Factors Related to Mental Health of Native Americans in Eastern Tribes

This paper is part of a five-year research project funded by the National Institute on Disability and Rehabilitation Research (NIDRR) that addresses the health, disability and service needs of Native Americans in eastern tribes. The Participatory Action Research model with a community-based approach was used to facilitate collaboration among the participating tribes. Native American research technicians conducted individual interviews with members of their tribes. Demographics, prevalence of disabilities, and various factors associated with health and mental health are presented. Of the 858 tribal members who responded to survey questions, the third most prominent health problem reported was mental illness.

Youth-focused empowerment evaluation using Photovoice

The Carrera-Children's Aid Society of New York model is a proven model of teen pregnancy prevention. There is a need to evaluate the effect that the model has had on the participants as individuals. Brighter Futures is a replication of the Carrera-Children's Aid Society of New York youth development model operated by Planned Parenthood of Houston and Southeast Texas. A qualitative youth-focused Empowerment Evaluation was initiated to determine the individual impact of the achieved program outcomes. The Empowerment Evaluation assessed what impact the Brighter Futures program has had on the students. The youth used Community-based Participatory Research (CBPR) approaches, such as Photovoice, in conjunction with guided writing and participatory groups to conduct this evaluation with in the framework of Empowerment Evaluation. Additionally, a semi-structured CBPR exercise was used to evaluate the effectiveness of the feasibility of Photovoice methodology with urban youth. ^

The construction of aging and health in older African American women

Persistence of racial and ethnic health disparities and governmental policies based on outdated ideas of aging call for inclusive approaches to the study of elder African Americans. The lived experiences of aging among urban, poor African American women, who comprise a vulnerable population, are not well known, as most studies focus on mainstream populations. Gerontological studies have tended to employ methods that collapse contextual information for ease of analysis, thus failing to capture nuanced information critically relevant to health of marginalized groups. Few researchers have been successful highlighting the importance of local knowledge, resilience, and resources for health by using participatory methods with older Black women. This study utilizes participatory principles to gather discursive data from nine older African American women, engaged in three generational cohorts: those born around World War II, women born after the great depression, and those born before the great depression. Videotaped and transcribed conversations of cohorts were analyzed in search of contextual factors that influence their experience of aging and health. As women responded to general themes that provoked their talk about their lives, they helped answer the study's questions: How do older African American women make sense of their aging experience? What are some of the important social and cultural influences that shape the construction of aging and health by these women? Are generational discourse groups an effective tool for exploring changes in the experiences of aging? A key finding demonstrated rich heterogeneity of experiences with strong generational influences on the construction of aging and health. The participants' moral orders comprised of traditional values of family, reinforced by personal experiences and the church, have guided their lives through oppression and stress but appear to be failing younger women who have greater exposure to new environmental pressures. Limited time and the size of the study were weaknesses although the women's interest in the study and their participation were gratifying. The participants served to highlight the importance of recognizing generational and other contextual factors in formation of ideas of aging and likelihood of additional challenges to the experience of old age among older, poorer, African Americans. ^

The Comal County Needs Assessment Youth Survey

A crucial link in preserving and protecting the future of our communities resides in maintaining the health and well being of our youth. While every member of the community owns an opinion regarding where to best utilize monies for prevention and intervention, the data to support such opinion is often scarce. In an effort to generate data-driven indices for community planning and action, the United Way of Comal County, Texas partnered with the University Of Texas - Houston Health Science Center, School Of Public Health to accomplish a county-specific needs assessment. A community-based participatory research emphasis utilizing the Mobilization for Action through Planning and Partnership (MAPP) format developed by the National Association of City and County Health Officials (NACCHO) was implemented to engage community members in identifying and addressing community priorities. The single greatest area of consensus and concern identified by community members was the health and well being of the youth population. Thus, a youth survey, targeting these specific areas of community concern, was designed, coordinated and administered to all 9-11th grade students in the county. 20% of the 3,698 completed surveys (72% response rate) were randomly selected for analysis. These 740 surveys were coded and scanned into an electronic survey database. Statistical analysis provided youth-reported data on the status of the multiple issues affecting the health and well being of the community's youth. These data will be reported back to the community stakeholders, as part of the larger Comal County Needs Assessment, for the purposes of community planning and action. Survey data will provide community planners with an awareness of the high risk behaviors and habit patterns amongst their youth. This knowledge will permit more effective targeting of the means for encouraging healthy behaviors and preventing the spread of disease. Further, the community-oriented, population-based nature of this effort will provide answers to questions raised by the community and will provide an effective launching pad for the development and implementation of targeted, preventive health strategies. ^

