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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Item 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, SuzanneTreatment 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.Item 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, SuzanneChronic 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.Item Recruitment, retention, and intervention adherence for a chronic illness self-management intervention with the Apsáalooke Nation(Frontiers Media, 2022-06) Fimbel, Laurel; Pitts, Mikayla; Schure, Mark B.; McCormick, Alma Knows His Gun; Held, SuzanneRecruitment, retention, and adherence within health intervention research have been understudied in Indigenous communities, where well-known health disparities exist. The purpose of this paper is to describe planned versus actual recruitment, retention, and adherence strategies and the evaluation of retention and adherence strategies for a community-based research study of a Chronic Illness (CI) self-management intervention within an Indigenous community. A Community-Based Participatory Research (CBPR) approach was used to develop and implement Báa nnilah, a culturally consonant educational intervention to improve CI self-management. Reasons for participant adherence and retention were tracked and recorded over time. A post-intervention survey assessed barriers and facilitators to intervention adherence. Overall, recruitment, retention, and adherence methods were successful in enrolling and maintaining participation. Using a CBPR approach and culturally consonant strategies may assist in meeting recruitment goals and improving sustained participation of community members, thus impacting health disparities among Indigenous communities.Item 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, NinaBáa 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)Item Reliability, construct validity, and measurement invariance of the PROMIS Physical Function 8b—Adult Short Form v2.0(Springer Science and Business Media LLC, 2020-12) Feng, Du; Laurel, Fimbel; Castille, Dorothy; McCormick, Alma Knows His Gun; Held, SuzannePurpose The National Institutes of Health established the Patient-Reported Outcomes Measurement Information System (PROMIS) to assess health across various chronic illnesses. The standardized PROMIS measures have been used to assess symptoms in studies that included Native American participants, although the psychometric properties of these measures have not been assessed among a solely Native American population. This study aimed to assess the reliability, construct validity, and measurement invariance of a widely used PROMIS Physical Function survey among Native Americans residing on or near the Apsáalooke (Crow) Reservation who were living with chronic illnesses. Methods Participants aged 24 to 82 years and living with at least one chronic illness were recruited for a community-based participatory research project. Baseline data were used for the current study (N = 210). The 8-item PROMIS Physical Function 8b—Adult Short Form v2.0 was used to assess the function of upper and lower extremities, central core regions, and the ability to complete daily activities on a 5-point Likert scale. Results Results indicated that the above PROMIS survey had high internal consistency (Cronbach’s α = 0.95) and split-half (r = 0.92, p < 0.001) reliabilities. Confirmatory factor analyses supported construct validity among females of the above population and when the two sex groups were combined. Results also indicated that corresponding thresholds and factor loadings were invariant across male and female groups. Conclusions The above PROMIS measure had good psychometric properties in females and when the two sex groups were combined among Native American adults living on or near the Apsáalooke reservation with chronic illnesses. Thresholds and factor loadings appeared to be invariant by sex. Future studies with a larger sample size among males and more studies on the psychometric properties of other PROMIS measures among Native American populations are needed.Item The effects of foods available through the Food Distribution Program on Indian Reservations (FDPIR) on inflammation response, appetite, and energy intake(2020-09) Smith, Melinda S.; Held, Suzanne; Rink, Elizabeth; Byker Shanks, Carmen; Miles, Mary P.Objective: To compare the effects of a typical Food Distribution Program on Indian Reservations (FDPIR) diet with an FDPIR diet that meets Dietary Guidelines for Americans (DGA) on inflammation response, appetite and energy intake on a combination of American Indian (AI) and non-AI individuals. Design: A within-subjects, randomised, crossover design was used to compare two dietary conditions: (1) a FDPIR diet that met DGA and (2) a FDPIR diet that did not meet DGA. Each participant served as their own control and was exposed to both dietary conditions. Repeated-measures ANOVA and t tests assessed significance between the two dietary conditions. Setting: This took place in the Montana State University Nutrition Research Laboratory in the USA. Participants: Female and male participants (n 13) aged 18–55 years from the university and local community. Results: There were no significant differences in inflammatory response and appetite sensations between the two dietary conditions. Findings indicated that participants ate 14 % more (P < 0·01) kcal on a typical FDPIR diet compared with a FDPIR diet that met DGA. Conclusions: Higher energy intake during a typical FDPIR diet compared with a FDPIR diet that meets DGA may increase risk for obesity and nutrition-related diseases, including type 2 diabetes and other chronic inflammatory conditions.Item 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, SuzanneIn 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.Item Latino Health Perceptions in Rural Montana: Engaging Promotores de Salud Using Photovoice Through Facebook(2019-04) Nitzinger, Violeta; Held, Suzanne; Kevane, Bridget; Eudave, YanetThe primary purposes of this study were to use photovoice with Facebook to explore health perceptions and health needs among promotores living in rural Montana and to build community among geographically dispersed promotores. Seven promotores participated in a photovoice project where they uploaded photographs and shared comments in a private Facebook group. Emergent themes based on the promotores' health perceptions, discussions, and interviews were transcribed and coded. Findings of this study will be used to assess health perceptions and needs of the promotores and Latino community in rural Montana.Item What Touched Your Heart? Collaborative Story Analysis Emerging From an Apsaalooke Cultural Context(2017-07) Hallett, John; Held, Suzanne; Knows His Gun McCormick, Alma; Simonds, Vanessa W.; Real Bird, Sloane; Martin, Christine; Simpson, Colleen; Schure, Mark B.; Turnsplenty, Nicole; Trottier, ColeenCommunity-based participatory research and decolonizing research share some recommendations for best practices for conducting research. One commonality is partnering on all stages of research; co-developing methods of data analysis is one stage with a deficit of partnering examples. We present a novel community-based and developed method for analyzing qualitative data within an Indigenous health study and explain incompatibilities of existing methods for our purposes and community needs. We describe how we explored available literature, received counsel from community Elders and experts in the field, and collaboratively developed a data analysis method consonant with community values. The method of analysis, in which interview/story remained intact, team members received story, made meaning through discussion, and generated a conceptual framework to inform intervention development, is detailed. We offer the development process and method as an example for researchers working with communities who want to keep stories intact during qualitative data analysis.