Abstract
A comparative analysis of telephone versus in-person survey administration for health risk factor surveillance in three rural tribal communities
Kevin English, DrPH1, Dornell Pete, MPH2, Judith Espinoza, MPH2 and Amanda Tjemsland2
(1)Albuquerque Area Indian Health Board, Inc., Albuquerque, NM, (2)Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, NM
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Purpose: The Behavioral Risk Factor Surveillance System (BRFSS), a nationwide telephone-based health survey, has historically underrepresented the on-reservation, rural American Indian population. This study compared telephone versus in-person BRFSS administration in three rural Tribes to assess the impact of administration mode upon survey participation.
Methods: Participants 18 years and older were randomly selected for survey participation. Telephone administration was conducted via Computer Assisted Telephone Interviewing software (cell phones and landlines) and the in-person survey was administered by trained community interviewers. A total of 704 adults participated in the survey (telephone = 166; in-person = 538). Significance testing was performed to assess differences in response rate, participant demographics, administration cost, and risk factor prevalence estimates by survey administration type.
Results: In-person administration yielded a higher response rate (68.5%) than telephone administration (35.7%). Telephone participants were older, wealthier, and more educated than those in the in-person sample. The telephone sample was also significantly more likely to report current smoking (28.4% vs. 15.1%, p-value < 0.01), having diabetes (32.9% vs. 21.3%, p-value < 0.01), and obtaining preventive cancer screenings (e.g., mammography rate = 65.2% vs. 46.4%, p-value < 0.01) than those in the in-person group. In-person survey administration was slightly more cost effective ($191.95 vs. $210.84 per completed survey) due to the low response rate of the telephone survey.
Conclusion: The findings from this study have important implications for public health surveillance in rural tribal communities, where telephone survey administration is unlikely to yield sufficient coverage to produce meaningful tribe-specific data.
Epidemiology Public health or related research
Abstract
Engaging families to improve diabetes and hypertension management at an Urban Indian Health Organization
Meredith Fort, PhD, MPH1, John Steiner, MD, MPH2, Kelly Moore, MD, FAAP3, Maria de los Angeles Villaverde, MS1 and Spero Manson, PhD4
(1)University of Colorado - Anschutz Medical Campus, Aurora, CO, (2)Institute for Health Research, Denver, CO, (3)Colorado School of Public Health, CU Anshutz, Aurora, CO, (4)University of Colorado, Anschutz Medical Campus, Aurora, CO
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background. Cardiovascular disease remains the primary cause of mortality in American Indians and Alaska Natives. Management of type 2 diabetes and hypertension are key to preventing CVD. Although care for chronic disease has traditionally focused on individual patients, evidence of the importance of the family in disease management is increasing. Recognizing this opportunity, researchers and staff from First Nations Community HealthSource - an Urban Indian Health Organization - based in Albuquerque, New Mexico, Kaiser Permanente Colorado, and the Centers for American Indian and Alaska Native Health are working collaboratively on a qualitative study on family engagement in diabetes and hypertension management.
Methods. In spring 2016, we conducted semi-structured interviews with 30-40 patients with a dual diagnosis of type 2 diabetes and hypertension, and 30-40 adult family members, to capture family roles, relationships, and resources that support or inhibit chronic disease management. In patient interviews we used complementary visual techniques: genograms and ecomaps. Following the interviews, a subset of patients and family members took part in an analysis session to collaboratively develop a set of family-level strategies to support patients in meeting self-management goals.
Results. We will present results on: how family members influence improved or inhibited medication adherence, appointment-keeping, and implementation of self-management plans; and strategies proposed by patients and family members for improving diabetes and hypertension management.
Discussion. We will reflect on how the proposed strategies were received by a Community Advisory Board and the potential for their future adoption locally in Albuquerque as well as in other settings.
Chronic disease management and prevention Public health or related research
Abstract
Innovative Multigenerational Household Intervention to Reduce Stroke and Cardiovascular Disease in American Indian Populations
Lindsey Montileaux Mabbutt, Research Coordinator1, Tauqeer Ali, PhD, MPH, MBBS2, Lonnie Nelson, PhD1 and Dedra S. Buchwald, MD1
(1)Washington State University, Seattle, WA, (2)Oklahoma University Health Sciences Center, OK
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Compared to other U.S. racial and ethnic groups, American Indians have a higher prevalence of stroke and specifically, compared to Whites, Native people experience younger ages of stroke onset. Stroke risk factors are disproportionately higher in Native communities. This situation underscores the need for stroke prevention efforts that target the social determinants of health and promote healthy lifestyle behaviors. However, no rigorous, large-scale studies of behavioral approaches to stroke prevention have previously been conducted in Native populations. In 2014, Washington State University's Partnerships for Native Health received funding to assess the effectiveness of a household-based program: “Family Intervention in the Spirit of Motivational Interviewing” (FITSMI). Its goal is to produce measurable reductions in stroke risk factors in tribal communities in Oklahoma, Arizona, and North and South Dakota. It promotes individual behavior change among household members, including healthier diet, smoking cessation, and physical activity. The intervention uses a cultural adaptation of Motivational Interviewing, an evidence-based, client-oriented approach to help people initiate behavioral change. In FITSMI, facilitators in each community are trained to conduct “talking circle” discussions that incorporate Motivational Interviewing techniques. Participants are guided to identify personal and household goals and to create tailored plans for sustainable implementation. The intervention also includes digital stories in which community members share their personal experiences with stroke. FITSMI is currently in its second of five study years. We offer insight on combining Motivational Interviewing with talking circles in the conduct of community-based participatory research in Native communities.
Implementation of health education strategies, interventions and programs
Abstract
Using EHR and team based care on an Indian Reservation to improve colon cancer screeenig to 65%
Danny Tadgerson, MPH
Bay Mills Health Center, Brimley, MI
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
The Bay Mills Health Center is an accredited Patient Center Medical Home with the Joint Commission and designated as a Patient Centered Medical Home by Blue Cross Blue Shield. It is located on the Bay Mills Indian Reservation funded under a 638 contract with Indian Health Services and awarded a HRSA 330(b) grant to operate a Federally Qualified Health Center. This mix has created an opportunity for patients to experience the Patient Centered Medical Home care model with clinical performance measures in a system utilizing tools in the Indian Health Services system.
BMHC is required to implement clinical performance measures and the Indian Health
Service Resources and Patient Management System (EHR) has the capability to monitor population health. In addition to the clinical performance measures BMHC is required to implement a continuous quality Improvement system. BMHC uses quality improvement methodologies while working the PCMH team based care approach. Our Quality Improvement Subcommittee includes the QI Coordinator, Electronic Medical Records Specialist, Clinical Coordinator, Medical Director, Health Information Specialist, Medical Providers, and the Medical Case Manager.
This team identified the problem of high deaths from colorectal cancer and low screening rates. Many Tribal Communities have similar situations; Medical Clinics, EHR, Health Technicians, medical travel, Patient Referred Care, and patients in need of cancer screening. BMHC increased colorectal screening rates from 39% to 65% in one year using the Tribal 638 contract common in many Tribal communities.
Administer health education strategies, interventions and programs Clinical medicine applied in public health Epidemiology Program planning Public health administration or related administration