Youth empowerment evaluation to improve afterschool programming

Community-based participatory research necessitates that community members act as partners in decision making and mutual learning and discovery. In the same light, for programs/issues involving youth, youth should be partners in knowledge sharing and evaluation (Checkoway & Richards-Schuster, 2004). This study is a youth-focused empowerment evaluation for the Successful Youth program. Successful Youth is a multi-component youth development after-school program for Latino middle school youth, created with the goal of reducing teen pregnancy. An empowerment evaluation is collaborative and participatory (Balcazar and Harper 2003). The three steps of an empowerment evaluation are: (1) defining mission, (2) taking stock, and (3) planning for the future (Fetterman 2001).^ In a program where youth are developing leadership skills, making choices, and learning how to self reflect and evaluate, the empowerment evaluation could not be more aligned with promoting and enhancing these skills. In addition, an empowerment evaluation is designed to "foster improvement and self-determination" and "build capacity" (Fetterman 2001). Four empowerment groups were conducted with approximately 6-9 Latino 7th grade students per group. All participants were enrolled in the Successful Youth program. Results indicate points where students' perceptions of the program were aligned with the program's mission and where gaps were identified. Students offered recommendations for program improvements. Additionally, students enjoyed expressing their feelings about the program and appreciated that their opinions were valued. Youth recommendations will be brought to program staff; and, where possible, gaps will be addressed. Empowerment evaluations with youth will continue during the duration of the program so that youth involvement and input remains integral in the evaluation and to ascertain whether the program's goals are being met. ^

Household risk factors and the health and nutritional status of children in rural Honduras

During this cross-sectional study, both quantitative and qualitative research methods were used to elucidate the role that household environment and sanitation play in the nutritional status of children in a rural Honduran community. Anthropometric measurements were taken as measures of nutritional status among children under five years of age, while interviews regarding the household environment were conducted with their primary caregivers. Community participatory activities were conducted with primary caregivers, and results from water quality testing were analyzed for E. coli contamination. Anthropometric results were compared using the 1977 NCHS Growth Charts and the 2006 WHO Child Growth Standard to examine the implications of using the new WHO standard. The references showed generally good or excellent agreement between z-score categories, except among height-for-age classifications for males 24-35.9 months and weight-for-age classifications for males older than 24 months. Comparing the proportion of stunted, underweight, and wasted children, using the WHO standard generally resulted in higher proportions of stunting, lower underweight proportions, and higher overweight proportions. Logistic regression was used to determine which household and sanitation factors most influenced the growth of children. Results suggest only having water from a spring, stream, or other type of surface water as the primary source of drinking water is a significant risk factor for stunting. A protective association was seen between the household wealth index and stunting. Through participatory activities, the community provided insight on health issues important for improving child health. These activities yielded findings to be harnessed as a powerful resource to unify efforts for change. The qualitative findings were triangulated with the quantitative interview and water testing results to provide intervention recommendations for the community and its primary health care clinic. Recommendations include educating the community on best water consumption practices and encouraging the completion of at least some primary education for primary caregivers to improve child health. It is recommended that a community health worker program be developed to support and implement community interventions to improve water use and household sanitation behaviors and to encourage the involvement of the community in targeting and guiding successful interventions. ^

