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(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 Food Insecurity in US Military Veterans(SAGE Publications, 2020-12) Cypel, Yasmin S.; Katon, Jodie G.; Schure, Mark B.; Smith, ShannaBackground: Food insecurity (FI) is an important public health issue for US veterans. For many veterans, civilian life is fraught with service-incurred health issues and socioeconomic challenges, each risk factors for FI. The FI literature on veterans is limited due to insufficient coverage of the topic’s complexity and the methods used to study it in this population. No published analysis has evaluated how FI has been examined in US veterans. Objectives: We assessed how FI has been examined in US military veterans by identifying (1) the major content areas, or domains, studied in association with FI and (2) the existing research gaps. Methods: A scoping literature review was conducted to map the main research domains of the FI literature and identify knowledge gaps. Electronic database and hand searches identified potentially relevant studies (n = 61). Data extraction, utilizing a standardized set of design parameters, was completed. Duplicate removal and application of inclusion/exclusion criteria resulted in the studies (n = 21) selected for critical review. Results: Eight research domains were determined: FI prevalence, health status, dietary practices, health care utilization, economic instability, homelessness/housing instability, food program participation, and community/emergency preparedness—the most dominant was health status and the least dominant were social determinants (ie, homelessness/housing instability, food program participation). Research on validity and usability of FI assessment methods in veterans was virtually absent. Military service factors, longitudinal effects, FI among women, intervention effectiveness, and other areas lacked sufficient inquiry. Conclusion: Research is required on lesser examined content areas and methodology to optimize surveillance and policy for veteran FI.Item Frailty in Older American Indians: The Native Elder Care Study(2019-06) Turner Goins, Ruth; Schure, Mark B.; Winchester, BlytheIntroduction Frailty is often described as a reduction in energy reserves, especially with respect to physical ability and endurance, and it has not been examined in American Indians. The goals of this study were to estimate the prevalence of frailty and identify its correlates in a sample of American Indians. Methods We examined data from 411 community-dwelling American Indians aged ≥55 years. Frailty was measured with weight loss, exhaustion, low energy expenditure, slowness, and weakness characteristics. Results Slightly over 44% of participants were classified as pre-frail and 2.9% as frail. Significant correlates of a combined pre-frail and frail status identified in the fully adjusted analyses were younger age, female gender, lower levels of education, increased number of chronic medical conditions, and increased number of activities of daily living limitations. Marital status, chronic pain, and social support were not associated with pre-frail/frail status. Conclusions Our findings point to specific areas in need of further research, including use of frailty measures that also capture psychosocial components and examining constructs of physical resilience. Targeting those with multiple chronic medical conditions may be an important area in which to intervene, with the goal of reducing risk factors and preventing frailty onset.Item Exploring Perceptions of a Computerized Cognitive Behavior Therapy Program in a U.S. Rural Western State(2018-10) Schure, Mark B.; Howard, Meredith; Bailey, Sandra J.; Bryan, Bill; Greist, JohnComputerized mental health interventions have the potential to address existing mental health care disparities in rural communities. The aim of this study was to conduct an exploratory examination on the acceptability of an interactive computerized cognitive behavior therapy program to reduce depressive symptoms for adults in a rural Western state. Partnering with the land-grant university Extension system and a state non-profit organization, we identified and interviewed 18 key informants and conducted 19 focus groups in 15 rural communities to ascertain attitudes and perspectives about the program. Key informants were provided access to the Thrive program prior to the interviews. Focus group participants were provided a brief demonstration of the program and asked to provide feedback. Content analyses of interview and focus group transcripts yielded four general themes of program acceptability: privacy, accessibility, user-friendliness, and cultural inappropriateness. Overall, participants indicated that the Thrive program would be useful for many in their communities. They also reported that the program could be improved by making videos that better represent rural community members' lifestyles and experiences. The study team members acted on these findings to improve the Thrive program for rural Western populations.Item Type 2 diabetes management among older American Indians: Beliefs, attitudes, and practices(2018-07) Goins, R. Turner; Jones, Jacqueline; Schure, Mark B.; Winchester, Blythe; Bradley, VickieObjective: The purpose of this study was to examine beliefs, attitudes, and practices of older American Indians regarding their type 2 diabetes mellitus (T2DM) management. T2DM is one of the leading causes of morbidity and mortality among American Indians. American Indians are more than twice as likely to have T2DM and have over three times a T2DM mortality rate as Whites. Design: Study participants were older members of a federally recognized tribe who had T2DM. A low-inference qualitative descriptive design was used. Data were collected through semi-structured in-depth qualitative interviews with a mixed inductive, deductive, and reflexive analytic team process. Results: Our study sample included 28 participants with a mean age of 73.0 ± 6.4 years of whom 16 (57%) were women. Participants’ mean self-confidence score of successful T2DM management was 8.0 ± 1.7 on a scale from 1 to 10 with 10 