Resilience in American Indian and Alaska Native Public Health: An Underexplored Framework

Objective: To conduct a systematic literature review to assess the conceptualization, application, and measurement of resilience in American Indian and Alaska Native (AIAN) health promotion. Data Sources: We searched 9 literature databases to document how resilience is discussed, fostered, and evaluated in studies of AIAN health promotion in the United States. Study Inclusion and Exclusion Criteria: The article had to (1) be in English; (2) peer reviewed, published from January 1, 1980, to July 31, 2015; (3) identify the target population as predominantly AIANs in the United States; (4) describe a nonclinical intervention or original research that identified resilience as an outcome or resource; and (5) discuss resilience as related to cultural, social, and/or collective strengths. Data Extraction: Sixty full texts were retrieved and assessed for inclusion by 3 reviewers. Data were extracted by 2 reviewers and verified for relevance to inclusion criteria by the third reviewer. Data Synthesis: Attributes of resilience that appeared repeatedly in the literature were identified. Findings were categorized across the lifespan (age group of participants), divided by attributes, and further defined by specific domains within each attribute. Results: Nine articles (8 studies) met the criteria. Currently, resilience research in AIAN populations is limited to the identification of attributes and pilot interventions focused on individual resilience. Resilience models are not used to guide health promotion programming; collective resilience is not explored. Conclusion: Attributes of AIAN resilience should be considered in the development of health interventions. Attention to collective resilience is recommended to leverage existing assets in AIAN communities

The School Health Index as an Impetus for Change

BACKGROUND: The increase in childhood obesity and prevalence of chronic disease risk factors demonstrate the importance of creating healthy school environments. As part of the Border Health Strategic Initiative, the School Health Index was implemented in public schools in two counties along the Arizona, United States-Sonora, Mexico border. Developed in 2000 by the Centers for Disease Control and Prevention, the School Health Index offers a guide to assist schools in evaluating and improving opportunities for physical activity and good nutrition for their students. CONTEXT: Between 2000 and 2003, a total of 13 schools from five school districts in two counties participated in the School Health Index project despite academic pressures and limited resources. METHODS: The Border Health Strategic Initiative supported the hiring and training of an external coordinator in each county who was not part of the school system but who was an employee in an established community-based organization. The coordinators worked with the schools to implement the School Health Index, to develop action plans, and to monitor progress toward these goals. CONSEQUENCES: The School Health Index process and school team participation varied from school to school. Individual plans were different but all focused on reducing in-school access to unhealthy foods, identified as high-fat and/or of low nutritional value. Ideas for acting on this focus ranged from changing the content of school lunches to discontinuing the use of nonnutritious foods as classroom rewards. All plans included recommendations that could be implemented immediately as well as those that would require planning and perhaps the formation and assistance of a subcommittee (e.g., for developing or adopting a district-wide health curriculum). INTERPRETATION: After working with the School Health Index, most schools made at least one immediate change in their school environments. The external coordinator was essential to keeping the School Health Index results and action plans on the agendas of school administrators, especially during periods of staff turnover. Staff turnover, lack of time, and limited resources resulted in few schools achieving longer-term policy changes

The School Health Index as an Impetus for Change

Background The increase in childhood obesity and prevalence of chronic disease risk factors demonstrate the importance of creating healthy school environments. As part of the Border Health Strategic Initiative, the School Health Index was implemented in public schools in two counties along the Arizona, United States-Sonora, Mexico border. Developed in 2000 by the Centers for Disease Control and Prevention, the School Health Index offers a guide to assist schools in evaluating and improving opportunities for physical activity and good nutrition for their students. Context Between 2000 and 2003, a total of 13 schools from five school districts in two counties participated in the School Health Index project despite academic pressures and limited resources. Methods The Border Health Strategic Initiative supported the hiring and training of an external coordinator in each county who was not part of the school system but who was an employee in an established community-based organization. The coordinators worked with the schools to implement the School Health Index, to develop action plans, and to monitor progress toward these goals. Consequences The School Health Index process and school team participation varied from school to school. Individual plans were different but all focused on reducing in-school access to unhealthy foods, identified as high-fat and/or of low nutritional value. Ideas for acting on this focus ranged from changing the content of school lunches to discontinuing the use of nonnutritious foods as classroom rewards. All plans included recommendations that could be implemented immediately as well as those that would require planning and perhaps the formation and assistance of a subcommittee (e.g., for developing or adopting a districtwide health curriculum). Interpretation After working with the School Health Index, most schools made at least one immediate change in their school environments. The external coordinator was essential to keeping the School Health Index results and action plans on the agendas of school administrators, especially during periods of staff turnover. Staff turnover, lack of time, and limited resources resulted in few schools achieving longer term policy changes

Community engagement practices at research centers in U.S. minority institutions: Priority populations and innovative approaches to advancing health disparities research

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns

Using a Community-Based Participatory Research Approach to Collect Hopi Breast Cancer Survivors' Stories

INTRODUCTION AND OBJECTIVES: Breast cancer is the most frequent cancer endured by women on the Hopi Indian Reservation in northern Arizona. Women diagnosed with breast cancer and their family caregivers need knowledge of how other native women living on the reservation have successfully survived. Focus groups were used to explore local perceptions of breast cancer and breast cancer caregiving. Insights gained were incorporated into digital stories on a DVD designed for the Hopi Women’s Health Program (HWHP) as an educational and navigational tool for those receiving a mammogram, those newly diagnosed with breast cancer, their caregivers, and community members at large attending community health events. METHODS: Three separate focus groups representing three different sets of participants were conducted: Hopi female breast cancer survivors, caregivers of Hopi breast cancer survivors, and HWHP staff and community health workers (CHW). RESULTS: Based on three focus group outcomes, conceptual topics were identified and included in the stories created. Story topics were: HWHP information, breast cancer support systems, surviving breast cancer, treatment side effects, and family support. DISCUSSION: The strengths of the project included the development of a strong collaboration with the HWHP; the realization that focus groups are not an appropriate method for gathering personal information, particularly in a small community setting; the integration of local perspective in the creation of a health education tool, specifically the DVD of digital stories; and the successful application of a community based participatory research (CBPR) approach in a Native community. Digital stories created from this project have been used at local community events to educate about breast cancer and caregiving within the Hopi reservation. The primary limitation of the project was the small number of focus group participants

Community-Based Participatory Research: Conducting a Formative Assessment of Factors that Influence Youth Wellness in the Hualapai Community

Objectives. Using a community-based participatory research approach, a tribe–university team conducted a formative assessment of local factors that influence youth wellness to guide the design of a culturally and locally relevant health promotion program. Methods. Open-ended interviews with key informants, a school self-assessment using the Centers for Disease Control’s School Health Index, and a locally generated environmental inventory provided data that were triangulated to yield a composite of influential factors and perceived need within the community. Results. Family involvement and personal goal setting were identified as key to youth wellness. Supportive programs were described as having consistent adult leadership, structured activities, and a positive local and regional image. Availability of illicit drugs and alcohol, poor teacher attitude, and lack of adult involvement were significant negative factors that impact youth behavior. Conclusions. Local/native (emic) and university/nonnative (etic) perspectives and abilities can be combined to yield a culturally relevant formative assessment that is useful to public health planning. In this collaborative effort, standard means of data collection and analysis were modified in some cases to enhance and build upon the knowledge and skills of community researchers