Regina Kuhnley

Bridging Storytelling Traditions with Digital Technology

Objective The purpose of this project was to learn how Community Health Workers (CHWs) in Alaska perceived digital storytelling as a component of the “Path to Understanding Cancer” curriculum and as a culturally respectful tool for sharing cancer-related health messages. Design A pre-course written application, end-of-course written evaluation, and internet survey informed this project. Methods Digital storytelling was included in seven 5-day cancer education courses (May 2009–2012) in which 67 CHWs each created a personal 2–3 minute cancer-related digital story. Participant-chosen digital story topics included tobacco cessation, the importance of recommended cancer screening exams, cancer survivorship, loss, grief and end-of-life comfort care, and self-care as patient care providers. All participants completed an end-of-course written evaluation. In July 2012, contact information was available for 48 participants, of whom 24 completed an internet survey. Results All 67 participants successfully completed a digital story which they shared and discussed with course members. On the written post-course evaluation, all participants reported that combining digital storytelling with cancer education supported their learning and was a culturally respectful way to provide health messages. Additionally, 62 of 67 CHWs reported that the course increased their confidence to share cancer information with their communities. Up to 3 years post-course, all 24 CHW survey respondents reported they had shown their digital story. Of note, 23 of 24 CHWs also reported change in their own behaviour as a result of the experience. Conclusions All CHWs, regardless of computer skills, successfully created a digital story as part of the cancer education course. CHWs reported that digital stories enhanced their learning and were a culturally respectful way to share cancer-related information. Digital storytelling gave the power of the media into the hands of CHWs to increase their cancer knowledge, facilitate patient and community cancer conversations, and promote cancer awareness and wellness.

Digital storytelling: a tool for health promotion and cancer awareness in rural Alaskan communities.

Background The purpose of this study was to learn community members’ perspectives about digital storytelling after viewing a digital story created by a Community Health Aide/Practitioner (CHA/P). Methods Using a qualitative research design, we explored digital storytelling likeability as a health-messaging tool, health information viewers reported learning and, if viewing, cancer-related digital stories facilitated increased comfort in talking about cancer. In addition, we enquired if the digital stories affected how viewers felt about cancer, as well as if viewing the digital stories resulted in health behaviour change or intent to change health behaviour. Findings A total of 15 adult community members participated in a 30–45 minute interview, 1–5 months post-viewing of a CHA/P digital story. The majority (13) of viewers interviewed were female, all were Alaska Native and they ranged in age from 25 to 54 years with the average age being 40 years. Due to the small size of communities, which ranged in population from 160 to 2,639 people, all viewers knew the story creator or knew of the story creator. Viewers reported digital stories as an acceptable, emotionally engaging way to increase their cancer awareness and begin conversations. These conversations often served as a springboard for reflection, insight, and cancer-prevention and risk-reduction activities.

Readers’ Theatre: A Communication Tool for Colorectal Cancer Screening

Colorectal cancer (CRC) is the second leading cause of cancer mortality for Alaska Native people, yet it can be almost totally prevented through colonoscopy screenings. Purpose: A 25-minute Readers’ Theatre script was developed with and for Alaska Native and American Indian Community Health Workers (CHWs) and the people in their communities to provide CRC screening information, model ways to talk about CRC screening, increase comfort with talking about CRC, and encourage healthy lifestyle choices. Methods: Grounded in Indigenous methodologies, this paper describes the collaborative development, implementation, and evaluation of a CRC Readers’ Theatre. Results: 94% (161/172) of participants from 11 Readers’ Theatre completed a written evaluation. 90% (145) of participants reported feeling more comfortable talking about CRC and 77% (124) described healthy changes they planned to make. Readers’ Theatre was associated with increased knowledge, comfort talking about CRC, and served as a catalyst for positive intent to change behavior.

Learning About Cancer Has Brightened My Light: Cancer Education for Alaska Community Health Aides and Community Health Practitioners (CHA/Ps)

In response to Alaska’s Community Health Aides/Practitioners (CHA/Ps) request for cancer information, the “Path to Understanding Cancer” course was developed, implemented, and extensively evaluated. Using a qualitative approach as one evaluation component, 128 of 168 course participants engaged in post-course telephone interviews. Of these, 116 (81%) CHA/Ps felt more comfortable in talking about cancer and 57% had increased cancer screening referrals for patients. Additionally, 28% of 110 CHA/P respondents and 21% of 114 CHA/Ps’ family members sought and received cancer screening; they had also made lifestyle changes to reduce cancer risk, including tobacco cessation and healthy changes in nutrition and exercise. Through qualitative design, we gained insight into CHA/Ps’ lived experience of cancer and an understanding of ways the course made a difference in patient care as well as cancer risk reduction, cancer screening, and prevention for themselves, their families, and people in their communities.

