Tag Archive for: Culturally Informed Care

The Culture is Prevention Project: Measuring Cultural Connectedness and Providing Evidence that Culture is a Social Determinant of Health for Native Americans

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Authors: Paul Masotti, John Dennem, Karina Bañuelos, Cheyenne Seneca, Gloryanna Varlerio-Leonce, Christina Tlatilpa Inong, Janet King

Publication Year: 2023

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Keywords: Social Determinants of Health

 

Short Abstract: Background It is important for non-Native persons to understand that the meaning of culture to Native American/Indigenous Peoples is not about esteem, taste or music but rather is described as a cognitive map on how to be. Native American/Indigenous culture can be thought of as all the things and ways in which Native/Indigenous people understand who they are, where they come from and how they are to interact with others.

 

Abstract: Background It is important for non-Native persons to understand that the meaning of culture to Native American/Indigenous Peoples is not about esteem, taste or music but rather is described as a cognitive map on how to be. Native American/Indigenous culture can be thought of as all the things and ways in which Native/Indigenous people understand who they are, where they come from and how they are to interact with others. Hundreds of years across many generations have taught that culture-based activities and interventions improve Native/Indigenous health and wellbeing. We explore if increased Native American culture/cultural connectedness is associated with better mental health/well-being and physical health. Methods We analyzed data from a two-phased study (N = 259 and N = 102) of 361 urban Native Americans in California (2018–2021). The 29 items validated Cultural Connectedness Scale-California (CCS-CA) measured Native culture/cultural connectedness. Mental health/well-being and physical health were assessed using the: modified Herth Hope Index (mHHI), Satisfaction with Life (SWL), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R-10), Substance Abuse (CAGE-AID), and Health Related Quality of Life (HRQOL). We conducted Pearson correlations and stepwise regression analyses with CCS-CA as the independent (predictor) variable to explore our main research questions: 1) Is increased Native American/Indigenous culture associated with: 1) better mental health/well-being; and 2) better physical health? Results Increased Native/Indigenous culture (CCS-CA scores) is significantly associated with better mental health/well-being (mHHI, p < .001) and satisfaction with life (SWL, p < .001) predicts good physical health days (HRQOL, p < .001). Increased connection to Native American/Indigenous culture (CCS-CA scores) is significantly associated with decreased risk for depression (CESD-R-10, p < .0) and substance abuse and (CAGE-AID, p < .07). Significant results for culture as protective against risk for substance abuse (CAGE-AID) was most likely affected (p value approaching significance) due to an error in language on the measure (i.e., created double negative). Conclusions Native American/Indigenous culture is a predictor of improved outcomes for mental health/well-being and physical healthy days. Native culture is an important social determinant of health. We add to the evidence that Native/Indigenous culture (i.e., cultural connectedness) be considered an important intervention objective and health-related outcome measure.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10120477/pdf/12889_2023_Article_15587.pdf

Type of Resource: Peer-reviewed scientific article

Narratives from African American/Black, American Indian/Alaska Native, and Hispanic/Latinx community members in Arizona to enhance COVID-19 vaccine and vaccination uptake

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Authors: Matt Ignacio, Sabrina Oesterl , Micaela Mercado, Ann Carver, Gilberto Lopez 3, Wendy Wolfersteig 2, Stephanie Ayers, Seol Ki , Kathryn Hamm, Sairam Parthasarathy, Adam Berryhill, Linnea Evans, Samantha Sabo, Chyke Doubeni

Publication Year: 2023

Last Updated: April 2023

Journal:

Keywords: Awareness; Covid-19; Cultural Sensitivity and Appropriateness; Health Disparities; Infection Disease; Minority Groups; Vaccination/Immunization

 

Short Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals.

 

Abstract: The state of Arizona has experienced one of the highest novel coronavirus disease 2019 (COVID-19) positivity test rates in the United States with disproportionally higher case rates and deaths among African-American/Black (AA/B), American Indian/Alaska Native (Native), and Hispanic/Latinx (HLX) individuals. To reduce disparities and promote health equity, researchers from Arizona State University, Mayo Clinic in Arizona, Northern Arizona University, and the University of Arizona formed a partnership with community organizations to conduct state-wide community-engaged research and outreach. This report describes results from 34 virtually-held focus groups and supplemental survey responses conducted with 153 AA/B, HLX, and Native community members across Arizona to understand factors associated with COVID-19 vaccine hesitancy and confidence. Focus groups revealed common themes of vaccine hesitancy stemming from past experiences of research abuses (e.g., Tuskegee syphilis experiment) as well as group-specific factors. Across all focus groups, participants strongly recommended the use of brief, narrative vaccination testimonials from local officials, community members, and faith leaders to increase trust in science, vaccine confidence and to promote uptake.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8942760/

Type of Resource: Peer-reviewed scientific article

Cultural Dynamics, Substance Use, and Resilience Among American Indian/Alaska Native Emerging Adults in Urban Areas

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Authors: Ryan A. Brown et al.

