scholarly journals An Internet-Based Therapeutic Tool for American Indian/Alaska Native Adults With Posttraumatic Stress Disorder: User Testing and Developmental Feasibility Study

10.2196/13682 ◽  
2019 ◽  
Vol 3 (4) ◽  
pp. e13682
Author(s):  
Vanessa Y Hiratsuka ◽  
Laurie Moore ◽  
Jaedon P Avey ◽  
Lisa G Dirks ◽  
Barbara D Beach ◽  
...  
Keyword(s):  
Primary Care ◽  
American Indian ◽  
Alaska Native ◽  
Stress Disorder ◽  
Alaska Natives ◽  
Ptsd Symptoms ◽  
Web Based ◽  
Study Enrollment ◽  
Culturally Adapted ◽  
Website Use

Background Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native populations. Primary care clinics are often the first point of contact for American Indian and Alaska Natives seeking health care and are feasible locations for trauma-focused interventions. Objective Web-based therapeutic interventions have the potential to reduce PTSD symptoms by offering psychoeducation and symptom self-management tools. We investigated the feasibility of a culturally adapted Web-based therapeutic intervention in two American Indian and Alaska Native–serving primary care sites. We developed and tested a self-guided Web-based therapeutic intervention aimed at improving knowledge and awareness of, and provision of guidance, support, and symptom-management for, PTSD symptoms. Methods A community-based participatory research process was used to refine adaptations to the veteran’s administration’s PTSD Coach Online, to develop new content, and to guide and interpret the results of the feasibility pilot. This process resulted in a 16-guide intervention “Health is Our Tradition: Balance and Harmony after Trauma” website. The feasibility pilot included 24 American Indian and Alaska Natives aged 18 years and older who scored positive on a primary care PTSD screener. Enrolled participants completed a demographic questionnaire, an experience with technology questionnaire, and baseline behavioral health measures. Once measures were complete, research staff described weekly text messages, minimum study expectations for website use, and demonstrated how to use the website. Feasibility measures included self-reported website use, ratings of satisfaction and perceived effectiveness, and website metrics. Feasibility of obtaining measures for an effectiveness trial was also assessed to include behavioral health symptoms and service utilization through self-report instruments and electronic health record queries. Self-reported measures were collected at enrollment and at 6 and 12 weeks post enrollment. Electronic health records were collected from 12 months before study enrollment to 3 months following study enrollment. Changes between enrollment and follow-up were examined with paired t tests, analysis of variance or logistic regression, or the Wilcoxon signed rank test for nonnormally distributed data. Results The culturally adapted website and associated text message reminders were perceived as satisfactory and effective by participants with no differences by age or gender. The majority of participants (86%, 19/24) reported use of the website at 6 weeks and nearly all (91%, 20/22) at 12 weeks. At 6 weeks, 55% (12/22) of participants reported using the website at the recommended intensity (at least three times weekly), dropping to 36% (8/22) at 12 weeks. Participant use of modules varied from 8% (2/24) to 100% (24/24), with guide completion rates being greater for guides that were only psychoeducational in nature compared with guides that were interactive. There were no significant changes in patterns of diagnoses, screening, medications, or service utilization during exposure to the website. Conclusions “Health is Our Tradition: Balance and Harmony after Trauma” shows promise for an effectiveness pilot.

scholarly journals Feasibility, acceptability, and effectiveness of a web-based therapeutic intervention for post-traumatic stress disorder among American Indian/Alaska Native adults in primary care (Preprint)

2019 ◽  
Author(s):  
Vanessa Hiratsuka ◽  
Laurie Moore ◽  
Jaedon P Avey ◽  
Lisa G Dirks ◽  
Barbara D Beach ◽  
...  
Keyword(s):  
Primary Care ◽  
American Indian ◽  
Alaska Native ◽  
Repeated Measures ◽  
Stress Disorder ◽  
Health Concern ◽  
Web Based ◽  
Study Enrollment ◽  
Primary Care Patients

