Using Community-based Participatory Research To Address Disparities In Obesity And Diabetes Among...
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Using Community-based Participatory Research To Address Disparities In Obesity And Diabetes Among American Indians/Alaskan Natives: A Focus On The Partnership Development Process Community Campus Partnership for Health 13 th Annual International Conference May 3, 2014 10:30 AM – 12:00 PM Ramin Naderi, MA Jan Vasquez , CHES, MPHc Lisa Goldman Rosas, PhD, MPH Jill Evans, MPH
Using Community-based Participatory Research To Address Disparities In Obesity And Diabetes Among American Indians/Alaskan Natives: A Focus On The Partnership
Using Community-based Participatory Research To Address
Disparities In Obesity And Diabetes Among American Indians/Alaskan
Natives: A Focus On The Partnership Development Process Community
Campus Partnership for Health 13 th Annual International Conference
May 3, 2014 10:30 AM 12:00 PM Ramin Naderi, MA Jan Vasquez, CHES,
MPHc Lisa Goldman Rosas, PhD, MPH Jill Evans, MPH
Slide 2
Introductions Introduce yourselves Are you an academic partner,
community partner, or something else? Level of experience with CBPR
Brainstorm challenges with building a successful CBPR partnership
Assign a spokesperson to report to larger group
Slide 3
Forming a CBPR partnership BackgroundEvaluating the partnership
Outcomes and future directions of partnership Group Exercise
Outline
Slide 4
BACKGROUND
Slide 5
American Indian/ Alaskan Native Peoples Prior to colonization
10 million AIANs By 1860 250,000 remaining Health of AI/ANs has
been shaped by: Warfare and other forms of aggression, diplomatic
manipulation, forced assimilation, legal actions, contagious
diseases to which they had no immunity, and economic pressure for
over 500 years IHS responsible for providing health services
through treaty Medicare$7,631 VA$5,234 Medicaid$5,012 Prison$3,985
IHS$2,130
Slide 6
Santa Clara County 50,000 American Indian/Alaska Natives
(including mixed race) Diabetes County Wide = 7.9% Overweight (37%)
and Obese (15%) = 52% Based on the California Health Interview
Survey (CHIS) 2007, Center for Health Statistics, and Department of
Finance population estimates.
Slide 7
Indian Health Center: A Federally Qualified Health Center
(FQHC) Established in 1976 to support the health and wellness needs
of American Indians in Santa Clara County
Slide 8
IHC Wellness Center Fitness center Health education Case
management and referral Transportation Injury prevention Cultural
activities
Slide 9
Wellness Center: The Setting Socialization Group activities
Supportive environment for fitness regardless of ability Welcoming
Cultural sensitivity Celebration Building community
Slide 10
IHCs DPP (Based on NIH/NIDDK DPP study) National research study
on diabetes prevention: Conducted 1999 2001 3,000 participants All
races Study showed that: Losing 7% of body weight, and Increasing
physical activity to 150 minutes per week decreased chances of
developing diabetes by 58% (twice as much as medication)
Slide 11
IHCs Diabetes Prevention Program (DPP) (Based on NIH/NIDDK DPP
study) After core support & activities Practicing a healthy
lifestyle Incentives Ongoing celebrations Healthy cooking classes
Group support Interactive Curriculum Fitness instruction Nutrition
education Fitness classes Lifestyle coaching Health education
Healthy food & snacks Goal Lose body weight and increase
physical activity to prevent diabetes. Connect healing with fun,
recreation, and fellowship and to empower.
Slide 12
Multi-disciplinary Team Approach As compared to the national
sample, participants at IHC are more likely to be: Unemployed (42%
vs. 19%) Making less than $15,000 annually (44% vs. 21%) Have
higher rates of co-occurring illnesses (High blood pressure,
depression, arthritis, back pain) Have higher rates of negative
emotional experiences (distress, posttraumatic stress, anger-
especially older males
Slide 13
DPP Holistic Approach Holistic and based on American Indian
Cultural Practices We address the 4 aspects of a person: Physical
Mental Spiritual Emotional
Slide 14
Multi-disciplinary Team Approach MD Mental Health Counselor
RD/CDE Health Education Specialist Kinesiologist Registered Nurse
Fitness instructors Data coordinator Patient advocate Volunteers,
interns
Slide 15
IHCs DPP Annual Conversion Rate to Diabetes
Slide 16
FORMING A CBPR PARTNERSHIP
Slide 17
With so many successes, why the need for CBPR? To reduce
disparities by addressing gaps in the current model Address
historical trauma through diverse strategies developed through
community engagement Increase Lifestyle coaching (case management)
Add tools that assess and measure historical trauma Add DPMP Why
CBPR?
