Abstract
American Indian and Alaska Native (AI/AN) people suffer a disproportionate burden of diabetes and cardiovascular disease. Urban Indian Health Organizations (UIHOs) are an important source of diabetes services for urban AI/AN people. Two evidence-based interventions—diabetes prevention (DP) and healthy heart (HH)–have been implemented and evaluated primarily in rural, reservation settings. This work examines the capacity, challenges and strengths of UIHOs in implementing diabetes programs.Methods: We applied an original survey, supplemented with publicly-available data, to assess eight organizational capacity domains, strengths and challenges of UIHOs with respect to diabetes prevention and care. We summarized and compared (Fisher's and Kruskal-Wallis exact tests) items in each organizational capacity domain for DP and HH implementers vs. non-implementers and conducted a thematic analysis of strengths and challenges.Results: Of the 33 UIHOs providing services in 2017, individuals from 30 sites (91% of UIHOs) replied to the survey. Eight UIHOs (27%) had participated in either DP (n = 6) or HH (n = 2). Implementers reported having more staff than non-implementers (117.0 vs. 53.5; p = 0.02). Implementers had larger budgets, ~$10 million of total revenue compared to $2.5 million for non-implementers (p = 0.01). UIHO strengths included: physical infrastructure, dedicated leadership and staff, and community relationships. Areas to strengthen included: staff training and retention, ensuring sufficient and consistent funding, and data infrastructure.Conclusions: Strengthening UIHOs across organizational capacity domains will be important for implementing evidence-based diabetes interventions, increasing their uptake, and sustaining these interventions for AI/AN people living in urban areas of the U.S.
Highlights
Urban American Indian and Alaska Native (AI/AN) people suffer a disproportionate burden of diabetes and cardiovascular disease (CVD)
We conducted a cross-sectional analysis of an original 75question survey for Urban Indian Health Organizations (UIHOs) aimed at assessing organizational capacity and aspects of diabetes prevention and care that would benefit from investment and strengthening
The survey was created in SurveyMonkey which included an assessment of diabetes prevention and care program experience that drew from a diabetes care coordination survey [13]; Special Diabetes Program for Indians (SDPI) familiarity; the eight domains of public health services and systems organizational capacity [12]; and strengths and challenges that UIHOs face in implementing their work
Summary
Urban American Indian and Alaska Native (AI/AN) people suffer a disproportionate burden of diabetes and cardiovascular disease (CVD). Urban AI/AN people are 20% more likely to die of heart disease and are three times more likely to die from diabetes [1]. Many urban AI/AN people receive care at Urban Indian Health Organizations (UIHOs), which provide culturally appropriate primary health care services. Recognizing the need for expanded health services, the United States Congress established the Special Diabetes Program for Indians (SDPI) in 1997. Two IHS demonstration projects were initiated to translate evidencebased practices for diabetes and CVD prevention to AI/AN communities and people [3]. The second project, SDPI-Healthy Heart (HH) focused on intensive case management activities to reduce CVD risk factors in individuals with diagnosed diabetes. SDPI’s national competitive grant program encouraged existing SDPI recipients to compete for additional funds and provided the opportunity to participate in a collaborative process to develop and implement DP or HH projects
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