Jon Tilburt, MD - Assessing Health Priorities of Tribal Health Directors with Surveys: Lessons from...

Assessing Health Priorities of Tribal Health Directors with Surveys: Lessons from a pilot study?

Jon Tilburt, MD, Mayo Clinic

Native American Interest Group Mayo Clinic, Rochester, MN November 3, 2014

Where’s the bullet ?

You cain’t say!

Our knowledge limited by the tools we use to gather information

John Tarpley, MD

“You see what you look for; you diagnose what you know.”

Bottom Line: Survey Methods

• are a crucial research tool • to prepare for change • can help avoid focusing on pet topics • can be used to link potential partners • can help honor sovereignty, BUT • Come with biases, assumptions & values

– that must be acknowledge – can’t be substituted for listening – tell only part of the study

Objectives

• Moving toward change • Change and “pet topics” • Research, sovereignty, & change • Merits & Mischief of surveys • Experience using surveys

Change

Moving toward Change

• Change requires – building on partner assets – building on what’s already going on – sustained energy – local champion – capacity

• Must acknowledge – competing priorities – Opportunity costs

Change and “Pet Topics”

Pet Health Topics

• Cancer screening • Heart disease • Immunizations • HIV • Education • Maternal/Child health • Addiction • PTSD

Men’s Health

www.menshealthnetwork.org

Men’s Health

• An important topic • Policy opportunities • Grass roots efforts ongoing • Just a “pet topic”, priority, or something else

nativemenshealth.org

Researcher Challenge

• Go for what is fundable • Go for what is important, for change

Research, Sovereignty, & Change

In order to meaningful research that leads to community change researchers need to be able to • Ask • Listen • Link • Bond • Submit • Sell • Persevere

How about a survey?

Survey Merits & Mischief

Survey methods are a powerful (but limited) social science tool to build

toward change

Estimating What Is

Features of the Method Itself

• Discrete number of carefully worded items • Closed ended • High-level summaries for distracted audiences • A high-level snap shot • Quantitative • At one moment in time

Survey Merits

• Quick • Cost-effective • More “generalizable” • Great “snap shot” • Fit “national” scale

Survey Mischief

• Only as good as question • Often close-ended less curiosity

Surveys can’t measure

• Meaning • Motivation • Complex behaviors/relationships • Nuance

Are surveys strong or weak?

Can surveys facilitate change?

• Asking • Listening • Linking • Bonding • Submitting • Selling • Persevering

Experience

Beyond “Pet Topic” Research

• Men’s health & local Indian health leadership priorities?

• Opportunities to ask leaders, link expertise, priorities & capacity?

• Can we ask without “leading the witness” • ? platform to convince funding bodies (sell)

Motivating Question

How does men’s health fit with tribal leadership priorities?

Bottom Line Answer:

It depends on how you ask

Survey “Native Community Health Needs & Research Interests”

• Spring 2014 • 448 ITU directors • Topic: men’s health, health priorities, working w/

researchers, • 372 with known emails • 103 bounced back (leaving 269) • Mayo Clinic IRB #13-005953 (exempt) • 87/269 (32% “cooperation rate”) • 87/448 (19% “response rate”)

Priorities Assessment (top 5) • Men’s Health as an issue We want to know which health issues are of greatest concern in your community. For the list of broad health issues below, please select one issue for each of the five priorities on which your community intends to focus or grow programs in the coming 3-5 years (Indicators of priorities might include areas of relative anticipated personnel or budgetary growth, for example.) Priority #1 (please choose one) Tobacco Cancer screening Diabetes Obesity Suicide Addiction and its Consequences Men's health Women's health Public safety Access to basic dental services Social assistance issues Adapting to health care reform access to clinical trials Domestic violence Sexual abuse Other

Men’s Health Contents

• Men’s Health as a strategy For each priority . . . “Please rate the importance of gender targeted approaches for each priority” (very, somewhat, not important)

• Evidence of Men’s health investment

–existing men’s health programs –Offender re-entry or Veteran

programs

Other Survey Contents

• Biggest Challenge implementing priorities (free text)

• Specific Issues (Major, somewhat, not a challenge) – Funding deficiencies; Bureaucratic constraints;

Community leadership issues; Community unrest/resistance; Lack of trained staff

• Working with Researchers (+/-) • Perceived Capacity

Other Survey Content

• Attractiveness of starting something new with researchers

• Confidence that research could lead to change • Examples of success (free text) • Years in current position, stressfulness of work

environment, interested in discussing further.

Men’s Health Activity (n=87)

• Men’s health: 31% (27/80) • Veteran re-integration: 12% (10/87) • Offender re-entry: 18% (16/87)

Top Health Issues

1. Diabetes (61/87)* 2. Alcohol/Substance Abuse (59/87) 3. Mental Health (52/87) 4. Obesity (49/87) 5. Addiction (30/87) 6. Cancer Screening (20/87) … 19. Men’s Health (9/87)

Framed as an “issue” . . .

Men’s health is high on priority list of a few Indian health leaders’

What if its framed as a “strategy”?

Gender-based Strategy

“Please rate the importance of gender targeted approaches for each priority” (very important) • Priority #1 -- 25/87 • Priority #2 -- 33/87 • Priority #3 -- 25/87 • Priority #4 -- 25/87 • Priority #5 -- 30/87

Framed as a “strategy” . . .

Men’s health may be an important means for achieving Indian health

leader priorities in many cases

Men’s Health in Indian Country: “Issue” or “Strategy”?

Working with Researchers

Challenges (major challenge)

• Funding deficiencies (63/87) • Lack of trained staff (25/87) • Bureaucratic constraints (22/87) • Community leadership issues (19/87) • Community unrest/resistance (17/87)

Experience, Capacity, Enthusiasm

• “Usually/Always positive” experience working w/researchers (55/87)

• “Lots of/Sufficient/a little bit of” capacity to take on a research project in a priority area (42/87)

• “Very/Somewhat attractive” (80/87) to take on research program with outreach component in priority area.

Experience Summary

• Few responding ITU leaders have something going in men’s health

• Men’s health as an “issue” high priority for a few

• Gender tailored “strategies” to achieve other priorities, promising

• Useful, but challenging tool

Surveys ≠ Change

• Asking • Listening • Linking • Bonding • Submitting • Selling • Persevering

Asking & Linking

• Avoid familiarity bias (new relationships?) • Open up a conversation • Readiness & capacity

Acknowledgements

• Funding: Mayo Clinic Office of Health Disparities Research

• Alex Fiksdahl, MA (Analyst) • Men’s Health Network • AZ Men’s Health Coalition • Indian Health Service • Wes Petersen, Judith Kaur, Christi Patten, Steve

Alberts, • Phil, Ouran, Pat, Monte, Bryce

Thank You

tilburt.jon@mayo.edu