Improving Chronic Illness Management with the Apsaalooke Nation: The Baa nnilah Project

 描述（由申请人提供）：迫切需要注意解决白人和美洲印第安人（AI）在慢性疾病（CI）死亡年龄方面的显着差异。在我们蒙大拿州，患有心脏病或肾病的人的死亡时间提前14年，糖尿病患者提前12.5年，脑血管疾病患者提前11年。现有的人工智能管理计划可以降低死亡率和提高生活质量，但由于与人工智能文化不一致而失败。为了解决这个问题，我们开发了Baa nnilah，这是一个创新和独特的计划，旨在提高蒙大拿州Apsáalooke（乌鸦）印第安人的CI管理能力。该研究基于Apsáalooke Nation和蒙大拿州立大学之间为期19年的基于社区的参与性研究（CBPR）伙伴关系的方法和结果。Baa nilah翻译为从别人那里得到的生活建议或指示，通常是以故事的形式。 该方法以Apsáalooke文化价值观为中心。内容是基于我们的概念框架的影响力CI管理收集初步访谈数据。衡量的成果直接来自概念框架和干预内容。Baa nilah是一个由11名部落成员组成的10个小组的团体干预：一名训练有素的导师领导人，被认为是他/她的CI的成功管理者，以及10名没有很好地管理自己疾病的学员。每个11人小组将举行7次会议，内容和方法包括小型讨论，谈话圈和技能建设活动。使用CBPR方法，我们将追求以下具体目标：目标1：完善和加强以社区为基础的，文化上适当的巴尼拉干预和研究方案。目标2：在Apsáalooke保留地随机分配的200名25岁及以上患有CI的AI男性和女性中，使用等待列表对照组有效性试验来测试干预与常规护理的效果。在干预后6个月和12个月测量的结果包括生活质量、对社会角色和活动的满意度和参与度、社会隔离、患者激活、医疗保健关系、身体功能和抑郁。我们的混合方法设计包括干预后立即对保真度和可接受性进行定性评估。Baa nilah可以作为其他社区和部落国家寻求改善CI健康差距的重要模式，并对急性疾病的管理产生影响。

 DESCRIPTION (provided by applicant): Urgent attention is needed to address the significant disparities between whites and American Indians (AIs) in age at death for those with chronic illness (CI). In our state of Montana, AIs die 14 years earlier for those with heart or kidney disease, 12.5 years for those with diabetes, and 11 years for those with cerebrovascular disease. Existing programs addressing CI management, which can lead to lower mortality rates and a higher quality of life, fail because they are not consonant with the AI culture. To address this failing, we developed Baa nnilah, an innovative and unique program to improve capabilities for CI management among Apsáalooke (Crow) Indians in Montana. The study is based on methods and findings from a 19-year community-based participatory research (CBPR) partnership between the Apsáalooke Nation and Montana State University. Baa nnilah translates to advice or instructions for life that are received from others, often in a story form. The method is centered on Apsáalooke cultural values. The content is based on our conceptual framework of influencers of CI management gleaned from preliminary interview data. The measured outcomes flow directly from the conceptual framework and intervention content. Baa nnilah is a group intervention comprised of 10 groups of 11 tribal members: a trained Mentor leader, who is considered a successful manager of his/her CI, and 10 mentees, who are not managing their illness well. Each 11-member group will meet 7 times covering content and using methods that include a mini-discussion, talking circle and skill-building activity. Using a CBPR approach, we will pursue the following SPECIFIC AIMS: AIM 1: Refine and strengthen the community-based, culturally appropriate Baa nnilah intervention and study protocol. AIM 2: Test the effects of the intervention versus usual care using a wait-list control group effectivenes trial among 200 randomly assigned AI men and women 25 and older who have CI on the Apsáalooke Reservation. Outcomes, measured at 6 and 12 months post-intervention, include quality of life, satisfaction in and participation with social roles and activities, social isolatin, patient activation, health care relationship, physical function, and depression. Our mixed-methods design includes a qualitative evaluation of fidelity and acceptability immediately post-intervention. Baa nnilah can serve as an important model for other communities and tribal nations looking to improve CI health disparities and has implications for management of acute conditions.