BACKGROUND Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native (AI/AN) populations. Primary care clinics are often the first point of contact for AI/AN people seeking health care and are feasible locations for trauma-focused interventions. OBJECTIVE Web-based therapeutic interventions (WBTI) for PTSD have the potential to reduce PTSD symptoms in AI/AN primary care patients by offering culturally tailored psychoeducation and symptom self-management tools. In this study, we investigate the feasibility and acceptability in two AI/AN serving primary care sites and effectiveness of a WBTI on trauma symptom changes in a 12-week period. METHODS A community-based participatory research process was used to refine the WBTI adaptations and content, and conduct a feasibility test of the resultant 16-guide intervention “Health is Our Tradition: Balance and Harmony after Trauma” within two AI/AN healthcare settings. AI/AN people ages 18 years and older who were not in crisis and scored positive on the primary care PTSD instrument completed baseline measures and were trained on WBTI usage. Participants were provided weekly tip via text message during the 12-week intervention. Content was devised to reinforce website use, complement website content, and remind participants about follow-up visits. At each visit, participants completed follow-up versions of all baseline measures (except demographics) including the PC-PTSD and a satisfaction/acceptability questionnaire. Electronic health records were collected for the periods extending to 12 months prior to study enrollment and 3 months following study enrollment. Changes in perceptions of acceptability/feasibility between the 6-week and 12-week follow-up were examined with paired t-tests. Analysts explored changes in symptomatology over the 12-week intervention with one-way ANOVAs for repeated measures or repeated measures logistic regression tests. To examine the effect of the intervention on service utilization, analysts compared clinic visit frequency from the health record data in the 12 months before the intervention (divided by 4 for comparison) and the 3 months after it with paired t-tests. The Wilcoxon Signed Rank Test for non-parametric data was used to test significance for non-normally distributed data. RESULTS In a sample of N=24, the WBTI was well received with no difference in use, engagement, satisfaction or technical skills needed for use by age or gender. Website usage decreased significantly over the course of the 12-week intervention period yet participants reported significant reductions in PTSD, depression, and physical symptoms related to PTSD, and problematic alcohol use over the same period of WBTI usage. CONCLUSIONS The website shows promise for integration into primary care and behavioral health settings to augment and improve access to treatment of the health consequences of trauma exposure among adult AI/AN primary care patients.

scholarly journals Culturally Adapting an Advance Care Planning Communication Intervention With American Indian and Alaska Native People in Primary Care

2019 ◽  
Vol 31 (2) ◽  
pp. 178-187
Author(s):  
Kate M. Lillie ◽  
Lisa G. Dirks ◽  
J. Randall Curtis ◽  
Carey Candrian ◽  
Jean S. Kutner ◽  
...  
Keyword(s):  
Primary Care ◽  
American Indian ◽  
Cultural Values ◽  
Advance Care Planning ◽  
Alaska Native ◽  
Native People ◽  
Care Planning ◽  
Primary Care Settings ◽  
Patient Provider Communication ◽  
Advance Care

Introduction: Advance care planning (ACP) is a process in which patients, families, and providers discuss and plan for desired treatment goals. American Indian and Alaska Native people (AI/AN) have higher prevalence of many serious, life-limiting illnesses compared with the general population; yet AI/ANs use ACP considerably less than the overall population. Method: We conducted a qualitative study to culturally adapt an existing ACP intervention for AI/ANs in two primary care settings. Results: We found that it is important to incorporate patients’ cultural values and priorities into ACP, determine who the patient wants involved in ACP conversations, and consider the culturally and locally relevant barriers and facilitators when developing an ACP intervention with AI/AN communities. Discussion: At the core, ACP interventions should be clear and understandable across populations and tailored to facilitate culturally appropriate and meaningful patient–provider communication. Our results and methodology of culturally adapting an intervention may be applicable to other underrepresented populations.

scholarly journals Guideline concordant detection and management of depression among Alaska Native and American Indian people in primary care

2015 ◽  
Vol 74 (1) ◽  
pp. 28315 ◽  
Author(s):  
Vanessa Y. Hiratsuka ◽  
Julia J. Smith ◽  
Sara M. Norman ◽  
Spero M. Manson ◽  
Denise A. Dillard
Keyword(s):  
Primary Care ◽  
American Indian ◽  
Alaska Native ◽  
Indian People ◽  
American Indian People

scholarly journals Potential Disparate Impact CAEP Standard 3.2 on the Protected Classes of Alaska Native, American Indian, African American, and Latino Members of Descent

