C. June Strickland

Challenges in community-based participatory research implementation: experiences in cancer prevention with Pacific Northwest American Indian tribes.

BACKGROUND Much has been written about community-based participatory research (CBPR) history and principles, but few have addressed challenges in implementation in transcultural situations. The goal of this discussion is to address CBPR implementation issues in cancer prevention research with American Indian tribal communities in the Pacific Northwest. METHOD Information in this discussion is drawn from qualitative research conducted over a 10-year period in which CBPR was employed in cancer prevention research with Pacific Northwest Indian tribes. CBPR principles provide the framework for the discussion: establishing trusting relationships, assuring participation, sharing power, and communicating. RESULTS In this work, we found that CBPR is appropriate for use in Pacific Northwest Indian tribal communities and is compatible with cultural values. We also found that there are many challenges. Recommendations are provided on needed institutional and structural changes. CONCLUSIONS CBPR is an important research approach in addressing cancer prevention health disparities among American Indian tribal communities. Continued effort needs to be directed toward creating systems and structures to support researchers in utilizing this method. Findings are of value to researchers aiming to implement CBPR in Indian communities and to practitioners, policy makers, and administrators who make decisions about CBPR funding and support structures.

Healing fractured families: parents' and elders' perspectives on the impact of colonization and youth suicide prevention in a Pacific Northwest American Indian tribe

Suicide rates among American Indian youth in the United States are two to three times the national average. Risk factors for American Indian youth include depression, alcohol use, hopelessness and stress, and family conflict, abuse, poverty, and instability. In this descriptive study, the authors aimed to obtain parents’ and elders’ perspectives on community needs and to identify strengths on which the community might build to reduce youth suicide risk. Data were collected from focus groups with 40 American Indian parents and from individual interviews with 9 American Indian elders. The major task participants addressed was holding the family together and healing intergenerational pains. Topics parents discussed were holding onto cultural values, holding the family together, getting through school, and getting a job. These findings substantiate previous research and provide useful information for the design of culturally appropriate family or community-based interventions to prevent American Indian youth suicide.

The importance of qualitative research in addressing cultural relevance: experiences from research with Pacific Northwest Indian women.

Across Indian communities, the spirit of self-determination is in the air. Tribes are contracting with the federal government in order to take responsibility for health and governance as sovereign nations. For too long others have defined tribal needs, conceptualized tribal problems, and used their theoretical models in implementing interventions. In this age of self-determination, more tribal communities want to partner with others in studies affecting their communities. Qualitative research offers an approach that can be responsive to community needs. The strength of one qualitative method, Grounded Theory, for example, is presented here as one such tool. Using Grounded Theory in two Pacific Northwest tribal communities, the first study looked at attitudes about Papanicolaou (Pap) test screening and the second looked at conceptualization of pain. It is suggested that qualitative research is of particular value to the design of culturally relevant interventions.

Health Promotion in Cervical Cancer Prevention among the Yakama Indian Women of the Wa’shat Longhouse

The purpose of this 3-year study was to gain a greater understanding of the importance of the Wa’Shat Longhouse religion to the design of a culturally appropriate health promotion (cervical cancer prevention) program with the Yakama Indian people of eastern Washington. This descriptive study involved interviews with 10 Wa’Shat members, observations, and participant observations of 30 community ceremonial activities. The framework of health promotion planning guided the investigation. We found that (a) program goals needed to be holistic and wellness oriented, (b) teaching methods needed to include circular symbols, and (c) intervention strategies needed to be linked to the natural patterns of communication of the Wa’Shat Longhouse and to involve elders. Storytelling, talking circles, and use of role models were all found to be important teaching methods. We confirm previous perspectives on the importance of religion, provide greater depth in this understanding and outline implications for transcultural nursing practice.

Respecting tribal traditions in research and publications: voices of five Native American nurse scholars.

A dialogue with five Native American scholars provides insight into conducting research and publishing resulting manuscripts on Native American topics, specifically healing beliefs and practices. This information provides a means to develop sensitivity and create understanding about concerns held by Native Americans regarding sharing certain defined cultural information with those outside the culture. The article identifies salient tribal issues related to research, discusses perspectives important to tribal nations and Native individuals surrounding research, and supplies a base on which to formulate further discussions

Suicide Among American Indian, Alaskan Native, and Canadian Aboriginal Youth: Advancing the Research Agenda

Youth suicide robs a people of its dreams, its investment in the future, and its hope of passing the culture on to future generations. Although much research work has been done, the problem continues unabated. The purpose of this paper is to provide a review of research concerning suicide among native North American youth and to recommend a prevention research agenda to address gaps in knowledge. The paper is divided into three sections. The first section focuses on suicide rates by ethnicity, gender, and region. Risk factors are considered in the second section, with particular attention given to individual, family, tribal, and community factors. Finally, I highlight unanswered questions and propose a research agenda.

Research to practice: developing an integrated anaphylaxis education curriculum for school nurses.

The numbers of school-aged children with life-threatening allergies that cause anaphylaxis continues to increase. Many states, including Washington, have responded to this by developing specific guidelines for school districts to follow in order to provide a safe learning environment for children with medical conditions that put them at risk for anaphylaxis. School nurses require resources to assist them in providing health training for school staff on how to manage potentially life-threatening health conditions for children in their school, however, resources to address this training are limited. A search for and content analysis of currently available literature and resources about anaphylaxis and anaphylaxis training curricula revealed a lack of an integrated curriculum to train school staff. This article presents a discussion of the development of a train-the-trainer anaphylaxis education program providing school nurses with curriculum, lesson plans, teaching–learning activities, and resources for anaphylaxis education of all school staff.

Getting Into Trouble Perspectives on Stress and Suicide Prevention Among Pacific Northwest Indian Youth

Suicide rates among Indian youth in the United States are two to three times the national average. Although researchers have identified related risk and protective factors, they have limited understanding of the perspectives of youth at risk. In this descriptive, ethnographic study in a Pacific Northwest tribe, the goal was to gain an understanding of the life experiences of the youth. Focus groups and observations were conducted with 30 Indian youth aged between 14 and 19 years in a Pacific Northwest tribe. Youth were asked to talk about their stressors, sense of family/community support, and hopes for the future. Youth reported major stress and noted that friends and family were both a support and also a source of stress. They hoped for strengthening of cultural values, economic development, and opportunities to give their talents to the tribe. These findings provide further insight about suicide risk among Indian youth and advance the understanding of suicide prevention in a transcultural setting.

Retention of native American nurses working in their communities

Purpose: The purpose of this study was to describe the experiences of Native American nurses working in their tribal communities to address retention. Design: An interpretive phenomenological study guided by a Native American research agenda and a Native American nursing practice model. Methods: In-depth interviews with nine Native American nurses were conducted. Data analysis used interpretive phenomenological procedures including an iterative process with Native American consultants and researchers to develop themes. Conclusions: Native American nurses experienced a great deal of stress and illness as they attempted to fulfill their mission to help their people. The three themes were: (a) paying the price to fulfill my mission, (b) being and connecting holistically, and (c) transcending the system. Recommendations include strategies for nurse educators, tracking the ethnicity of nurses in each Indian Health Service area, documenting their reasons for leaving, and conducting further research to develop community-based interventions to improve retention.

Developing an academic and American Indian tribal partnership in education: a model of community health nursing clinical education.

American Indian tribes shoulder a heavy burden in health inequities and recognize the value of partnerships with academic institutions. This article describes a unique education model developed through a partnership between a school of nursing and 2 Pacific Northwest tribes to provide clinical education for students. Over 3 years, students and faculty worked with 2 tribal communities to design research and implement education programs.