Publication Year: 2022

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Journal: Adversity and Resilience Science

Keywords: Substance Use; Emerging Adulthood; Cultural Identity; Intervention Development; Qualitative

 

Short Abstract: Identity development during emerging adulthood helps lay down the structure of values, social bonds, and decision-making patterns that help determine adult outcomes, including patterns of substance use. Managing cultural identity may pose unique challenges for American Indian/Alaska Native (AI/AN) emerging adults in “urban” areas (away from tribal lands or reservations), who are relatively isolated from social and cultural connections.

 

Abstract: Identity development during emerging adulthood helps lay down the structure of values, social bonds, and decision-making patterns that help determine adult outcomes, including patterns of substance use. Managing cultural identity may pose unique challenges for American Indian/Alaska Native (AI/AN) emerging adults in “urban” areas (away from tribal lands or reservations), who are relatively isolated from social and cultural connections. This isolation is in turn a product of cultural genocide and oppression, both historically and in the present day. This paper uses qualitative data from 13 focus groups with urban AI/AN emerging adults, parents, and providers to explore how cultural dynamics are related to substance use outcomes for urban AI/AN emerging adults. We found that cultural isolation as well as ongoing discrimination presents challenges to negotiating cultural identity, and that the AI/AN social and cultural context sometimes presented risk exposures and pathways for substance use. However, we also found that culture provided a source of strength and resilience for urban AI/AN emerging adults, and that specific cultural values and traditions — such as mindfulness, connection to nature, and a deep historical and cosmological perspective — offer “binding pathways” for positive behavioral health. We conclude with two suggestions for substance use prevention and intervention for this population: (1) incorporate these “binding pathways” for health and resilience explicitly into intervention materials; (2) emphasize and celebrate emerging adulthood itself as a sacred cultural transition.

 

Source: Link to Original Article.

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Source: https://link.springer.com/article/10.1007/s42844-022-00058-w

Type of Resource: Peer-reviewed scientific article

Integrating Professional and Indigenous Therapies: An Urban American Indian Narrative Clinical Case Study

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Authors: Dennis C. Wendt and Joseph P. Gone

Publication Year: 2016

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Journal: Counseling Psychology

Keywords: Cultural Sensitivity and Appropriateness; Ethnicity; Mental and Behavioral Health; Race; Psychotherapy; Spirituality; Religion; Qualitative; Multiculturalism

 

Short Abstract: We present a narrative case study of an urban American Indian male college student who integrated Indigenous and professional therapies during an acute period of stress, loss, and depression.

 

Abstract: We present a narrative case study of an urban American Indian male college student who integrated Indigenous and professional therapies during an acute period of stress, loss, and depression. The first published case of an American Indian in an urban context, this article expands on previous clinical cases by focusing on the perspective of the client relative to his own conceptions of help-seeking behaviors. Based on qualitative analysis of five audio-recorded interviews, this case utilizes an innovative methodology to portray four approaches to healing (medication, counseling, bonding, and spirituality), which contribute to holistic well-being. Implications for counseling psychologists include being aware of how some American Indian clients may (a) view professional treatment dynamics through a Native cultural lens (e.g., seeing ideal communication as a “rhythm”); (b) utilize an expanded range of therapeutic agents; (c) resist medication for cultural and spiritual reasons; and (d) refrain from discussing spiritual matters with professionals.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007066/

Type of Resource: Peer-reviewed scientific article

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention

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Authors: Rachel L. Burrage, Joseph P. Gone, and Sandra L. Momper

Publication Year: 2016

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Journal: American Journal of Community Psychology

Keywords: Cultural Sensitivity and Appropriateness; Mental and Behavioral Health; Suicide and Suicide Prevention; Youth; Prevention; Informal Supports

 

Short Abstract: American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources.

 

Abstract: American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre-existing interview data from 15 self-identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community’s knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.

 

Source: Link to Original Article.

