scholarly journals Diabetes Prevention and Care Capacity at Urban Indian Health Organizations

2021 ◽  
Vol 9 ◽  
Author(s):  
Meredith P. Fort ◽  
Margaret Reid ◽  
Jenn Russell ◽  
Cornelia J. Santos ◽  
Ursula Running Bear ◽  
...  
Keyword(s):  
Alaska Native ◽  
Urban Areas ◽  
Diabetes Prevention ◽  
Organizational Capacity ◽  
Evidence Based ◽  
Health Organizations ◽  
Data Infrastructure ◽  
Indian Health ◽  
Urban Indian ◽  
Original Survey

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.

scholarly journals Our Collective Needs and Strengths: Urban AI/ANs and the COVID-19 Pandemic

2021 ◽  
Vol 6 ◽  
Author(s):  
Tara L. Maudrie ◽  
Kerry Hawk Lessard ◽  
Jessica Dickerson ◽  
Kevalin M. W. Aulandez ◽  
Allison Barlow ◽  
...  
Keyword(s):  
Alaska Native ◽  
Urban Areas ◽  
Blind Spot ◽  
Health Programs ◽  
Local Data ◽  
Baltimore City ◽  
Care Community ◽  
Community Needs ◽  
Urban Indian ◽  
Health Assessments

The COVID-19 pandemic has raised national consciousness about health inequities that disproportionately impact American Indian/Alaska Native (AI/AN) communities, yet urban AI/AN communities continue to remain a blind spot for health leaders and policymakers. While all United States cities have been the traditional homelands of AI/AN peoples since time immemorial, urban AI/ANs are consistently excluded in local and national health assessments, including recent reports pertaining to COVID-19. Today the majority of AI/ANs (71%) live in urban areas, and many cities have strong Urban Indian Health Programs (UIHPs) that provide space for medical care, community gatherings, cultural activities, and traditional healing. Many of these UIHPs are currently scrambling to meet the needs of their AI/AN service communities during the pandemic. While the COVID-19 pandemic brought new sources of funding to UIHPs, the lack of local AI/AN data and arbitrary funding restrictions precluded some UIHPs from addressing their communities’ most immediate challenges such as food and economic insecurities. Despite these challenges, urban AI/AN communities carry the historical resilience of their ancestors as they weave strong community networks, establish contemporary traditions, and innovate to meet community needs. This article focuses on the experiences of one UIHP in Baltimore City during the COVID-19 pandemic to illustrate present-day challenges and strengths, as well as illuminate the urgency for tailored, local data-driven public health approaches to urban AI/AN health.

scholarly journals Key factors to facilitate locally driven family planning programming: a qualitative analysis of urban stakeholder perspectives in Africa and Asia

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Lisa Mwaikambo ◽  
Sarah Brittingham ◽  
Saori Ohkubo ◽  
Ruwaida Salem ◽  
Denis Joel Sama ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Systems ◽  
Thematic Analysis ◽  
Urban Areas ◽  
Local Governments ◽  
Scale Up ◽  
Analytical Framework ◽  
Essential Elements ◽  
Evidence Based ◽  
Country Ownership

Abstract Background There has been greater recognition of the importance of country ownership in global health and development. However, operationalising country ownership to ensure the scale up and sustainability of proven interventions remains elusive at best. To address this challenge, we undertook a thematic analysis of interviews collected from representatives of local governments, public health systems, and communities in poor urban areas of East Africa, Francophone West Africa, India, and Nigeria, supported by The Challenge Initiative (TCI), aiming to rapidly and sustainably scale up evidence-based reproductive health and family planning solutions. Methods The main objective of this study was to explore critical elements needed for implementing and scaling evidence-based family planning interventions. The research team conducted thematic analysis of 96 stories collected using the Most Significant Change (MSC) technique between July 2018 and September 2019. After generating 55 unique codes, the codes were grouped into related themes, using TCI’s model as a general analytical framework. Results Five key themes emerged: (1) strengthening local capacity and improving broader health systems, (2) shifting mindsets of government and community toward local ownership, (3) institutionalising the interventions within existing government structures, (4) improving data demand and use for better planning of health services, and (5) enhancing coordination of partners. Conclusion While some themes feature more prominently in a particular region than others, taken together they represent what stakeholders perceive to be essential elements for scaling up locally-driven health programmes in urban areas in Africa and Asia.

