Llanque: Historical background

Sarah Llanque, NURS 7455

Introduction

This annotated bibliography includes five relevant articles to describe how CBPR is used with Native Elders suffering from chronic disease. These articles were chosen due to being recently published (within the past 10 years) and their relevance to the topic at hand. Each article provides insight in how chronic disease affects Native Elders, as well as how interventions, which are rooted in the community can change the course of the disease process. All articles, have addressed, in some form or another, the fact that researchers must respect the community they are engaged in, and acknowledge the historical trauma, broken treatise, and current social conditions that Native Elder current face. In spite of this, hope rings through these articles as the authors provide implications for future research to address how researchers can use CBPR to empower Native communities and build community capacity.

Goins, R. T., & Pilkerton, C. S. (2010). Comorbidity among Older American Indians: The Native Elder Care Study. J Cross Cult Gerontol, 25(4), 343-354. doi: 10.1007/s10823-010-9119-5

Goins and Pilkerton set the stage in uncovering rates of chronic disease amongst Native Elders. They describe comorbidities affecting Native Elders in their Native Elder Care Study. Goines and Pilkerton state that there is a dearth of studies addressing comorbidities affecting Native Elders. To rectify this they conducted a cross-sectional study looking at rates of diabetes, hypertension, lower back pain, and vision loss amongst the population. They also looked at socio-demographic information, functional limitations and psychosocial correlates of comorbidity. In a sample of n=505 Native Elders aged 55 years and older, they found that Native Elders experience higher rates of chronic disease compared with other groups of Elders (national statistics). Approximately 2/3rds of the sample experienced some form of chronic disease. Depression, old age, poor physical health, and lower personal mastery scores where correlates of higher comorbidity. Key findings from this study support the need for chronic disease interventions for Native Elders.

Holkup, P. A., Tripp-Reimer, T., Salois, E. M., & Weinert, C. (2004). Community-based participatory research: An approach to intervention research with a Native American community. ANS. Advances in nursing science, 27(3), 162-175.

Holkup et al. (2004) introduces the reader to using community-based participatory research with their Native American Elder’s study. Realizing that past research methodologies have poor results with marginalized and minority participants, Holkup et al. advocates that researchers use CBPR. However, the authors note specific challenges they have encountered with this methodology. These challenges include issues of confidentiality, how to manage information from the study that may cast the Native community in a negative light, and ownership of data. Another concern with using the CBPR approach is time. Many hours were donated by the research team prior to receiving funding for their study. Developing trust with the community takes time. Key points this article provides is how they evaluated their research project. Due to the naturalistic or qualitative methods they used they identified four criterion that would to evaluate the study. They include: a) level of community involvement, b) community voice to address community participation, c) acceptable problem resolution, and d) feasibility of project sustainability. The article does not provide results from the study itself. I wish it did, because it would have been helpful in seeing how the CBPR methodology impacts outcomes with Native Elders.

Roubideaux, Y. (2002). Perspectives on American Indian health. American Journal of Public Health, 92(9), 1401-1403.

Dr. Roubideaux provides a candid look at the Native health experience in Indian country. She discusses her, as well as her relatives experience, with using the Indian Health Service and the long waits to receive health care. She discusses the federal trust responsibility to provide health care for Native people based on multiple treatise and court decisions, many of them broken. Moreover, federal funds for Indian Health are severely underfunded. In spite of these challenges and obstacles, there are positive changes that have occurred in recent time. Some tribes have opted to manage the health of their community independent from IHS, which has result in successful program. Additionally, many tribes have taken the initiative in improving their health by implementing wellness programs and fitness centers, as well as understanding their traditions related to health. One key element of this article is that Roubideaux (2002) expresses that “we must resist the temptation to enter Indian communities as ‘experts’ who will control programs and outcomes… A more productive role is to be a resource to the community and health to build local capacity” (p. 1403).

Moss, M. P. (2005). TOLERATED ILLNESS™ Concept and Theory For Chronically Ill and Elderly Patients As Exemplified in American Indians. Journal of Cancer Education, 20(sup1), 17-22. doi: 10.1207/s15430154jce2001s_05

In this article Dr. Moss introduces the reader to the concept and theory of Tolerated Illness™ derived from her work and ethnographic research with Zuni Elders. Chronic disease effects Native people at, not only, a higher rate but also at a much younger age than the over all US population. Additionally, past research has found that Natives Elders with chronic disease and/or disabilities may see their health as fair or good, in spite of their chronic condition. Moss goes on to illustrate that Zuni elder’s ability to perform their prayers and blessings, or attend traditional and religious ceremonies were more correlated with their function than ADL determinations. A key point that Moss discusses in this article is that of the concept of Tolerated Illness™ which results in the Native Elders rating their self-rated health status as more favorable than their functional health status (ADLs or IADLs). One probable reason for this is to not want to make trouble for one’s family members and to maintain one’s role as an elder within the household. Moss’ ethnographic work found that maintaining a positive outlook was a cultural value health of elders in Pueblo areas. The concept and theory of TI should be used with chronically ill Native Elders, as a means of assessing the Elders and guiding practitioners and researchers in care and advocacy.

Jernigan, V. B. B. (2010). Community-Based Participatory Research With Native American Communities: The Chronic Disease Self-Management Program. Health Promotion Practice, 11(6), 888-899. doi: 10.1177/1524839909333374

Jernigan’s 2010 CBPR intervention was the only study that used CBPR and included results from her intervention with Native Elders. Specifically, Jernigan used CBPR in an urban Native American community to implement the Stanford Chronic Disease Self-Management Intervention to address diabetes education and prevention in participants. She describes how she started out as a community health services director in an Indian Health Center in Santa Clara Valley, California. She had to gain the trust of the community since she was considered an outsider. She was able to do this with the help of an Elder. The Diabetes Community Action Project was detailed as a success. However, she did not use instruments to measure success of the program, but rather, assessed if goals were met. Goals included whether participants showed up and participated in the program, individual interventions, usage rates of the wellness and fitness center, and attendance in the next class, as well as community events. These outcomes are unique for research interventions. Interviews were also conducted with participants to assess the success of the program. The goal of the intervention was to see if participants engaged in healthier lifestyles, of which they did.

Conclusion

After reading these articles and writing a brief summary with key points and pros and cons of each article, I feel that these articles provide me some insight on the community I have partnered with. I am more convinced than ever, that I am in the right path with my research with Native Elders and using a CBPR approach to impact chronic disease in this population. Although, there are few studies that document rates of chronic disease and comorbidities amongst Native Elders, there is a need to partner with communities and be a resource for communities rather than the “expert.” Based on my positionality in this field assignment I propose the following research question with this population:
What successful CBPR interventions have been used with indigenous (American Indian, Alaskan Native, Hawaiian, Maori, Aboriginal people, etc.) Elder populations?