American Indian Health Care Research Articles

Identifying Priorities and Strategies for Improving Colorectal Cancer Screening in Tribal Clinics.

BackgroundColorectal cancer (CRC) is the 3rd most frequently diagnosed cancer and the 2nd leading cause of cancer death in the United States (US), and incidence and mortality rates in Oklahoma are higher for many American Indian (AI) populations than other populations. The AI CRC Screening Consortium addresses major regional CRC screening disparities among AIs with shared objectives to increase CRC screening delivery and uptake in AIs aged 50 to 75 years at average risk for CRC and to assess the effectiveness of implementations of the interventions. This manuscript reports environmental scan findings related to current practices and multi-stakeholder experiences with CRC screening in two Oklahoma Indian health care systems.MethodWe conducted a mixed methods environmental scan across five clinical sites and with multiple stakeholders to determine the scope and scale of colorectal cancer screening in two separate AI health care delivery systems in Oklahoma. Data collection consisted of a mixture of individual interviews and group discussions at an urban site, and four clinical care sites within a tribal health system.ResultsSixty-two individuals completed interviews. Data from these interviews will inform the development of evidence-based intervention strategies to increase provider delivery, community access to, and community priority for CRC screening in diverse AI health care delivery systems. Conversations with patients, providers, and clinical leadership point to individual and system-level opportunities for improvement at each site, shaped in part by differences in the delivery of services, structure of the health care system, and capacity to implement new intervention strategies. The thematic areas most central to the process of evidenced-based intervention development included: current practices, needs and recommendations, and CRC site priorities.ConclusionEnvironmental scan data indicated clear opportunities for individual and system-level interventions to enhance CRC screening and was critical for understanding readiness for EBI implementation at each site.

Ambiguous Jurisdiction: Governmental Relationships that Affect American Indian Health Care Access.

The United States has an obligation to provide health care to American Indians. Services are generally provided through the Indian Health Service, tribal, or urban Indian health programs. Despite the availability of government-sponsored health services, health care access remains a concern for American Indians.

Unconscious biases: racial microaggressions in American Indian health care.

This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM). This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM. Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models. Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.

Fighting a Two-Front War: Dr. Albert D. Lake, Thomas Indian School Physician, 1880–1922

