PROGRAMS FOR FELLOWS AND JUNIOR FACULTY
THE COMMONWEALTH FUND/HARVARD UNIVERSITY FELLOWSHIP IN MINORITY HEALTH POLICY
FELLOWS' PRACTICUM: 2000-2001
Patrik Johansson, MD, MPH
“Health Policy for Native American Communities in Massachusetts: Development of a Health Assessment Survey Instrument for Native Americans through Talking Circles"
To create a health assessment survey instrument for Native American Communities in Massachusetts, and to establish research protocol guidelines for conducting research in tribal communities in Massachusetts.
As health policy is data driven and the Commonwealth of Massachusetts Department of Public Health (MDPH) has limited data on the health status of the 10 tribal groups of Massachusetts, implementing health policies directed at these Native American communities remains difficult. The Behavioral Risk Factor Surveillance System (BRFSS) represents the sole source of continuously collected, population-based information on American Indian and Alaskan Native health behaviors . Furthermore, the BRFSS is utilized to measure progress towards national and state health objectives. Modified versions of the BRFSS have been used in health assessments of several Native American communities in other states. In an initial effort to start surveying tribal communities across Massachusetts, the MDPH plans to conduct a health assessment of the Mashpee Wampanoag Tribe with a modified version of the BRFSS. The BRFSS for this study has been modified through tribal input gained from Talking Circles in the Mashpee Wampanoag Tribe, Assonet Band of the Wampanog Nation, and the Wampanoag Tribe of Gay Head/Aquinnah. The ten tribes in Massachusetts are classified as either federally acknowledged tribes, Massachusetts historic tribes, and other tribal groups. The aforementioned tribes represent each category, and were therefore asked to participate in this study.
Approval for research in each community was granted by the tribal councils of the Wampanoag Tribe of Gay Head Aquinnah and the Mashpee Wampanoag Tribe, while a community member of the Assonet Band of the Wampanoag Nation enlisted participants in the study. In Mashpee and Assonet, participants were recruited by elders, and in Aquinnah, by health program staff. Sessions were tape recorded with the tape destroyed following transcription. Tribes and researcher agreed that data would be used for the exclusive purpose of modifying the BRFSS, and the tribes would receive the transcripts following completion of the survey instrument. Focus groups were held in the form of talking circles, a traditional Native American custom, which allows for each participant’s voice to be heard, and talking circles have been employed as a data collection tool in other qualitative research involving Native Americans. Each talking circle was preceded by a prayer from a tribal member. The researcher posed questions, which were designed with the assistance of Patricia M. Gallagher, PhD, Senior Research Fellow, Center for Survey Research, University of Massachusetts Boston. A total of four Talking Circles, with six to nine participants, were conducted in the aforementioned communities, with two in Mashpee, one in Aquinnah and one in Assonet. Qualitative data was coded with assistance from Patricia M. Gallagher, PhD.
Major health issues facing tribal communities, as articulated by participants, include: diabetes, heart disease, arthritis, cancer, substance abuse, and mental health problems.
Cancer is caused by a polluted environment, and diabetes is a result of Native Americans straying from their traditional Indian diet.
Barriers to care include a lack of insurance, lack of transportation, fear of Western medicine, and lack of culturally appropriate care.
Traditional medicine in the form of herbal medicine, is widely used, but other forms of alternative medicine are also utilized.
Good health is viewed as a balance between body, mind, and spirit, gathering of tribal members, and relearning language.
Native Americans have a different genetic make-up, which causes an increased susceptibility to certain diseases.
Tribes without tribal lands feel that lack of tribal lands causes difficulty in gathering of tribal members, and this promotes poor health. Other social injustices also promote poor health.
The modified BRFSS for Massachusetts tribal communities should include questions on traditional and complementary medicine usage, differentiate between spiritual tobacco usage and other tobacco usage, address environmental health issues, modify the diet questions so they correlate with Wampanoag diets, and include more questions on substance abuse.
The health assessment should be piloted, and following the completion of the Mashpee survey, other tribes should be surveyed.
In approaching tribes to conduct research, researchers should initially approach health programs and tribal councils. If researchers lack contacts within a tribal community, they should consult the Commonwealth of Massachusetts Commission on Indian Affairs for assistance.
Tribes should participate in existing pipeline programs, in order to increase the number of Native American health care providers representing Massachusetts tribal communities.
1. Morbidity and Mortality Weekly Report, U.S. Department of Health and Human Services, February 4, 2000/Vol. 49/ No. 4
2. Strickland CJ: Health Promotion in Cervical Cancer Prevention Among the Yakama Indian Women of the Wa'Shat Longhouse. Journal of Transcultural Nursing 10(3):190-196, June 1999.
Jim Peters, Executive Director, The Commonwealth of Massachusetts Commission of Indian Affairs
Irvin Rich, HCFA, Health Insurance Specialist, DHHS, Health Care Financing Admin., Boston Regional Office
Albert Yee, MD MPH, Regional Health Administrator, DHHS, Office of Public Health and Science, Region I
Patricia M. Gallagher, PhD, Senior Research Fellow, Center for Survey Research, UMass, Boston
Joan Y. Reede, MD, MPH, Associate Dean for Faculty Development and Diversity, Harvard Medical School
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