2016 ◽  
Vol 4 (8) ◽  
pp. 151-160
Author(s):  
Roy Roehl
Keyword(s):  
African American ◽  
Native American ◽  
American Indian ◽  
American Indians ◽  
Alaska Native ◽  
Teacher Candidates ◽  
National Policy ◽  
Alaska Natives ◽  
Disparate Impact ◽  
Minority Teacher

CAEP Standard 3.2 has a demonstrated disparate impact on several protected classes of individuals, including African Americans, Alaska Natives, American Indians, and Latinos. The data from this study clearly shows a national policy that will have an unequal impact for future genrations of minority teacher candidates.

scholarly journals Blood Politics, Ethnic Identity, and Racial Misclassification among American Indians and Alaska Natives

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Emily A. Haozous ◽  
Carolyn J. Strickland ◽  
Janelle F. Palacios ◽  
Teshia G. Arambula Solomon
Keyword(s):  
Ethnic Identity ◽  
American Indian ◽  
American Indians ◽  
Alaska Native ◽  
Historical Context ◽  
Alaska Natives ◽  
Political Processes ◽  
Current State ◽  
Native Identity ◽  
State Of The Science

Misclassification of race in medical and mortality records has long been documented as an issue in American Indian/Alaska Native data. Yet, little has been shared in a cohesive narrative which outlines why misclassification of American Indian/Alaska Native identity occurs. The purpose of this paper is to provide a summary of the current state of the science in racial misclassification among American Indians and Alaska Natives. We also provide a historical context on the importance of this problem and describe the ongoing political processes that both affect racial misclassification and contribute to the context of American Indian and Alaska Native identity.

Primary care depression screening among American indian and Alaska native adults: The role of patient and provider characteristics

2010 ◽  
Vol 122 ◽  
pp. S55
Author(s):  
D.A. Dillard⁎ ◽  
C. Muller ◽  
J.J. Smith ◽  
V.Y. Hiratsuka ◽  
A. Lockhart ◽  
...  
Keyword(s):  
Primary Care ◽  
American Indian ◽  
Alaska Native ◽  
Depression Screening ◽  
Provider Characteristics

scholarly journals The Impact of Patient and Provider Factors on Depression Screening of American Indian and Alaska Native People in Primary Care

2011 ◽  
Vol 3 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Denise A. Dillard ◽  
Clemma J. Muller ◽  
Julia J. Smith ◽  
Vanessa Y. Hiratsuka ◽  
Spero M. Manson
Keyword(s):  
Primary Care ◽  
American Indian ◽  
Organizational Support ◽  
Alaska Native ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Care Providers ◽  
Indian People ◽  
American Indian People ◽  
The Impact

Introduction: The US Preventive Services Task Force recommends routine depression screening in primary care, yet regular screening does not occur in most health systems serving Alaska Native and American Indian people. The authors examined factors associated with administration of depression screening among Alaska Native and American Indian people in a large urban clinic. Methods: Medical records of 18 625 Alaska Native and American Indian adults were examined 1 year after implementation of a depression screening initiative. Multilevel logistic regression models examined associations between patient and provider factors and administration of the Patient Health Questionnaire–9. Results: Forty-seven percent of patients were screened. Women were more likely than men to be screened (50% vs 43%, P < .001). Increased screening odds were associated with older age, increased service use, and chronic disease ( P < .001) but not with substance abuse disorders or prior antidepressant dispensation. Women previously diagnosed with depression had higher odds of screening ( P = .002). Men seen by male providers had higher odds of screening than did men seen by female providers ( P = .040). Screening rates peaked among providers with 2 to 5 years of employment with the clinic. Limitations: Cross-sectional analysis of medical record data was of unknown reliability; there were limited sociodemographic data. Conclusions: Even with significant organizational support for annual depression screening, primary care providers systematically missed men and patients with infrequent primary care visits. Outreach to male patients and additional supports for primary care providers, especially in the first years of practice, may improve screening and treatment for depression among Alaska Native and American Indian people.

Sign in / Sign up

Export Citation Format

Share Document