New York History Summer 2014© 2014 by The New York State Historical Association 408 Fighting a Two-Front War: Dr. Albert D. Lake, Thomas Indian School Physician, 1880–1922 Laurence Marc Hauptman, SUNY Distinguished Professor Emeritus of History Amajor omission from the literature on Native American health in New York is an analysis of the role of state-appointed physicians in the state’s Indian schools. Records held by the New York State Archives and New York State Library offer a valuable picture of the medical practice of an extraordinary physician among the Iroquois [Hodinöhsö:ni’] in the late nineteenth and early twentieth centuries. From 1880 until 1922, Albert D. Lake attended to the medical care of children and adolescents at the state-administered Thomas Asylum for Orphan and Destitute Indians. This institution, which was renamed the Thomas Indian School in Figure 1. Dr. Albert D. Lake (1846–1923). Lake was the physician at the Thomas Asylum and School and health care advocate for the Senecas and other Hodinöhsö:ni’ from 1880 until 1922. New York State Archives. Hauptman Dr. Albert D. Lake, Thomas Indian School Physician, 1880–1922 409 1905, was located at the center of the Seneca Nation’s Cattaraugus Indian Reservation in western New York. Dr. Lake served the Native American children residing at the institution for over forty years. Over the course of his career, he fought a two-front war: first against the ever-present contagions that beset children at the school; and second, against state legislative inertia and bureaucratic resistance to supporting improvements in Indian health care delivery. Despite the frustrations caused by these two struggles, Lake made major contributions, which in some instances far outdistanced those of his medical contemporaries in the federal boarding school system.1 1. The best study of federal Indian health policies in this period is Diane T. Putney, “Fighting the Scourge; American Indian Morbidity and Federal Policy, 1897–1928,” (Ph.D. dissertation, Marquette University, 1980); see also David H. DeJong, “If You Knew the Conditions”: A Chronicle of the Indian Medical Service and American Indian Health Care, 1908–1955 (New York: Lexington Books, Rowman and Figure 2. The Cattaraugus Reservation in 1890. From: Thomas Donaldson, Comp., The Six Nations of New York. Extra Census Bulletin for the Eleventh Census of the United States, 1890. Washington, D.C.: United States Census Printing Office, 1892. 410 ■ NEW YORK HISTORY While federal Indian health policies have long been the focus of scholars , the history of medical care provided to Native Americans by New York State has yet to be written.2 The Thomas Asylum and School never operated as a federal institution, although at times it received a small allocation from Washington in its stated educational mission to bring “civilization” to the Indians. In the 1870s, the federal government hired doctors to vaccinate the Senecas, temporarily appointed the agency physician , and opened short-lived, underfunded, and undermanned infirmaries. Nevertheless, Washington officials almost entirely deferred to Albany in providing medical care to Native American communities. Indeed, the Indian Health Service (IHS), which was founded as the Indian Medical Service in 1908, did not enter the picture of providing health care delivery in the state until the Seneca Nation of Indians successfully lobbied for and secured these federal services in 1976. Long before Hodinöhsö:ni children were sent to the Carlisle Indian Industrial School in Pennsylvania, Native American students in New York were being instructed in district schools operated and administered by state administrators. The first state district schools were established in 1846. From the mid 1850s onward, orphaned and impoverished Hodinöhsö:ni, as well as a few Shinnecock children from Long Island, were sent to reside at and attend the Thomas Asylum and School. Still other children were Littlefield, 2008), 1–58. For health concerns and policies in the federal Indian boarding school system in this era, see Jean A. Keller, Empty Beds: Indian Student Health at Sherman Institute, 1902–1922 (East Lansing: Michigan State University Press, 2002); David H. DeJong, “‘Unless They are Kept Alive’: Federal Indian Schools and Student Health, 1878–1918,” American Indian Quarterly 31 (Spring, 2007): 256–282; David Wallace Adams, Education for Extinction...

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Summit on American Indian Health Care Bridging the Cultural Canyon: Strategies to Reduce Health Inequities for American Indians

Summit on American Indian Health Care Bridging the Cultural Canyon: Strategies to Reduce Health Inequities for American Indians

Beyond Red Lake — The Persistent Crisis in American Indian Health Care

On March 21, 2005, at the high school on the Red Lake Indian reservation in Minnesota, a troubled American Indian teenager went on a shooting rampage. Dr. Yvette Roubideaux writes that this calamity seems to have reminded our country that many American Indian and Alaska Native communities continue to be affected by significant socioeconomic and health disparities.

Information technology as a tool to improve the quality of American Indian health care.

The American Indian/Alaska Native population experiences a disproportionate burden of disease across a spectrum of conditions. While the recent National Healthcare Disparities Report highlighted differences in quality of care among racial and ethnic groups, there was only very limited information available for American Indians. The Indian Health Service (IHS) is currently enhancing its information systems to improve the measurement of health care quality as well as to support quality improvement initiatives. We summarize current knowledge regarding health care quality for American Indians, highlighting the variation in reported measures in the existing literature. We then discuss how the IHS is using information systems to produce standardized performance measures and present future directions for improving American Indian health care quality.

Improving American Indian health care: the Western Cherokee experience

Indicators point to continuing lower health status among Native Americans as compared to the general population. Just a decade ago, the mortality rate of Native Americans was 37 percent greater than the rate for the general population, and Native Americans are still more likely to suffer from diabetes, tuberculosis, alcoholism, depression, and suicide.To address the basic health concerns of all Native Americans, this book examines the response of the Cherokee Nation of Oklahoma to critical medical issues. After 1976, the Cherokee Nation aggressively addressed inadequate levels of health services for tribal members and better coordinated efforts to deal with the health problems of their population. Improving American Indian Health Care shares the Western Cherokee experience so that other tribal governments may adopt or adapt the approaches particularly suitable to their own circumstances.