Evading the Patronage Trap: Organizational Capacity and Demand Making in Mexico

2019 ◽  
Vol 52 (13-14) ◽  
pp. 2097-2134 ◽  
Author(s):  
Brian Palmer-Rubin
Keyword(s):  
Social Class ◽  
Small Business ◽  
Organizational Capacity ◽  
Process Tracing ◽  
Economic Interest ◽  
Business Organizations ◽  
Economic Sectors ◽  
Private Goods ◽  
Original Survey ◽  
Interest Organizations

When do organizations broadly represent the interests of their economic sectors and when do they narrowly represent the interests of members? This article investigates how agricultural and small-business organizations in Mexico make demands for programmatic policies or patronage benefits. Contrary to explanations based on the class of members, I show that the source of organizational capacity shapes demand-making strategies. Organizations that generate selective benefits internally are able to engage in programmatic policies that shape sectoral competitiveness, whereas organizations that fail to solve membership challenges internally are vulnerable to the patronage trap, a self-reproducing cycle wherein they become specialized in demand making for discretionary private goods. I generate this argument through process tracing of two agricultural organizations in Mexico. Analysis of an original survey of economic interest organizations provides broader evidence that organizational capacity is a better predictor of policy demands than social class.

scholarly journals Identifying as American Indian/Alaska Native in Urban Areas: Implications for Adolescent Behavioral Health and Well-Being

2019 ◽  
Vol 53 (1) ◽  
pp. 54-75 ◽  
Author(s):  
Ryan A. Brown ◽  
Daniel L. Dickerson ◽  
David J. Klein ◽  
Denis Agniel ◽  
Carrie L. Johnson ◽  
...  
Keyword(s):  
Mental Health ◽  
Identity Development ◽  
American Indian ◽  
Behavioral Health ◽  
Alaska Native ◽  
Urban Areas ◽  
Mental Health Problems ◽  
Well Being ◽  
Racial Ethnic ◽  
Health And Well Being

American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racial-ethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.

scholarly journals Disparities in accessibility to evidence‐based breast cancer care facilities by rural and urban areas in Bavaria, Germany

Cancer ◽  
2021 ◽  
Author(s):  
Stephanie Stangl ◽  
Sebastian Rauch ◽  
Jürgen Rauh ◽  
Martin Meyer ◽  
Jacqueline Müller‐Nordhorn ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Urban Areas ◽  
Evidence Based ◽  
Breast Cancer Care ◽  
Rural And Urban Areas ◽  
Cancer Care Facilities ◽  
Rural And Urban ◽  
Care Facilities

American Indian Behavioral Health Treatment Preferences as Perceived by Urban Indian Health Program Providers

2021 ◽  
pp. 104973232110578
Author(s):  
Andrew Pomerville ◽  
Anna Kawennison Fetter ◽  
Joseph P. Gone
Keyword(s):  
Focus Groups ◽  
American Indian ◽  
Behavioral Health ◽  
Cultural Values ◽  
The United States ◽  
Treatment Preferences ◽  
Health Staff ◽  
Indian Health ◽  
Urban Indian ◽  
Therapy Room

Behavioral health services specifically targeted for ethnoracial clients are typically tailored to the specific needs and preferences of these populations; however, little research has been done with American Indian clients specifically. To better understand how clinicians handle provision of treatment to this population, we interviewed 28 behavioral health staff at six Urban Indian Health Programs in the United States and conducted focus groups with 23 staff at five such programs. Thematic analysis of transcripts from these interviews and focus groups suggests that these staff attempt to blend and tailor empirically supported treatments with American Indian cultural values and practices where possible. Simultaneously, staff try to honor the client’s specific preferences and needs and to encourage clients to seek cultural practices and connection outside of the therapy room. In so doing staff members were acutely aware of the limitations of the evidence base and the lack of research with American Indian clients.

scholarly journals POLITICAL ABSTENTION IN THE INDIAN MIDDLE CLASS, THE RISE OF POPULISM AND THE REINFORCEMENT OF RENT

2018 ◽  
Author(s):  
Arkaprabha Pal
Keyword(s):  
Middle Class ◽  
Urban Areas ◽  
Lower Class ◽  
Religious Fundamentalism ◽  
Parliamentary Democracy ◽  
New Middle Class ◽  
Political Relationships ◽  
Urban Indian ◽  
English Speaking ◽  
Major Section