Process evaluation of intervention program for prevention of early sexual activity and alcohol use among Hispanic teenagers

Hispanic teens are a high-risk population for initiation of early sexual activity and alcohol use which in turn has numerous social and health consequences. One strategy to address prevention of these behaviors is to implement a capacity building intervention that promotes parent child communication, encompasses their cultural values and community participation. This study describes the process evaluation of a pilot intervention program amongst Hispanic teens and their families living along the Texas-Mexico border. “Girls Lets Talk” is a small group intervention with 10-14 year old teens and their female adult family members that involves education regarding effects of alcohol use and sexual activity as well as activities for monitoring and refusal skills to prevent risky behaviors. Two waves of the program each consisting of at least seven mother daughter dyads were conducted. During the designing process, community advisory board meetings and focus groups were held to review course materials and ensure they were appropriate to the Mexican American culture. Parent and adolescent surveys were administered at the beginning and end of the intervention to assess for psychosocial outcome variables. All sessions received high mean satisfactory scores (mean of 4.00 or better on a five point scale) for both adult and adolescent participants. Qualitative feedback was obtained via debriefing sessions to evaluate experience as well as alter recruitment strategies. A Wilcoxon Sign Rank analysis of the pre and post intervention surveys was done that showed significant changes in some outcome variables such as intentions and confidence for monitoring behaviors for adults and beliefs regarding sexual activity. “Girls Lets Talk” is a promising example of how a process evaluation plan can help develop a theory based health promotion program using the community based participatory research approach. The intervention may also be effective in altering intentions and enhancing self-efficacy among parents and teens in order to decrease risky behaviors such as early sexual activity and alcohol use.^

Democracy in the healthcare workplace: A critical perspective

A review of existing literature revealed at least two distinct theoretical perspectives or schools of thought which are troubled by problems of the lack of participation in the workplace: Jurgen Habermas' ideal of communicative rationality (1984; 1987); and the field of workplace democracy. Whereas Habermas' ideal of communicative rationality establishes communication as necessary to attain a democratic workplace, the ideal of workplace democracy focuses on a participatory ideal in which conditions of open participation must be fulfilled in order to attain a democratic workplace. This study compared the strengths and weaknesses of the conditions proposed by Habermas with the strengths and weaknesses of the conditions selected to represent the workplace democracy ideal. Two incidents were selected for analysis which occurred within a period of one year within one large healthcare organization. The author was present as a participant-observer to assess these incidents. Each of the conditions for the ideal of communicative rationality and for the workplace democracy ideal was systematically applied to both incidents selected for analysis. The results of the analysis suggested that application of Habermas' theory provided more insight into potential distortions in communication than did the conditions selected to represent workplace democracy. Although the conditions of both models were frequently complementary and even overlapping at times, application of each theory to the same incident produced distinctly different results. ^

Sacred vocation program follow up evaluation at the Baylor healthcare system

Background: The Sacred Vocation Program (SVP) (Amick B, Karff S., 2003) helps workers find meaning, spirituality, and see their job as a sacred vocation. The SVP is based on Participatory Action Research (PAR) (Minkler & Wallerstein, 1997; Parker & Wall, 1998). This study aims to evaluate the SVP implemented at the Baylor Healthcare System, Dallas-Fort Worth. ^ Methods: The study design is a qualitative design. We used data from study participants who have participated in focus groups. During these focus groups specific questions and probes regarding the effectiveness of the SVP have been asked. We analyzed the focus groups and derived themes. ^ Results: Results of this study demonstrate SVP helps graduates feel valued and important. The SVP has improved meaningful work for employees and improved a sense of belonging for participants. The program has also increased participant spirituality. The coping techniques developed during a SVP class helps participants deal with stressful situations. The SVP faces challenges of implementation fidelity, poor communication, program viability in tough economic times and implementation of phase II. Another sustainability challenge for SVP is the perception of the program being a religious one versus a spiritual program. ^ Conclusion: Several aspects of the SVP work. The phase I of SVP is successful in improving meaningful work and a sense of belonging for participants. The coping techniques help participants deal with difficult work situations. The SVP can increase effectiveness through improvements in implementation fidelity, communication and leadership commitment. ^