Working with American Indians toward educational success.

Past research has focused on identifying barriers that American Indian college students experience in attempting to complete programs in higher educational systems. Recommendations to reduce these barriers have not significantly decreased attrition rates or increased the completion rates of this minority group. Nationally, nursing professionals recognize the shortage of minorities in the field of nursing. Likewise, the need for American Indian health care providers is growing in direct proportion to the number of health care issues facing this population. This grounded theory study focused on the enablers that supported educational success of American Indian baccalaureate nursing graduates between the years 1986 and 1995 in a western university. Through constant comparative analysis of 18 interviews, four core variables emerged. The interactive core variables are individual American Indian student, instructor, institutions (university and college of nursing), and external influences. This article focuses on the core variable individual American Indian student and the following seven properties that support success: focuses on goal, adjusts to dominant cultural, invests in self-assessment, develops assertive skills, establishes support community, socializes into roles of student and nurse, and masters content. This central core variable and properties create a gestalt that promotes educational success. The implications are that faculty, in their roles as advisor and instructor, can assist in the development and maintenance of these seven properties. This can be achieved through proactive culturally responsive advisement, creation of a culturally relevant environment, and use of humanistic andragogical approaches to teaching-learning processes.

Patient and smoking patterns in Northern California American Indian clinics: Urban and rural contrasts

This article elaborates on an earlier article about a smoking cessation program conducted in Northern California Indian clinics. Whereas the previous article discussed Indian smoking rates in general, this article compares the smoking patterns of Indians who live in urban and rural settings. The differences between the two populations are described, and the implications of these differences for planning, policy, and education are discussed. A self-report questionnaire was administered to 1369 adult Indians seeking health services at 18 American Indian health care clinics in Northern California. Data were collected on demographic characteristics; smoking behaviors; readiness to quit smoking; knowledge, behavior, and attitude; and a social support and "hassles" measures. Urban Indians were more mobile and reported higher smoking rates, a higher level of education, less social support, and more hassles than rural Indians. Indians living in urban areas continue to experience a high degree of stress. Long-term isolation from reservations and traditional homelands may have contributed to the breakdown of social support systems among urban Indians. These and several other factors should be considered when designing tobacco control programs.

Patient and smoking patterns in Northern California American Indian clinics: Urban and rural contrasts

This article elaborates on an earlier article about a smoking cessation program conducted in Northern California Indian clinics. Whereas the previous article discussed Indian smoking rates in general, this article compares the smoking patterns of Indians who live in urban and rural settings. The differences between the two populations are described, and the implications of these differences for planning, policy, and education are discussed.A self-report questionnaire was administered to 1369 adult Indians seeking health services at 18 American Indian health care clinics in Northern California. Data were collected on demographic characteristics; smoking behaviors; readiness to quit smoking; knowledge, behavior, and attitude; and a social support and "hassles" measures.Urban Indians were more mobile and reported higher smoking rates, a higher level of education, less social support, and more hassles than rural Indians.Indians living in urban areas continue to experience a high degree of stress. Long-term isolation from reservations and traditional homelands may have contributed to the breakdown of social support systems among urban Indians. These and several other factors should be considered when designing tobacco control programs.

Training Outreach Workers to Serve American Indian Elders with Visual Impairment and Diabetes

American Indians experience diabetes and diabetic retinopathy at a rate considerably higher than the overall U.S. population, and the number and lifespan of American Indian elders is steadily increasing. These demographics, combined with the underrepresentation of American Indians in the rehabilitation system, document the need for an innovative service delivery model for training American Indian elders, both on and off reservations, in independent living skills. This article describes a federally funded rehabilitation project developed and implemented by the American Foundation for the Blind to teach American Indian health care workers about aging and vision loss and independent living skills.

American Indian Health Care Practices: A Cross-Cultural Perspective

American Indian Health Care Practices: A Cross-Cultural Perspective