Customizing Health Messages Based On Cultural Understanding of Disease
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Choctaw Nation Health Services Authority
Southeastern Oklahoma
Diabetes
Rural Primary Care Clinic
American Indians
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PROJECT
Community Health Educators make a series of eight, hour-long home visits over the course of nine months.
To prepare for the visits, Community Health Educators receive 12 hours of interactive, workshop-based training on semi-structured interviewing techniques to help better elicit a patient’s personal and cultural understanding of diabetes—
his or her beliefs about diabetes, its development and progression, treatment, preferred lifestyle changes
and relationships with health care providers.
The intervention takes place in a culturally traditional area of the Choctaw Nation in the homes of tribal members with diabetes who are also patients at a clinic managed by the Choctaw Nation Health Services Authority.
RATIONALE
Cultural beliefs may shape a patient’s understanding of diabetes in ways that conflict with the predominant medical
model and therefore create a barrier to effective self-management and treatment. By tapping into a tribal value known as “anumpuli”—a true dialogue or give-and-take conversation—the approach of the Community Health Educators creates an opportunity for open communication. Learning the patient’s personal and cultural understanding of diabetes, and how it compares to the traditional medical model, allows the Community Health Educators to tailor their advice and education accordingly.
EVALUATION PLAN
Funded by Finding Answers in 2006.
Researchers at the University of Oklahoma Health Sciences Center are conducting a randomized controlled trial involving 162 Choctaw patients with diabetes, balanced for age and gender. The intervention and control groups are being compared on the following measures, taken every three months: weight, BMI, HbA1c level, blood pressure and LDL cholesterol.
In addition, members from both the intervention and control groups are taking surveys at the beginning and end of the intervention period to measure their health locus of control and confidence in diabetes self-care. The survey assesses participants’ beliefs about their ability to take control of their health and manage diabetes.
Principal Investigators
- L. Carson Henderson, PhD, MPH, RN
- J. Neil Henderson, PhD
RESULTS
Overall, the intervention did not make a significant difference in improving diabetes-related health indicators or confidence in diabetes self-care. Among the group that received home visits, there was a decrease of 9.41 in mean LDL levels and a decrease of 1.02 in mean BMI between beginning of the study and first 3-month measurement. However, these early improvements were not sustained. There was no significant difference in survey scores between the two groups.
CHALLENGES
The project's original protocol required the CHEs to write down the patient’s responses to interview questions. However, the CHEs often had difficulty completing this task and many of the interview forms were returned blank, which left project leaders with little information about how the patient interviews were going and what explanatory models of diabetes patients preferred. Possible solutions to this challenge could include: additional training and performance feedback for the CHEs, audio recording the interview and CHE commentary, creating a written record after the fact, or using staff who are more familiar with taking notes/updating charts during patient encounters such as public health nurses or MPH-level health educators.
The project also demonstrated the difficulties inherent in conducting a research project in a rural area. Project leaders faced a five-hour drive each way to the project site, which forced them to limit visits after the first few months and therefore reduced the ability to provide appropriate supervision to the project. As a result, some of the CHEs prioritized other aspects of their job responsibilities or neglected the project’s goals altogether. An example of this was when the CHEs temporarily ceased work on the project to help a tribal council member run for re-election (a generally acceptable and encouraged tradition in the Choctaw culture). The researchers concluded that the design of the project might have been improved by hiring a professional research assistant to live on-site, manage day-to-day operations, and coordinate with the project leaders.
Fore More Information
Please Contact:
L. Carson Henderson, PhD, MPH, RN
carson-henderson@ouhsc.edu |