Post-Permanency: An Assessment for Families’ Needs for Services and Supports

This article reports the results of a qualitative study that sought the perspectives of birth parents and adoptive parents following reunification or adoption of children from foster care. Using a participatory action design that actively involved young adults formerly in foster care and parents in the design and implementation of the study, the study focused on the consumers’ perspectives on several issues related to permanency. The article reports findings from interviews with a subset of 27 birth and adoptive families in New York City who were asked about their post-permanency experiences and from interviews with 38 child welfare professionals who were asked to respond to the parents’ perspectives. The article offers directions for child welfare practice and program development.

Let their voices be heard: Understanding the barriers to seeking early prenatal care for low-income non-Hispanic Black women

Background: Receipt of early prenatal care, care during the first three months of pregnancy, is the standard in the United States. Sixty percent of non-Hispanic Black women who had a live birth in the Sunnyside community of Houston did not obtain early prenatal care in 2009. ^ This study's aims were to: 1) Describe the barriers to obtaining early prenatal care in non-Hispanic Black women who live in the Sunnyside community of Houston; and, 2) Describe the actions that could encourage non-Hispanic Black women who live in the Sunnyside Community to obtain early prenatal care. The goal was to provide information to organizations that promote early prenatal care use in non-Hispanic Black women in Harris County that may aid in developing interventions. ^ Methods: The Participatory Learning for Action rapid assessment qualitative method was used in a group setting to answer the research questions on behalf of women in the community. Women who participated in the group sessions also participated in an in-depth interview. Key informants who work in the community with pregnant women, or promote the use of prenatal care services, were also interviewed. An inductive analysis of the data was conducted to identify common themes that address the study's aims. ^ Results: Aim 1: Group participants identified fear of the reaction from family and/or the baby's daddy and shame, not having insurance or money, and lack of knowledge of the pregnancy and resources as the top three barriers to early prenatal care for women in the community. Aim 2: Group participants stated that to help women to overcome these barriers, communication, awareness and support; help, resources and services; and information and early education are needed. Participant in-depth interviewees echoed the themes of fear of the reaction from family and/or the baby's daddy and not knowing of the pregnancy. Key informants mentioned these themes as well, though not at the same priority level. Participants and key informants also mentioned similar themes for helping women to overcome barriers to early prenatal care. ^ Conclusion: A comprehensive approach is needed to improve early prenatal care use in the Sunnyside community. Education efforts must include all members of the community, young and old, to promote support for pregnant women. Community members must be a part of the process for developing education campaigns. Engaging the community builds a relationship with organizations that serve the community, which may promote use of the organizations' services, and build trust with the community. All efforts must be ongoing so that women and men of all ages in the community understand the importance of prenatal care and support women obtaining care early in the pregnancy.^

Use of empowerment evaluation to determine a sustainability plan for a community-based preconception care program