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Source: https://deepblue.lib.umich.edu/bitstream/handle/2027.42/134173/ajcp12080.pdf?sequence=1

Type of Resource: Peer-reviewed scientific article

Urban-Indigenous Therapeutic Landscapes: A Case Study of an Urban American Indian Health Organization

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Authors: Dennis C. Wendt and Joseph P. Gone

Publication Year: 2012

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Journal: Health & Place

Keywords: Cultural Sensitivity and Appropriateness; Health Disparities; Therapeutic Landscapes

 

Short Abstract: We engage and extend the concept of therapeutic landscapes through a case study at an urban American Indian health organization in the Midwestern United States.

 

Abstract: We engage and extend the concept of therapeutic landscapes through a case study at an urban American Indian health organization in the Midwestern United States. This case affords insights at the unique confluence of indigeneity and urbanization, prompting us to coin the construct ‘‘urban indigenous therapeutic landscapes’’ to characterize such sites. These landscapes warrant urgent attention in light of increasing urbanization and health disparities among indigenous peoples internationally. On the basis of thematic content analysis, three themes were identified from 17 open-ended interviews with American Indian community members. Specifically, respondents viewed the health organization as (a) a vital place to be among other American Indians and connected to Native culture, (b) a place where one feels at home and welcome, and (c) a place in which health services are delivered in an especially intimate and hospitable manner. Significant challenges and tensions were also communicated, in terms of unique intersections of health care and indigeneity. Results are interpreted in terms of urban Indian health organizations as urban-indigenous therapeutic landscapes.

 

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Source: http://gonetowar.com/wp-content/uploads/2013/11/TxLandscapes.pdf

Type of Resource: Peer-reviewed scientific article

Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults

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Authors: Elizabeth J. D'Amico et al.

Publication Year: 2021

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Journal: Addiction Science & Clinical Practice

Keywords: Cultural Sensitivity and Appropriateness; Substance Use; Emerging Adults; Resiliency; TACUNA; Opioids

 

Short Abstract: Nonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18–25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development.

 

Abstract: Background Nonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18–25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. Data from 2015 show that American Indian/Alaska Native (AI/AN) people have the highest rates of diagnosis for opioid use disorders (OUDs). One recent study found that the overdose death rate among urban-dwelling AI/AN individuals was 1.4 times higher compared to those living in rural areas. To date, there are no evidence-based prevention programs addressing opioid use among urban AI/AN emerging adults that integrate culturally-appropriate strategies with evidence-based treatment. Traditions and Connections for Urban Native Americans (TACUNA) builds on our prior work with AI/AN communities across California to develop and evaluate culturally appropriate programming to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults. Methods/design In a randomized controlled trial, 18–25 year old urban AI/AN emerging adults will receive either TACUNA (n = 185), which comprises three virtual workshops utilizing motivational interviewing, social network visualization, and integrating traditional practices and a wellness circle, or one virtual culturally sensitive opioid education workshop (n = 185). We will evaluate intervention effects on primary outcomes of frequency of opioid, alcohol, and cannabis use, as well as secondary outcomes of social network characteristics and cultural connectedness, over a 12-month period. Discussion This project has the potential to expand the range and effectiveness of opioid, alcohol, and cannabis services for urban AI/AN emerging adults by addressing the opioid epidemic and use of other substances at both the community and individual level. In addition, it provides important culturally grounded conceptual and practical information to advance the field of substance use interventions and enhance resiliency among this population.

 

Source: Link to Original Article.

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Source: https://link.springer.com/article/10.1186/s13722-021-00265-3

Type of Resource: Peer-reviewed scientific article

Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial

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Authors: Elizabeth J. D'Amico et al.

Publication Year: 2020

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Journal: Journal of Substance Abuse Treatment

Keywords: Cultural Sensitivity and Appropriateness; Substance Use; Adolescents; Motivational Interviewing; Intervention; Traditional Practices

 

Short Abstract: To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design.

 

Abstract: To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014–2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14–18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477923/

Type of Resource: Peer-reviewed scientific article

Effects of culturally tailored smoking prevention and cessation messages on urban American Indian youth

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Authors: Marco Yzer et al.

Publication Year: 2021

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Journal: Preventive Medicine Reports

Keywords: Cultural Sensitivity and Appropriateness; Health Disparities; Tobacco Use (non-traditional); Smoking Cessation; Youth; Cultural Tailoring

 

Short Abstract: American Indians (AI) face significant disparities in smoking-related diseases. In addition, smoking prevalence increases exponentially between ages 11 and 18. Smoking prevention and cessation efforts aimed at AI youth therefore are important. In order to strengthen understanding of evidence-based message strategies for smoking prevention and cessation among AI youth.