The Indian middle class witnessed a reconfiguration in its composition after the failure of the secular nationalists in their method of development and redistribution of resources. This reconfiguration used cultural and religious fundamentalism in the form of Hindutva as its instrument to assert their right to access the resources and strive towards a non-State centric redistribution. However, this new middle class, which was mainly conversing in the vernacular and had its base in the smaller urban areas, was also faced with the assertion of the lower class identarian groups. In such a situation, a large section of the urban Indian middle class shied away from taking part in the electoral process citing moral crises of the corrupt secular English speaking elite on one hand and the lowly criminal nature of the lower class political assertion on the other. Taking hints from the works of Christophe Jaffrelot, I would try to argue in this paper, that non-participation of a major section of the urban middle class was a manifestation of securing the rechanneled and partially redistributed rent legitimised through the instrument of Hindutva. This has led to increased persona-centric populist narratives from the mid-1990s to the present times with efforts to undermine parliamentary democracy (which is associated as an institiution of the immoral secular nationalists). This in turn, I would try to argue by the end of this paper, has again assisted in concretising the very rent-seeking practices and patron-client political relationships that the new middle class had initially opposed to rise to political prominence throughout the late 1970s and 1980s

scholarly journals IDENTIFICATION OF DEVELOPMENT DETERMINANTS OF GREEN INFORMATION SYSTEMS FOR URBAN AREAS – POLISH CASE STUDY

2020 ◽  
Vol 19 (1) ◽  
pp. 45-60
Author(s):  
Magdalena Nowak ◽  
Agnieszka Dawidowicz ◽  
Ryszard Źróbek ◽  
Mai Do Thi Tuyet
Keyword(s):  
Information Systems ◽  
Spatial Data ◽  
Green Infrastructure ◽  
Urban Areas ◽  
Impact Factors ◽  
Green Is ◽  
Data Infrastructure ◽  
Urban Greenery ◽  
The Creation ◽  
Green Information Systems

The green information systems (green IS) address the demand for information about green spaces in both urban and non-urbanized areas. This systems are part of green infrastructure (GI) and National Spatial Data Infrastructure (NSDI). GI are very important for the urban environment, and it improves the quality of life. There are various types of urban greenery. The green IS can support the management, maintenance, monitoring, protection and revitalization of urban greenery and all GI. This systems contribute to the sustainable development of urban areas, the development of smart and green cities and spatially enabled societies where community members are involved in local projects. In Poland, few cities have so far taken the effort to create a green IS due to the costs of starting and maintaining the system. Municipalities give up the creation of this system because it is not a good first necessity. However, green infrastructure is developing in Poland and there is a strong demand for green IS for easier GI management. Therefore, the aim of the research was to identify various determinants (factors) that may affect the development of green IS in Poland. Analysisof determinants is necessary and important from the point of view of knowledge of mechanisms affecting the development of green IS and may be useful to develop a strategy for further activities promoting the creation of green IS in all cities in Poland. The research results provided the basis for distinguishing groups of impact factors due to their specificity and showed which instruments are applied to them taking into account global and local initiatives.

COVID-19 Telehealth for Indian Country: Tribal Response to an Emerging Pandemic

2020 ◽  
Vol 44 (3) ◽  
pp. 37-44
Author(s):  
David Stephens ◽  
Alexander Wu ◽  
Eric Vinson ◽  
Megan Woodbury ◽  
Celeste Davis ◽  
...  
Keyword(s):  
Emergency Response ◽  
Alaska Native ◽  
Health Professionals ◽  
Healthcare Outcomes ◽  
Community Healthcare ◽  
Native Communities ◽  
Indian Health ◽  
Indian Country ◽  
Baseline Evaluation ◽  
Poor Outcomes

American Indian/Alaska Native communities are at higher risk of poor outcomes from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The Northwest Portland Area Indian Health Board’s program Indian Country Extensions for Community Healthcare Outcomes (ECHO) initiated telehealth sessions for health professionals. All resources were centralized at www.IndianCountryECHO.org. In its first six weeks, the program had 4,579 attendees. Participants submitted 563 questions to specialists. There were 22,683 webpage views, more than three times the pre-COVID-19 baseline. Evaluation found 94 percent of clinicians reported knowledge increase and 93 percent reported greater social support, demonstrating that a teleECHO network serving Indian country is an important part of emergency response.

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