Women With IMPACT (WWI) is a community-based preconception care educational intervention. WWI is being implemented by the Impacting Maternal and Prenatal Care Together (IMPACT) Collaborative and targets zip codes in Harris County, Texas at high risk for infant mortality, low birthweight, and preterm birth. WWI started March 2012 and continues through August 2013. Three workshop series are planned. This study was conducted with participants and facilitators from the first workshop series. This study aimed to 1) evaluate the WWI program using empowerment evaluation, 2) engage all WWI stakeholders in an empowerment evaluation so the method could be adopted as a participatory evaluation process for future IMPACT activities, and 3) develop recommendations for sustainability of the WWI intervention, based on empowerment evaluation findings and results from the pre/post program evaluation completed by WWI participants. Study participants included WWI participants and facilitators and IMPACT Collaborative Steering Committee members. WWI participants were female, 18-35 year-old, non-pregnant residents of zip codes at high risk of adverse birth outcomes. All other study participants were 18 years or older. A two-phased empowerment evaluation (EE) was utilized in this study. Sessions 1-4 were conducted independently of one another – 3 with participants at different sites and one with the facilitators. The fifth session included WWI participant and facilitator representatives, and IMPACT Steering Committee members. Session 5 built upon the work of the other sessions. Observation notes were recorded during each session. Thematic content analysis was conducted on all EE tables and observation notes. Mission statements drafted by each group focused on improvement of physical and mental health through behavior change and empowerment of all participants. The top 5 overall program components were: physical activity, nutrition, self-worth, in-class communication, and stress. Goals for program improvement were set by EE participants for each of these components. Through thematic content analysis of the tables and observation notes, social support emerged as an important theme of the program among all participant groups. Change to a healthy lifestyle emerged as an important theme in terms of program improvement. Two-phased EE provided an opportunity for all program stakeholders to provide feedback regarding important program components and provide suggestions for program improvement. EE, thematic content analysis, pre/post evaluation results, and inherent program knowledge were triangulated to make recommendations to sustain the program once the initial funding ends. ^

“Realidad o Utopía" : : ley de ordenamiento territorial

La lógica del mercado y al cambio de modelo de desarrollo en América Latina, en el intento de poder competir a nivel mundial, ha agudizado las disparidades y el deterioro ambiental. La presión que ejercen las grandes empresas y ciertos grupos con poder, el enquistamiento de una estructura administrativa que puja por mantener esquemas tradicionales ya perimidos y la falta de planificación impiden atender uno de los problemas claves que plantea la economía en el territorio, el de la concentración y los desequilibrios territoriales. Surge entonces el Ordenamiento Territorial como alternativa válida para atenuar estos procesos y dar respuesta a la sociedad. El caso que se presenta pone en el tapete muchos de estos temas que hoy preocupan y puede servir como experiencia transferible y aplicable a otras realidades que buscan consolidar un desarrollo local sustentable. El ante-proyecto de Ley de Ordenamiento Territorial y Usos del Suelo para la provincia de Mendoza, República Argentina, es un instrumento elaborado en el año 2006 por el sector académico-científico que desde una visión interdisciplinaria incorpora fundamentos técnicos y aportes de los actores sociales involucrados. La metodología aplicada permite consensuar por la sociedad en su conjunto los principios que sustentan la Ley, determinar la aplicación de ciertos instrumentos para efectivizar acciones en el territorio y definir una forma innovadora de hacer política, gestionar y planificar el uso del suelo. La propuesta considera al Ordenamiento Territorial como una política de Estado que debe propiciar condiciones de gobernabilidad. Sus principios y normas priorizan la equidad y el bienestar general por encima de los intereses particulares así como también el respeto de los valores y costumbres de la sociedad. Surge de un proceso participativo y sus principios y fines responden a los problemas actuales. Incorpora una serie de instrumentos debidamente jerarquizados conforme a las competencias jurisdiccionales y existencia de distintas escalas geográficas, como también, instrumentos jurídicos y prácticas administrativas innovadoras que permiten la resolución de conflictos territoriales. Identifica además recursos financieros para implementarla y prioriza el fortalecimiento de los mecanismos de control para un funcionamiento más ágil y eficaz de la gestión pública. Sin embargo existen riesgos vinculados a la voluntad política y el poder económico que pueden impedir que esta utopía se transforme en realidad. Solo la participación social es la que puede lograr vencer los intereses en juego y conseguir la aprobación de la Ley. Si esto se consigue se habrá dado un paso muy importante a ser imitado, sin lugar a dudas, en otros lugares de Argentina y América Latina.