Development of an Instrument for Assessment of Indigenous Historical Trauma as a Social Determinant of Health Among American Indian/Alaska Native Populations

开发一种评估土著历史创伤作为美洲印第安人/阿拉斯加原住民健康社会决定因素的工具

• 批准号: 10736011
• 负责人: MARK EDBERG
• 金额: $ 66.35万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-10 至 2027-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10736011
• 关键词: Accidental Injury; Address; Alaska Native; American; American Indians; Area; Assessment tool; Behavior; Behavioral; Birds; Categories; Characteristics; Cherokee Indian; Chronic; Collaborations; Colonialism; Communities; Community Health; Complex; Comprehension; Consensus; Data; Development; Device or Instrument Development; Diabetes Mellitus; Elderly; Ensure; Environmental Risk Factor; European; Face; Focus Groups; Foundations; Generations; Genocides; Goals; Government; Grief reaction; Health; Health Priorities; Health Status; Health behavior and outcomes; Heart; Homicide; Indigenous; Individual; Interview; Jordan; Link; Literature; Liver Cirrhosis; Measurement; Measures; Mediation; Mental Depression; Methods; Modeling; North Carolina; Outcome; Participant; Policies; Population; Post-Traumatic Stress Disorders; Prevention; Procedures; Process; Public Health Schools; Publications; Qualitative Methods; Qualitative Research; Reduce health disparities; Research; Respiratory Disease; Risk; Risk Behaviors; Sampling; Self-Injurious Behavior; Series; Shapes; Stress; Structure; Substance abuse problem; Suicide; Testing; Trauma; Tribes; Universities; Validation; Validity and Reliability; Violence; Washington; age stratification; assault; associated symptom; cardiovascular health; chronic liver disease; community based research; design; experience; health assessment; health determinants; health disparity; informant; innovation; instrument; intergenerational; member; parent grant; patient engagement; social; social factors; social health determinants; structural health determinants; theories; tool; tribal community; tribal member; wound

ABSTRACT American Indian/Alaska Native (AI/AN) populations experience some of the most extensive health disparities in the U.S. for any demographic group. Increasing evidence shows that indigenous historical trauma (IHT) is a likely causal factor for AI/AN health disparities. However, recent research has only begun the process of defining and operationalizing IHT as a construct that could be measured and assessed as a health determinant, and the instruments now available focus primarily on historical loss experience and associated symptoms, though the experience and effects of IHT are likely to be more extensive. Progress is needed to develop validated assessment tools that capture broader and cross-generational aspects of the phenomenon. To address this specific gap in the literature and contribute to the reduction of health disparities among AI/ANs, we propose community-based research that brings together complementary strengths of the Department of Prevention and Community Health (DPCH) at the George Washington University Milken Institute School of Public Health (GWSPH), the Eastern Band of Cherokee Indians (EBCI), and Western Carolina University (WCU) in a partnership to: 1) Use systematic qualitative methods, cultural models theory, and a community participatory approach to elicit/validate characteristics and manifestations of an expanded IHT construct (to include those identified in previous research), followed by scale development procedures to develop and pre- test an expanded IHT instrument that integrates these broader factors; and 2) administer the newly developed IHT scale and health assessment instrument to a sample of 400 Tribal participants to test its internal consistency, reliability, and factor structure. We will additionally evaluate the associations between IHT and behavioral risks/outcomes and priority health conditions prioritized by EBCI, including substance abuse and related issues, violence and abuse, diabetes, stress and depression. Results will be disseminated to EBCI and to the field.

摘要 美国印第安人/阿拉斯加原住民（AI/AN）人口在以下方面经历了一些最广泛的健康差异： 美国的任何一个人口统计学群体。越来越多的证据表明，土著历史创伤（IHT） AI/AN健康差异的可能因果因素。然而，最近的研究才刚刚开始， 将IHT定义为一种可以作为健康指标进行衡量和评估的结构， 决定性因素，现在可用的工具主要集中在历史损失经验和相关的 症状，虽然IHT的经验和影响可能更广泛。需要取得进展， 开发经过验证的评估工具，以捕捉这一现象的更广泛和跨代的方面。 为了解决文献中的这一具体差距，并有助于减少AI/AN之间的健康差距， 我们建议以社区为基础的研究，汇集了部门的互补优势， 乔治华盛顿大学米尔肯研究所 公共卫生（GWSPH），切罗基印第安人东部乐队（EBCI）和西卡罗莱纳大学 (WCU)在合作伙伴关系中：1）使用系统的定性方法，文化模型理论和社区 参与式方法，以引出/验证扩展的IHT结构的特征和表现（以 包括在以前研究中确定的那些），然后是规模开发程序，以开发和预- 测试一个扩展的IHT工具，整合这些更广泛的因素;和2）管理新开发的 IHT量表和健康评估工具对400名部落参与者进行样本测试，以测试其内部 一致性、可靠性和因子结构。我们还将评估IHT与 行为风险/结果和EBCI优先考虑的优先健康状况，包括药物滥用， 相关问题、暴力和虐待、糖尿病、压力和抑郁症。结果将分发给EBCI， 到外地。