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

 描述(由申请人提供)：需要紧急注意解决白人和美国印第安人(AIS)在慢性病(CI)患者的死亡年龄方面的显著差异。在我们蒙大拿州，患有心脏病或肾脏疾病的人工智能患者早14年死亡，糖尿病患者早12.5年死亡，脑血管疾病患者早11年死亡。现有的解决CI管理的计划可以导致更低的死亡率和更高的生活质量，但由于它们与人工智能文化不一致而失败。为了解决这一问题，我们开发了Baa nilah，这是一个创新和独特的计划，旨在提高蒙大拿州Apsáalooke(Crow)印第安人的CI管理能力。这项研究基于APSáalooke Nation和蒙大拿州立大学之间长达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 nnilah翻译为从别人那里得到的关于生活的建议或指示，通常是以故事的形式。 该方法以APSáalooke文化价值观为中心。内容基于我们从初步访谈数据中收集的CI管理影响者的概念框架。衡量的结果直接来自概念框架和干预内容。BAA nnilah是由10组11名部落成员组成的团体干预：一名训练有素的导师领袖，被认为是他/她的CI的成功管理者，以及10名没有很好地管理他们的疾病的学员。每个11人小组将举行7次会议，讨论内容和方法，包括小讨论、谈话圈和技能培养活动。利用CBPR方法，我们将实现以下具体目标：目标1：完善和加强以社区为基础、符合文化需要的巴尼拉干预和研究方案。目的2：在APSáalooke保留区随机分配的200名25岁及以上的人工智能男性和女性中，使用等待名单控制组有效试验来测试干预和常规护理的效果。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、社会孤立、患者活跃度、健康护理关系、身体功能和抑郁。我们的混合方法设计包括在干预后立即对保真度和可接受性进行定性评估。BAA nnilah可作为寻求改善CI健康差距的其他社区和部落国家的重要模式，并对急性疾病的管理具有影响。

 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.