 

Abstract: American Indians (AI) face significant disparities in smoking-related diseases. In addition, smoking prevalence increases exponentially between ages 11 and 18. Smoking prevention and cessation efforts aimed at AI youth therefore are important. In order to strengthen understanding of evidence-based message strategies for smoking prevention and cessation among AI youth. The objective of this study was to test whether a message that was tailored to AI cultural values associated with the sacredness of traditional tobacco can change variables that behavioral theories have identified as predictors of smoking (i.e., instrumental and experiential attitudes, injunctive and descriptive norms, perceived capacity and autonomy, and intention with respect to smoking). We conducted a randomized field experiment among 300 never-smoking and ever-smoking urban AI youth in Minneapolis-Saint Paul between May 18 and July 27, 2019. We used a 3 (message condition: cultural benefits of not smoking cigarettes, health benefits of not smoking cigarettes, comparison message about benefits of healthy eating) × 2 (smoking status: ever-smoked, never-smoked) between-subjects design. Multivariate analysis of variance showed that for ever-smokers, the cultural consequences of smoking message significantly lowered instrumental attitude (partial eta2 = 0.029), experiential attitude (partial eta2 = 0.041), perceived capacity (partial eta2 = 0.051), and smoking intention (partial eta2 = 0.035) compared to the healthy eating comparison message and the health consequences of smoking message. This was not observed among never-smokers, who already had very negative smoking perceptions. We conclude that messages that tailor to AI culture may be effective tools for discouraging smoking among AI youth.

 

Source: Link to Original Article.

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Source: https://reader.elsevier.com/reader/sd/pii/S2211335521002308?token=67C271FD1BE119934DCFB16CB491FA12F86702E0B83DC66A0DC54B0BDE5E77E3E872AFF96323FD8696981636F06E93F6&originRegion=us-east-1&originCreation=20230213211721

Type of Resource: Peer-reviewed scientific article

Mental health, family functioning, and sleep in cultural context among American Indian/Alaska Native urban youth: A mixed methods analysis

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Authors: Alina I. Palimaru

Publication Year: 2022

Last Updated:

Journal: Social Science & Medicine

Keywords: Cultural Sensitivity and Appropriateness; Mental and Behavioral Health; Socio-Economic Disparities; Family; Youth; Sleep; Actigraphy; Mixed Methods

 

Short Abstract: Mental health problems contribute significantly to the global burden of disease. Driven in part by family stressors and insufficient sleep, mental health disproportionately affects low SES urban adolescents. In the United States, American Indian/Alaska Native (AI/AN) youth exhibit excessively high rates of mental health problems. Family functioning is strongly associated with adolescent mental health, and sleep problems may serve as a pathway between family functioning and mental health. Using mixed methods we examine the associations among family functioning, subjective- and actigraphy-measured sleep, mental health (depressive and anxiety symptoms), and cultural identity in a sample of urban AI/AN youth.

 

Abstract: Mental health problems contribute significantly to the global burden of disease. Driven in part by family stressors and insufficient sleep, mental health disproportionately affects low SES urban adolescents. In the United States, American Indian/Alaska Native (AI/AN) youth exhibit excessively high rates of mental health problems. Family functioning is strongly associated with adolescent mental health, and sleep problems may serve as a pathway between family functioning and mental health. Using mixed methods we examine the associations among family functioning, subjective- and actigraphy-measured sleep, mental health (depressive and anxiety symptoms), and cultural identity in a sample of urban AI/AN youth. All participants (N = 142) completed surveys; a random subsample (n = 26) completed qualitative interviews to assess family and cultural dynamics related to sleep, which informed hypothesized direct and indirect effects that were tested using survey data. Narratives identified mechanisms of family cohesion (e.g., daily interactions that build perceived family togetherness and family-centered traditional activities) and the role that family cohesion plays in sleep (e.g., ensuring stability of sleep environments). Path analysis showed direct effects of improved family functioning on fewer depressive and anxiety symptoms, and indirect effects through lower self-reported sleep disturbance (but not through greater actigraphy-measured sleep duration or efficiency). Cultural identity did not moderate effects in quantitative tests. Our findings illustrate the complex associations among family functioning, sleep, and mental health in AI/ AN youth. Family-based interventions to improve adolescent mental health should address modifiable inter-vention targets such as sleep, and address sources of both risk and resilience relevant to urban AI/AN families, including extended family and cultural practices.

 

Source: Link to Original Article.

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Source: https://reader.elsevier.com/reader/sd/pii/S027795362100914X?token=483DC46A40790C32DB219B0D6C39C8328FC4937C9148E279B054798719CEB15FC24716A71D9D2CBA692237E258E06B75&originRegion=us-east-1&originCreation=20230213210922

Type of Resource: Peer-reviewed scientific article