Slide 18
Goals of CBPR Sustain and expand DPP program Increase funding
to enhance DPP to address specific historical trauma issues related
to our community Analyze DPP data Publish Disseminate Empower
community
Slide 19
Partnership Formation CBPR
Slide 20
Partnership formation process Attended CBPR Summer Institute at
UCSF and UCB Introduced to Stanford Office of Community Health
(OCH) Office of Community Health (OCH) searched within Stanford for
a good match Program on Prevention Outcomes and Practices
(PPOP)
Slide 21
Embarking on a Co-Learning Process IHC Mission To ensure the
survival and healing of American Indians by providing health
Stanford PPOP Mission To improve population health outcomes through
research that fosters evidence-based prevention interventions care
and wellness services IHC Mission To ensure the survival and
healing of American Indians by providing health Stanford PPOP
Mission To improve population health outcomes through research that
fosters evidence-based prevention interventions care and wellness
services Stanford PPOP Mission To improve population health
outcomes through research that fosters evidence-based prevention
interventions Stanford OCH Mission To develop, implement, and
integrate education, research, and clinical training programs aimed
at building leaders in community health Urban American Indian
Alaska Native Community
Slide 22
Collaborative Visioning Process This is an equal research
partnership between IHC and the Stanford University PPOP to
demonstrate effective models for improving health, reducing
disparities, and informing policy. As a partnership, we value
meaningful community engagement, primary prevention and wellness,
and rigorous research methodology We are committed to
sustainability of the IHC Community Wellness and Outreach
Programs
Slide 23
Partnership Agreement Development Process Collected examples
and identified components that reflected our needs Identified
common values, short-term goals, long-term goals Significant
co-learning: Urban AI/AN culture IHC wellness promotion Biomedical
research model CBPR Grant writing
Slide 24
Establish American Indian Community Action Board (AiCAB)
Strategized on how to incorporate diverse segments of Urban AI/AN
community Recruited 10 identified leaders Conducted digital
story-telling workshop Obtained seed grant from Stanford OCH
Conducted 3 four-hour workshops to develop group cohesion
Implemented Prevention Institute Training Completed CBPR
certification
Slide 25
AiCAB Members 2013 Board Members
Slide 26
PARTNERSHIP EVALUATION
Slide 27
Partnership Evaluation Adapted tool developed by Schultz et.
al. in 2003 to reflect urban AI/AN context OCH staff conducted
in-depth interviews with CAB members, IHC and PPOP staff 8 of 10
CAB members participated in in-depth interviews Partnership
interpreted findings collaboratively
Slide 28
Evaluation Findings Environmental characteristics shaped group
dynamics Importance of Urban AI/AN history and culture Previous
negative perceptions/experiences with academia/ Stanford University
Diversity and complexity of urban AI/AN community Community
perceptions of diabetes prevention
Slide 29
Evaluation Findings Group Dynamics Strong Evidence for: Shared
leadership Open communication Development of conflict resolution
process Cooperative development of goals Participatory decision
making (consensus) Development of mutual trust Well-organized
project management
Slide 30
Evaluation Findings Intermediate measures of partnership
effectiveness HIGH Member involvement and commitment Group and
community empowerment Benefits of participation Moderate to high
perceived effectiveness MODERATE TO HIGH
Slide 31
Lessons Learned Urban AI/AN culture at core of all activities
Initiation of partnership by community partner is ideal Sincere and
participatory co-learning was critical to process Overlapping goals
contributed to successes Stanford OCH provided key resources and
played critical facilitation and evaluation role
Slide 32
OUTCOMES AND FUTURE DIRECTION OF PARTNERSHIP
Slide 33
Early outcomes CBPR process: AiCAB Co-learning/training
activities IRB training Grants: Submitted R24 to NIMHD 2
successfully funded seed grants Successful CDC REACH grant
Successful PCORI grant CHRI grant (pending) Kaiser Community
Benefit grant (pending) Awards R24 unintended consequences
Derogatory comments in the review Collaboration with NIHB &
NCUIH Similar experiences among other AIAN groups Raise awareness
about unfair reviews for AIAN studies Advocated for training of
reviewers at NIH Article accepted for publication in AJPH
Slide 34
Near Future Develop local community IRB Expand programming and
research to reach AI/AN adolescents Increase capacity in addressing
historical trauma Continuously monitor and evaluate partnership
development process Develop tool kit with strategies for community
engagement in urban AIAN communities
Slide 35
Future Enhance DPP Bring DPMP to Native population Publish
Disseminate to other Native communities Achieve policy changes
Improve diabetes outcomes for AI/AN in Santa Clara County
Slide 36
Group Exercise: Solutions for Building a Successful CBPR
Partnership
Slide 37
Group Exercise Brainstorm potential solutions for building a
successful CBPR partnership Assign a spokesperson to report to
larger group
Slide 38
Our Challenges Developing trust (with each other and AI/AN
community) Our institutions Aligning goals Leadership challenges to
goal Slow process Adequate funding
Slide 39
Overcoming Challenges Having a broker Good match from the
beginning All team members had years of experience in community
Everyone was invested in making partnership work Taking time to lay
the groundwork Listening to everyone about direction Valuing and
acting on everyones contributions Establishing co-learning from the
start Consistency (always showing up) Going through challenges made
us a stronger team Having support from IHS An extended network of
support Raising awareness throughout the country Bringing in
funding Having optimism and hope
Slide 40
Thank You Urban AI/AN community of Santa Clara Valley AiCAB
members IHC staff PPOP staff OCH Staff
Slide 41
Contact Us Ramin Naderi, MA Community Wellness and Outreach
Director [email protected] Jan Vasquez (Chacon), CHES, MPHc
Associate DPP Director [email protected] Lisa Goldman-Rosas, PhD,
MPH Research Director, PPOP [email protected] Jill Evans, MPH
Research Program Director, OCH [email protected]