additional file 1: of Cultural elements underlying the community health representative – client relationship on Navajo Nation

CHR Interview Guide. The interview guide was developed by the authors with the help of the Community Health Advisory Panel (CHAP). The general topics covered in the interview guide were discussed during the interviews. (DOCX 90 kb

Providing Direct Services

Providing direct services centers on health-related services that are delivered in person or face-to-face and involves providing basic screening tests and basic services as well as meeting basic needs. The two authorship teams included describe ways Community Health Representatives (CHRs), Community Health Aides (CHAs), and Primary Dental Health Aides (PDHAs) are engaged in providing direct services. The lack of access to oral health care is of particular concern in Alaska, where a large proportion of the population are Alaska Native and live in the state’s 200 remote villages that are reachable only by boat, snowmobile, or bush plane. The Alaska team presents the Alaska Dental Health Aide Program (DHA program) and describes the training, work, and impact of PDHAs, who provide dental education and preventive dentistry services to their community members. The CHR team provides information on the roles, scope of work, and impacts of CHRs that primarily work in Native American communities on reservations and near reservations lands. Their stories share insight and information on the distinctive work of the culturally immersed roles of CHRs in various Southwest Tribes and Pueblos as they work to provide high-quality, culturally appropriate, clinically guided health, wellness, and social services. The diversity of tribal communities and the unique approaches CHRs take in providing services are highlighted