Mark C. Bauer

Using Cultural Knowledge in Health Promotion: Breastfeeding among the Navajo

Although many attempts have been made to promote breastfeeding in a variety of contexts, few programs have explicitly incorporated cultural beliefs in these efforts. This article describes a breastfeeding promotion program conducted on the Navajo reservation. This program was designed to be culturally appropriate. Background information regarding beliefs and factors affecting infant feeding practices in this setting is provided, followed by a description of the intervention. The intervention, which incorporated both social marketing and community participation techniques, consisted of three components: an intervention in the health care system, a community intervention, and an individual intervention. Based on medical records review of feeding practices of all the infants born the year before (n = 988) and the year after (n = 870) the intervention, the program was extremely successful. This combination of techniques, including qualitative and quantitative research into local definitions of the problem, collaboration with local institutions and individuals, reinforcement of traditional understandings about infant feeding, and institutional change in the health care system, is an effective way of facilitating behavioral change.

Qualitative Investigation of Factors Contributing to Effective Nutrition Education for Navajo Families

Objectives Obesity rates in American Indian and Alaskan Native children are a major health threat, yet effective ways to address this remain elusive. Building on an earlier dietary assessment of Navajo Head Start families which indicated a gap in parental nutrition awareness despite a strong program emphasis, the aim of this project was to identify culturally relevant nutrition education strategies for Navajo parents and educators of young children. Methods Eight focus group interviews were conducted with 41 parents and early childhood education paraprofessionals to identify contributors to both healthful and unhealthy food ways of Navajo preschoolers. Results were presented in two community venues to verify the themes and discuss implications. Results Barriers to healthful eating included availability/cost, parenting/control, preferences/habits, time pressures, and knowledge/education. Enablers to healthful eating included the categories of schools/education, and support/modeling. Reactions to these findings during community forums suggested (1) the need for stronger parenting and parental control over the food environment; (2) community-level action to address these barriers; and (3) the need for knowledge and culturally relevant educational strategies for caregivers and children. Conclusions Implications for interventions include building upon existing community resources to enhance culturally relevant and respectful parental, family, and community support for affordable and acceptable food experiences and choices for young children and their families.

Factors Associated With Failure to Complete Treatment for Diabetic Retinopathy Among Navajo Indians

OBJECTIVE— To determine the proportion of patients with suspected proliferative diabetic retinopathy who did not receive the recommended follow-up ophthalmological evaluation and care, and to examine associations between various patient characteristics and the failure to obtain care. RESEARCH DESIGN AND METHODS— The study cohort included all Navajo Indians identified by a retrospective review of records who had proliferative diabetic retinopathy diagnosed at an Indian Health Service Optometry Clinic between 1 October 1985 and 30 September 1988. Follow-up data were obtained by medical record reviews and by interviews with subjects. RESULTS— Of 69 patients identified, 57 of 61 living patients were interviewed. Twenty-three (40.4%) had failed to obtain recommended follow-up. The RR for incomplete treatment among those without a vehicle in the household compared with those with a vehicle was 1.91 (95% CI 1.32–2.76). Other factors associated with incomplete treatment were female sex and marital status other than currently married. Twelve (21%) patients answered “no” to the question, “Have you been told that diabetes was affecting your eyes?” Eight of 38 (21%) who confirmed that they had been told that diabetes was affecting their eyes responded “no” to the question, “Do you think that diabetes is affecting your eyes?” However, the answers to these questions did not distinguish between patients who obtained or did not obtain recommended care. CONCLUSIONS— Interventions to increase the proportion of Navajo Indians with diabetic retinopathy who receive appropriate ophthalmologic care must address the issue of transportation.

Erratum to: Development and Pilot Evaluation of a Cancer-Focused Summer Research Education Program for Navajo Undergraduate Students

This paper describes the development and pilot testing of a 10-week cancer research education program for Navajo undergraduate students. The program was piloted at Diné College with 22 undergraduates (7 men, 15 women) in 2007 and 2008. Students completed a pre–post program survey assessing attitudes, opinions, and knowledge about research and about cancer. The program was found to be culturally acceptable and resulted in statistically significant changes in some of the attitudes and opinions about research and cancer. Combining all 13 knowledge items, there was a significant (p = 0.002) change in the mean total correct percent from baseline [70.3 (SD = 15.9)] to post-program [82.1 (SD = 13.1)]. The curriculum was adapted for a new cancer prevention and control course now offered at Diné College, enhancing sustainability. Ultimately, these efforts may serve to build capacity in communities by developing a cadre of future Native American scientists to develop and implement cancer research.

Adapting a Cancer Literacy Measure for Use Among Navajo Women

Purpose: The authors designed a community-based participatory research study to develop and test a family-based behavioral intervention to improve cancer literacy and promote mammography among Navajo women. Method: Using data from focus groups and discussions with a community advisory committee, they adapted an existing questionnaire to assess cancer knowledge, barriers to mammography, and cancer beliefs for use among Navajo women. Questions measuring health literacy, numeracy, self-efficacy, cancer communication, and family support were also adapted. Results: The resulting questionnaire was found to have good content validity, and to be culturally and linguistically appropriate for use among Navajo women. Conclusions: It is important to consider culture and not just language when adapting existing measures for use with AI/AN (American Indian/Alaskan Native) populations. English-language versions of existing literacy measures may not be culturally appropriate for AI/AN populations, which could lead to a lack of semantic, technical, idiomatic, and conceptual equivalence, resulting in misinterpretation of study outcomes.

Development and pilot evaluation of Native CREST-a Cancer Research Experience and Student Training program for Navajo undergraduate students.

The Mayo Clinic Cancer Center and Diné College received funding for a 4-year collaborative P20 planning grant from the National Cancer Institute in 2006. The goal of the partnership was to increase Navajo undergraduates’ interest in and commitment to biomedical coursework and careers, especially in cancer research. This paper describes the development, pilot testing, and evaluation of Native CREST (Cancer Research Experience and Student Training), a 10-week cancer research training program providing mentorship in a Mayo Clinic basic science or behavioral cancer research lab for Navajo undergraduate students. Seven Native American undergraduate students (five females, two males) were enrolled during the summers of 2008–2011. Students reported the program influenced their career goals and was valuable to their education and development. These efforts may increase the number of Native American career scientists developing and implementing cancer research, which will ultimately benefit the health of Native American people.