Effective Educational Strategies Combining Emerging Genetic Science and Native American Cultural Issues

The purpose of this paper is to describe how new topics in genetic science are implemented and evaluated within Genetic Education for Native Americans (GENA®) workshops. These workshops are typically implemented during professional conferences, training programs, Native American meetings and at tribal colleges. As genetic science evolves, public health educators are more and more likely to need to understand increasingly complex components within genetic research. These research discoveries are likely to impact cardiovascular health, cancer treatments, prevention and control of diabetes. The public and patients want to understand health information that affects them personally, as well as their communities. The focus of this paper is on GENA® objective 14 (emerging genetic science: microRNA), but the three 2006 3-hour workshops also addressed excerpts of GENA® objectives 5 and 29. at three meetings: the 2006 summer and fall Disparities Training Programs held in Houston, Texas and the 2006 Society for the Advancement of Chicanos and Native Americans in the Sciences (SACNAS) conference (October, Tampa, Florida). The emphasis on objective 14 is because it was updated during spring 2006 (initial focus was on stem cell research) and selected components of objectives 5 and 20 have been published elsewhere. The paper briefly describes the content, interactive learning opportunity and the evaluation from the three 2006 workshops. The overall findings verify the effectiveness (p value of less than .01) of GENA® to significantly increase knowledge level of workshop participants about emerging genetic science breakthroughs

Interactive Lesson on the Cell

The purpose of this article is to explain how a basic hands-on lesson about the human cell was developed, implemented and evaluated through Genetic Education for Native Americans (GENA®) workshops

Lessons Learned From Community-Based Participatory Research in Indian Country

The purpose of this article is to share lessons learned from implementing community-based participatory research (CBPR) in Indian Country that may be generalizable to other medically underserved communities. CBPR is currently included in multiple grant announcements by the National Institute of Health and Centers for Disease Control and Prevention, but information about this methodology vs traditional research methodology is often misleading. This article addresses some common mistakes made by academic research institutes by sharing what we have learned about how CBPR can be implemented in a respectful manner. The majority of tribal Nations prefer, if not mandate, that CBPR be used in most proposed studies involving their communities today

Toward an mHealth Intervention for Smoking Cessation

The prevalence of tobacco dependence in the United States (US) remains alarming. Invariably, smoke-related health problems are the leading preventable causes of death in the US. Research has shown that a culturally tailored cessation counseling program can help reduce smoking and other tobacco usage. In this paper, we present a mobile health (mHealth) solution that leverages the Short Message Service (SMS) or text messaging feature of mobile devices to motivate behavior change among tobacco users. Our approach implements the Theory of Planned Behavior (TPB) and a phase-based framework. We make contributions to improving previous mHealth intervention approaches by delivering personalized and evidence-based motivational SMS messages to participants. Our proposed solution implements machine learning algorithms that take the participant\u27s demographic profile and previous smoking behavior into account. We discuss our preliminary evaluation of the system against a couple of pseudo-scenarios and our observation of the system\u27s performance

Building a Tailored Text Messaging System for Smoking Cessation in Native American Populations

When starting new and healthy habits or encouraging vigilance against returning to poor habits, a simple text message can be beneficial. Text messages also have the advantage of being easily accessible for lower-income populations spread over a rural area, who may not be able to afford smartphones with apps or data plans. Users benefit the most from text messages that are customized for them, but personalization requires time and effort on part of the user and the counselor. However, personalization that focuses on the cultural background of a pool of recipients, in addition to general personal preferences, can be a low-cost method of ensuring the best experience for patients interested in taking up new habits. In this paper, we discuss the development of a system for motivating users to quit smoking designed for Native American users in South Dakota, using text messaging as a daily intervention method for patients. Our results show that focusing on modular message customization options and messages with a conversational tone best helps our goal of providing users with customization options that help motivate them to live happy and healthy lifestyles

A Culturally Tailored Intervention System for Cancer Survivors to Motivate Physical Activity

It is necessary for a cancer survivor to have good health behavior. Essential exercise and proper diet are helpful to decrease the risk of recurrence of the disease and the development of a new cancer type. People from low socioeconomic status are more likely to participate in risky health behaviors and have a higher chance of recurrence of cancer. It is important to have a motivational system for cancer survivors that motivates them to perform regular physical activities. In this article, we discuss the development of an mHealth system, which aims to increase physical activity in Native American populations with culturally appropriate motivational text and video messages. The system also includes an e-journal to monitor and maintain proper healthcare. We will also analyze the pilot data to evaluate the usability and the effectiveness of the system

Reality Versus Grant Application Research “Plans”

This article describes the implementation of the American Indian mHealth Smoking Dependence Study focusing on the differences between what was written in the grant application compared to what happened in reality. The study was designed to evaluate a multicomponent intervention involving 256 participants randomly assigned to one of 15 groups. Participants received either a minimal or an intense level of four intervention components: (1) nicotine replacement therapy, (2) precessation counseling, (3) cessation counseling, and (4) mHealth text messaging. The project team met via biweekly webinars as well as one to two in-person meetings per year throughout the study. The project team openly shared progress and challenges and collaborated to find proactive solutions to address challenges as compared to what was planned in the original grant application. The project team used multiple strategies to overcome unanticipated intervention issues: (1) cell phone challenges, (2) making difficult staffing decisions, (3) survey lessons, (4) nicotine replacement therapy, (5) mHealth text messages, (6) motivational interviewing counseling sessions, and (7) use of e-cigarettes. Smoking cessation studies should be designed based on the grant plans. However, on the ground reality issues needed to be addressed to assure the scientific rigor and innovativeness of this study

Attitudes Toward Breast Cancer Genetic Testing in Five Special Population Groups

Purpose: This study examined interest in and attitudes toward genetic testing in 5 different population groups. Methods: The survey included African American, Asian American, Latina, Native American, and Appalachian women with varying familial histories of breast cancer. A total of 49 women were interviewed in person. Descriptive and nonparametric statistical techniques were used to assess ethnic group differences. Results: Overall, interest in testing was high. All groups endorsed more benefits than risks. There were group differences regarding endorsement of specific benefits and risks: testing to “follow doctor recommendations” (p=0.017), “concern for effects on family” (p=0.044), “distrust of modern medicine” (p=0.036), “cost” (p=0.025), and “concerns about communication of results to others” (p=0.032). There was a significant inverse relationship between interest and genetic testing cost (p Conclusion: Cost may be an important barrier to obtaining genetic testing services, and participants would benefit by genetic counseling that incorporates the unique cultural values and beliefs of each group to create an individualized, culturally competent program. Further research about attitudes toward genetic testing is needed among Asian Americans, Native Americans, and Appalachians for whom data are severely lacking. Future study of the different Latina perceptions toward genetic testing are encouraged

A Value-Based Approach to Increase Breast Cancer Screening and Health-Directed Behaviors among American Indian Women

American Indian/Alaska Native (AI/AN) women have the lowest cancer-screening rate of any ethnic or racial group; AI/AN women in all regions are less likely than non-Hispanic white women to be diagnosed with localized breast cancer; and those AI/AN women presenting with breast cancer have the lowest 5-year survival rate compared to other ethnic groups. This study found that cultural beliefs are more of a factor in mammography screening behavior than other barriers such as access; and that a more holistic educational intervention designed by AI/AN women prompted individual intent and actions to seek mammograms among AI/AN women >40 and to change unhealthy eating and sedentary lifestyles