Enhancing cancer education through the arts: building connections with Alaska Native people, cultures and communities

Building upon the dynamic traditions of Alaska Native people, which include the arts as a viable way of knowing, the expressive arts were woven into a five-day cancer education course for Alaska village-based Community Health Workers (CHWs). Cancer is the leading cause of mortality for Alaska Native people. Course learning modalities included moving, drawing, sculpting and storytelling. A total of six cancer education courses were provided for 57 CHWs. During extended-interval post-course interviews, CHWs described the arts as a culturally traditional way of knowing and talked about how the arts expanded their perspectives, sparked creativity and imagination, freed/transformed emotions, made learning more memorable/more meaningful, infused learning with laughter, created community and broke the silence that often surrounds the topic of cancer in Alaska rural communities. The expressive arts empowered adult learners to explore new dimensions of knowledge, create deeper understandings and expand their perceptions of possibilities.

Co-Creating a Culturally Responsive Distance Education Cancer Course with, and for, Alaska’s Community Health Workers: Motivations from a Survey of Key Stakeholders

To gain input on a proposed culturally responsive, distance-delivered cancer education course informed by empowerment theory and adult-learning principles, Alaska’s Community Health Aides/Practitioners (CHA/Ps) and CHA/P leadership were invited to take an online survey in February 2015. The proposed course will be developed as part of the “Distance Education to Engage Alaskan Community Health Aides in Cancer Control” project. The results of the survey demonstrate that respondents are both interested in taking the proposed class and engaging in course development. The results also indicate that respondents have the technological comfort and capacity to be engaged in online learning and have primarily positive experiences and perceptions of distance education. This survey is the beginning of the interactive development of the online cancer education course and part of a continuing endeavor to promote wellness with, and for, Alaska’s people by empowering Alaska’s CHA/Ps and inspiring positive behavioral change to both prevent cancer and support those who feel its burdens.

Qualitative evaluation of a colorectal cancer education CD-ROM for Community Health Aides/practitioners in Alaska.

Colorectal cancer (CRC) is an important contributor to the cancer burden among Alaska Native people. CRC is the leading incident cancer and the second leading cause of cancer mortality among Alaska Native people. Completing recommended CRC screening procedures has the potential to reduce both CRC incidence and mortality. “Taking Action Colorectal Health,” a multidimensional audiovisual, interactive CD-ROM, incorporates adult education learning principles to provide Alaskas Community Health Aides/Practitioners with timely, medically accurate, and culturally relevant CRC place-based education. Providing this resource on CD-ROM empowers learning within communities and places where people live or choose to learn. The dynamic process of developing, implementing, and evaluating this CRC CD-ROM was informed by a sociocultural approach to share health messages. Within this approach, cultural values, beliefs, and behaviors are affirmed as a place of wisdom and resilience and built upon to provide context and meaning for health messaging. Alaska Native values that honor family, relationships, the land, storytelling, and humor were included in CD-ROM content. Between January and May 2012, 20 interviews were conducted with individuals who had used the CD-ROM. Four categorical themes emerged from analysis of interview transcripts: likeability, utilization, helpfulness, and behavior change. As a result of self-paced learning through stories, movies, and interactive games, respondents reported healthy behavior changes they were making for themselves, with their families and in their patient care practices. This CD-ROM is a culturally based practical course that increased knowledge and activities around colorectal cancer screening by Community Health Aides/Practitioners in Alaska.

Creating Dialogue, Creating Change Through the Arts

The “wellness picnic,” an interactive hands-on learning activity, was developed to engage people in reflective conversations about their health behaviors and wellness journey. Participants used pictures, colors, and words to transform a paper plate into a symbolic representation of what wellness looked like to them. Within the wisdom of each participant’s paper plate drawing, there emerged pathways for living well, creating a respectful place for sharing wellness understandings and cancer risk reduction activities.

A Wellness Course for Community Health Workers in Alaska: ‘‘wellness lives in the heart of the community’’

Objectives. To develop, implement, and evaluate a culturally respectful Wellness Course with and for Alaskas village-based Community Health Workers (CHWs) to support community health promotion and disease prevention. Study design. This article describes Wellness Course development, implementation, and evaluation. Methods. Five 5-day Wellness Courses were provided for 55 CHWs from communities throughout Alaska. Fifty-two of 55 participants completed a post-course written evaluation. Post-course telephone interviews were conducted with participants (11/32) from the first 3 courses. Results. On written post-course evaluations, all participants wrote detailed descriptions of what they learned and 98% (51/52) felt more confident in their knowledge and ability to present community wellness information. As a result of course participation, 88% (46/52) of CHWs wrote ways they would support family and community wellness, and 85% (44/52) wrote ways they planned to take better care of their health. During the in-depth post-course interviews, all 11 CHWs interviewed described ways the Wellness Course increased their health knowledge, helped them in their work, and prepared them to effectively engage with their communities to promote health. Conclusions. Learning wellness information with hands-on activities and practising health presentation and community engagement skills within the course design increased participants’ wellness knowledge and skills, confidence, and motivation to provide community wellness activities. Techniques for active listening, engaging community, and using the arts and storytelling as culturally respectful health promotion are tools that when used by CHWs within their own community have potential to empower community wellness.