College of Letters & Science

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Community-based prevention education on abusive head trauma in a Montana Native American community
(Montana State University - Bozeman, College of Nursing, 2019) Schmitt, Emily Marie; Chairperson, Graduate Committee: Sandra Kuntz
This scholarly project cultivated a partnership with a Montana Native American community to develop an implementation method of an evidence-based, abusive-head-trauma-prevention education program. The partnering community felt that more could be done to prevent abusive head trauma. Utilizing the framework of Community-Based Participatory Research and the Rural Nursing Theory, this project identified the best available evidence and then developed multiple methods to implement this prevention material. Multiple lessons were learned and important reflections developed from the project process. These lessons can be utilized to guide future projects. A model for program implementation was developed for future use and implementation of the evidence-based, abusive-head-trauma-prevention program.
Babies and the environment : conducting focus groups to determine priority pediatric environmental health issues on a Northwest American Indian reservation
(Montana State University - Bozeman, College of Nursing, 2011) Grandchamp, Milissa Renee; Chairperson, Graduate Committee: Sandra Kuntz
American Indian/Alaska Native infant mortality rate is disproportionately higher than the dominant culture. Excess mortality and morbidity for this population may be linked to exposures such as environmental tobacco smoke (ETS), metal contaminants; outdoor air pollution, pesticides, and polychlorinated biphenyls (Karr 2010). Health care providers (HCPs) are positioned to identify, prevent and treat environmental exposures (EE). However, HCPs often lack basic and continuing education on pediatric environmental health (PEH) topics. The purpose of this study was to work with community partners to offer PEH training via a HCP conference on one northwest reservation. A descriptive, qualitative research design utilized focus groups to query HCP about their perceptions of local PEH issues. Moderators were trained via a written protocol to lead focus group discussions using a 12-question instrument. Discussions were audio recorded and transcribed. Content analyses were completed to identify the most frequent themes and question inter-rater reliability was established. The results of this study found that health care providers perceived environmental health (EH) as prevention of both physical toxins and behavioral aspects of population health. Excess infant/child mortality and morbidity were linked to sudden infant death syndrome (SIDS), and a lack of family/community education and resources. Substance abuse (drugs, alcohol, ETS) was recognized as a priority EH issue. Health care providers described their role in PEH as serving as and referring caregivers to resources. A barrier to implementing PEH into practice included the low priority of silent and unseen issues versus conditions with visible acuity. Resources were identified as potential interventions needed to protect the fetus, infant and child from harmful EE. Lack of coordination among agencies creates gaps in policies. Local tribal groups were recognized as entities to advocate for PEH issues. Health care provider identified ways to enhance their knowledge of PEH. In conclusions focus groups are a valuable approach to community-based participatory research. Local HCPs find PEH to be an important topic and are interested in increasing their knowledge. The recommendations are future focus groups on this topic should reorder the tool questions. The findings of this study should be returned to community groups for further action.
Prenatal interventions that improve Native American pregnancy outcomes and reduce infant mortality : an integrative review
(Montana State University - Bozeman, College of Nursing, 2012) Bloom, Jeanne Kathryn; Chairperson, Graduate Committee: Sandra Kuntz
Native mothers are at increased risk for negative pregnancy outcomes and within the first year of life, Native babies have substantially higher infant mortality rates than their White counterparts. The primary aim of this study was to identify a broad range of interventions/perspectives that positively affect pregnancy outcomes and reduce infant mortality in Indigenous communities. An integrative review using four databases was conducted. Thirty-four articles met the inclusion/exclusion criteria. The findings and recommendations of each article were documented in a chart (Appendix C) that gave rise to the development of a socioecological framework for pregnancy outcomes in Native women (Appendix D). Individual factors that influence pregnancy outcomes included behaviors/lifestyles, mental health, tobacco use, educational attainment, maternal age, prenatal care, breastfeeding, immunizations, family planning, and socioeconomics/WIC enrollment. Interpersonal factors included significant other, family support, peer support, and traditional beliefs. Community factors included: community health clinics, prenatal services, SIDS education, infant care education, home visits, smoking cessation & prevention programs, injury rates/environmental safety, tribal commitment to mothers and infants, and integration of traditional and western medicine. Public policy factors included WIC, safe water and sanitation, IHS funding, and systems to monitor Native health. In total, the synthesis of the findings from the literature appears to influence pregnancy outcomes. For Native American pregnancy outcomes to improve and infant mortality rates decline, interventions will need to target all levels of the socioecological framework: individual, interpersonal, community, and public policy. In addition, Maslow's Hierarchy of Needs must be considered.

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