representing the greatest amount of confidence. Participants’ mean HbA1c was 7.3% ± 1.5%. Overall, participants discussed T2DM management within five themes: 1) sociocultural factors, 2) causes and consequences, 3) cognitive and affective assessment, 4) diet and exercise, and 5) medical management. Conclusions: It is important to be aware of the beliefs and attitudes of patients. Lay understandings can help identify factors underlying health and illness behaviors including motivations to maintain healthy behaviors or to change unhealthy behaviors. Such information can be helpful for health educators and health promotion program staff to ensure their efforts are effective and in alignment with patients’ realities.Item Mindfulness-Based Processes of Healing for Veterans with Post-Traumatic Stress Disorder(2018-11) Schure, Mark B.; Simpson, Tracy L.; Martinez, Michelle; Sayre, George; Kearney, David J.OBJECTIVE: U.S. veterans are at increased risk of developing post-traumatic stress disorder (PTSD). Prior studies suggest a benefit of mindfulness-based stress reduction (MBSR) for PTSD, but the mechanisms through which MBSR reduces PTSD symptoms and improves functional status have received limited empirical inquiry. This study used a qualitative approach to better understand how training in mindfulness affects veterans with PTSD. DESIGN: Qualitative study using semistructured in-depth interviews following participation in an MBSR intervention. SETTING: Outpatient. INTERVENTION: Eight-week MBSR program. OUTCOME MEASURE: Participants\' narratives of their experiences from participation in the program. RESULTS: Interviews were completed with 15 veterans. Analyses identified six core aspects of participants\' MBSR experience related to PTSD: dealing with the past, staying in the present, acceptance of adversity, breathing through stress, relaxation, and openness to self and others. Participants described specific aspects of a holistic mindfulness experience, which appeared to activate introspection and curiosity about their PTSD symptoms. Veterans with PTSD described a number of pathways by which mindfulness practice may help to ameliorate PTSD. CONCLUSIONS: MBSR holds promise as a nontrauma-focused approach to help veterans with PTSD.Item Lifetime Trauma and Depressive Symptomatology Among Older American Indians: The Native Elder Care Study(2018-08) Cayir, Ebru; Burke, Michael P.; Spencer, Mindi; Schure, Mark B.; Goins, R. TurnerWe examined the association between lifetime traumatic events with or without trauma response symptoms and depressive symptomatology in American Indians aged ≥ 55 years from a tribe in the Southeastern US (N = 362). Twenty-three percent of the sample experienced a traumatic event without trauma-response symptoms, whereas 14% experienced a traumatic event with at least one trauma-response symptom. After adjustment for sociodemographic characteristics and social support, participants who experienced a traumatic event with one or more trauma-response symptoms had higher odds of clinically relevant depressive symptomatology compared to (1) those who never experienced a traumatic event [odds ratio (OR) 3.2, p < 0.05], (2) and those who experienced a traumatic event without further symptoms (OR 3.7, p < 0.05). Our results suggest that mental health providers who serve older American Indians should consider the experience of traumatic events followed with response symptoms as a potential risk factor for further disruptions in psychological functioning.Item Lower body functioning and correlates among older American Indians: The Cerebrovascular Disease and Its Consequences in American Indians Study(2018-01) Goins, R. Turner; Schure, Mark B.; Jensen, Paul N.; Suchy-Dicey, Astrid; Nelson, Lonnie; Verney, Steven P.; Howard, Barbara V.; Buchwald, DedraBackground More than six million American Indians live in the United States, and an estimated 1.6 million will be aged ≥65 years old by 2050 tripling in numbers since 2012. Physical functioning and related factors in this population are poorly understood. Our study aimed to assess lower body functioning and identify the prevalence and correlates of “good” functioning in a multi-tribe, community-based sample of older American Indians. Methods Assessments used the Short Physical Performance Battery (SPPB). “Good” lower body functioning was defined as a total SPPB score of ≥10. Potential correlates included demographic characteristics, study site, anthropometrics, cognitive functioning, depressive symptomatology, grip strength, hypertension, diabetes mellitus, heart disease, prior stroke, smoking, alcohol use, and over-the-counter medication use for arthritis or pain. Data were collected between 2010 and 2013 by the Cerebrovascular Disease and Its Consequences in American Indians Study from community-dwelling adults aged ≥60 years (n = 818). Results The sample’s mean age was 73 ± 5.9 years. After adjustment for age and study site, average SPPB scores were 7.0 (95% CI, 6.8, 7.3) in women and 7.8 (95% CI, 7.5, 8.2) in men. Only 25% of the sample were classified with “good” lower body functioning. When treating lower body functioning as a continuous measure and adjusting for age, gender, and study site, the correlates of better functioning that we identified were younger age, male gender, married status, higher levels of education, higher annual household income, Southern Plains study site, lower waist-hip ratio, better cognitive functioning, stronger grip strength, lower levels of depressive symptomatology, alcohol consumption, and the absence of hypertension, diabetes mellitus, and heart disease. In our fully adjusted models, correlates of “good” lower body functioning were younger age, higher annual household income, better cognitive functioning, stronger grip, and the absence of diabetes mellitus and heart disease. Conclusions These results suggest that “good” lower body functioning is uncommon in this population, whereas its correlates are similar to those found in studies of other older adult populations. Future efforts should include the development or cultural tailoring of interventions to improve lower body functioning in older American Indians.