Health & Human Development

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The Department of Health and Human Development is a group of dedicated faculty and staff whose interests, while diverse, center on one central theme: human beings. HHD works to help individuals from early childhood to mature adults though teaching, research, and service programs in both the public and private sectors.

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Community sharing: Contextualizing Western research notions of contamination within an Indigenous research paradigm
(Wiley, 2022-03) Allen, Sarah; Held, Suzanne; Milne‐Price, Shauna; McCormick, Alma; Feng, Du; Inouye, Jillian; Schure, Mark B.; Castille, Dottie; Howe, Rae B.; Pitts, Mikayla; Keene, Shannen; Belone, Lorenda; Wallerstein, Nina
Báa nnilah is a chronic illness self-management program designed by and for the Apsáalooke (Crow) community. Arising from a collaboration between an Indigenous non-profit organization and a university-based research team, Báa nnilah’s development, implementation and evaluation have been influenced by both Indigenous and Western research paradigms. Báa nnilah was evaluated using a randomized wait-list control group design. In a Western Research Paradigm (WRP), contamination, or intervention information shared by the intervention group with the control group, is actively discouraged as it makes ascertaining causality difficult, if not impossible. This approach is not consonant with Apsáalooke cultural values that include the encouragement of sharing helpful information with others, supporting an Indigenous Research Paradigm’s (IRP) goal of benefiting the community. The purpose of this paper is to address contamination and sharing as an area of tension between WRP and IRP. We describe how the concepts of contamination and sharing within Báa nnilah’s implementation and evaluation are interpreted differently when viewed from these contrasting paradigms, and set forth a call for greater exploration of Indigenous research approaches for developing, implementing and evaluating intervention programs in Indigenous communities. (Improving Chronic Illness Management with the Apsáalooke Nation: The Báa nnilah Project.:NCT03036189) ClinicalTrials.gov:NCT03036189)
Daasachchuchik:A Trauma-Informed Approach to Developing a Chronic Illness Self-Management Program for the Apsáalooke People
(2020-05) Shure, Mark B.; Allen, Sarah; Trottier, Coleen; McCormick, Alma; Other Medicine, Lucille; Castille, Dorothy; Held, Suzanne
In Montana, American Indians with chronic illnesses (CIs) die 20 years earlier than their White counterparts highlighting an urgent need to develop culturally consonant CI self-management programs. Historical and current trauma places Indigenous peoples at increased health risk relative to others, and negatively influences CI self-management. The Apsáalooke Nation and Montana State University worked together to develop and implement a trauma-informed CI self-management program to improve the Apsáalooke community's health. This paper describes the origins and development of the trauma-informed components of the program. Using community stories and a literature review of trauma-informed interventions, partners co-developed culturally consonant trauma materials and activities grounded in community values and spirituality. Trauma-informed content was woven throughout three intervention gatherings and was the central focus of the gathering, Daasachchuchik ('Strong Heart'). Apsáalooke ancestors survived because of their cultural strengths and resilience; these cultural roots continue to be essential to healing from historical and current trauma.
Improving Chronic Illness Self-Management with the Apsáalooke Nation: The Báa nnilah Project, a cluster randomized trial protocol
(MDPI, 2023-10) Keene, Shannen; Allen, Sarah; Knows His Gun McCormick, Alma; Trottier, Coleen; Bull Shows, Brianna; Hallet, John; Deernose, Rae; Held, Suzanne
Treatment fidelity remains underreported in health intervention research, particularly among Indigenous communities. One explanation for this gap is the lack of culturally consonant strategies listed in the National Institutes of Health (NIH) Behavior Change Consortium (BCC) treatment fidelity framework, the gold standard for understanding and measuring fidelity. This paper focuses on the development and implementation of a culturally consonant treatment fidelity support plan across two of the five BCC fidelity areas, provider training and treatment delivery, within a chronic illness self-management program for the Apsáalooke (Crow) Nation. Our team selected and adapted strategies from, and added strategies to, the BCC framework, that centered on relational accountability and the Apsáalooke culture. To be culturally consonant, we approached treatment fidelity as supporting Aakbaabaaniilea (Apsáalooke program facilitators) rather than monitoring them. This resulted in the development of a fifth treatment fidelity area: building and fostering relationships. We propose that fidelity to relational accountability is the foundation of successful programs in Indigenous communities. This suggests an important shift from tracking what was conducted in an intervention to prioritizing how things were conducted. We encourage others to view the BCC framework as a starting point in developing fidelity strategies that are consonant with local cultures.
Improving Chronic Illness Self-Management with the Apsáalooke Nation: The Báa nnilah Project, a cluster randomized trial protocol
(Elsevier BV, 2022) Hallett, John; Feng, Du; McCormick, Alma Knows His Gun; Allen, Sarah; Inouye, Jillian; Schure, Mark B.; Holder, Shannon; Other Medicine, Lucille; Held, Suzanne
Chronic illness (CI) is a major cause of morbidity and mortality for Indigenous people. In Montana, Indigenous communities disproportionately experience CI, a legacy of settler colonialism. For over two decades, Messengers for Health, an Apsáalooke (Crow Indian) non-profit, and Montana State University have partnered to improve community health using a community-based participatory research (CBPR) approach. We developed Báa nnilah, an intervention utilizing community strengths, to improve CI self-management. This manuscript describes the protocol for a cluster randomized trial with two arms: an intervention group and a wait list control group, who both participated in the Báa nnilah program. Enrollment occurred through family/clan networks and community outreach and attended to limitations of existing CI self-management interventions by using an approach and content that were culturally consonant. Participants received program materials, attended seven gatherings focused on improving CI management, and received and shared health information through storytelling based on a conceptual framework from the Apsáalooke culture and incorporating CI self-management strategies. Participant support occurred within partnership dyads during and between gatherings, from community mentors, and by program staff. The study used mixed methods to evaluate the intervention, with qualitative measures including the Short Form Health Survey (SF-12), Patient Health Questionnaire (PHQ-9), Patient Activation Measure (PAM), and a suite of PROMIS measures, various physical tests and qualitative survey responses, semi-structured interviews, and outcomes shared by participants with program staff. We hypothesized that Báa nnilah would significantly improve participant health outcome measures across multiple dimensions with quality of life (QoL) as the primary outcome.