Literature Review of CBPR Projects in American Indian Communities The community-Based Participatory Research, or CBPR, i

Literature Review of CBPR Projects in American Indian Communities

The community-Based Participatory Research, or CBPR, is a kind of research strategy that powerfully entails the involvement of the society members in the entire tenure of a research study. The CBPR is even more helpful when the researched community is vulnerable since it acknowledges and incorporates local culture, and community values into the research. (Rink et al., 2020). It has been applied more frequently in American Indian communities to overcome health inequalities, conserve the natives' wisdom, and help the communities assume ownership of health matters. This paper reviews sample CBPR projects in American Indian contexts, reviewing the details of the methodology, findings, and overall success of the projects.

Among the significant CBPR cases targeting American Indian populations, the most recognized is the Strong Heart Study (SHS), initiated in 1988. The SHS aims at identifying risk factors for Cardiovascular Diseases and CVD amongst the Native American Indians, a group that has remained for a long time under-studied. This was done because there have been increasing instances of CVD among the American Indian populace, and the study was conducted with the thirteen tribes and communities in Arizona, Oklahoma, and North and South Dakota. As a research framework, CBPR has been integral to developing the SHS from its grassroots. Tribal leaders and community participants approved the study to ensure that the study was culturally appropriate to the community and the context. It was equally apparent in every study stage, from formulating research questions and data collection to data analysis. The SHS implemented community participatory processes at each stage of the study, getting good insight into the prevalence of the CVD risk factors apart from empowering the community through the research process.

The other notable CBPR project is developed through the Navajo Nation, known as the Community Outreach and Patient Empowerment (COPE) project. The COPE project, therefore, sought to tackle the chronic disease problem, with particular focus on the Navajo population, who are prone to diabetes. The project's main objective was enhancing health literacy and encouraging sustainable behavioral modifications that would address chronic diseases among the Navajo populace. To ensure that a CBPR approach was used in the COPE project, the researchers engaged the community health representatives (CHRs). The CHRs, from the Navajo population, also helped to be middlemen. They gave health promotion messages by the culture and facilitated patients in managing chronic illnesses, which ensured that the treatments were culturally appropriate for the Navajo tribe. (Blue Bird Jernigan et al. 2017). This approach not only enhanced the effectiveness of the interventions but also increased capacity building in the community and strengthened the role of CHRs in the health system.

 The Healthy Children, Strong Families (HCSF) project is another example of a highly effective CBPR study in an American Indian community. Project HCSF was a collaborative effort between the Menominee Indian Tribe of Wisconsin and academic institutions to combat child obesity among American Indian children. Overweight and obesity continue to be significant health problems among American Indian individuals, and thus, the HCSF project aimed at improving the quality of dietary habits among Indigenous populations of North America using culturally appropriate strategies. The project involved the Menominee community in developing the interventions, their delivery, and assessment to make the program as culturally appropriate as possible for the participants. Items such as storytelling and traditional foods were incorporated into the program to help the families learn about the Menominee way of life and maintain good health. Through engaging and informing the community in every aspect of the work that went into the implementation of the HCSF initiative, the project met a specific health need, that is, obesity, and at the same time, empowered the community to continue making and supporting health choices far into the future.

While the content and scope of the CBPR projects within the case study vary significantly, these seven CBPR projects have similarities that likely informed their effectiveness. Perhaps the most evident similarity is the focus on cultures, which is evident throughout the flow of the shows. In all three projects, the researchers considered the value of involving traditional knowledge and cultural practices in the study process. It also made the interventions more acceptable and effective, as well as a way of showing some respect and embracing the community's customs. They show that by ensuring the cultural relevance of the projects, the research established trust and created the key element for any CBPR research: participation.

 The third commonality in these studies is that they aim at empowering the community. CBPR is an approach meant to engage the community as stakeholders in the research being conducted in the community. In the study done with the Strong Heart, COPE, and HCSF projects, the community members participated in planning, conducting, and assessing the research. (Sahota, 2010). As the community members were involved as agents and not objects of change, these projects evoked a sustainable positive change and established a map upon which future health interventions could be set.

 Despite evident similarities in the approach and results of these CBPR projects, the differences are also to be pointed as to emphasize the features of the health issues in American Indian tribes and as to demonstrate the versatility of the CBPR method. The first major difference is that the focus areas of the projects differ. The Strong Heart Study is focused on cardiovascular disease while the COPE project is concerned with chronic diseases such as diabetes and the HCSF project is interested in the prevention of obesity among children. (Katz et al. 2011). Even though cardiovascular disease is one of the primary concerns for the tribes participating in the SHS, diabetes is more prominent in the Navajo population, and childhood obesity in the Menominee population is the main issue to address. These differences show that CBPR projects should be oriented according to the needs and concerns of the particular community.

Another distinction is that the number of projects, size, and scope of work are quite different in the two cases. The Strong Heart Study is a community-based, prospective study of multiple tribes in different states. This scale has helped the SHS collect a wealth of information on CVD risk factors and has contributed toward formulating appropriate public health policies and programs at the national level. The COPE and the HCSF projects are narrower in scope as they are based on the Navajo Nation and the Menominee Nation, respectively. These projects are more likely to impact the health of the target population, but they might not reach the same extent regarding health policy reforms. It should also be noted that the project size and range define the difficulty level and time taken out on the research. The SHS is a long-term evolving structured research, and the COPE and HCSF projects are more result-oriented and aimed at bringing down the rate of specific diseases within the stipulated period.

 These outcomes can be used to assess the CDPR projects for their efficiency and success and for discovering how they influenced the identified communities. The Strong Heart Study has been extremely successful in terms of producing useful information in the area of the cardiovascular disease risks among the American Indians, which has been helpful in devising health polices and activities. These sets of results are feasible since this study has a long-term interest in the communities' health and follows up on the population's years after the interventions, therefore tapping into the communities' enhanced health and perceived risks of CVD.

 The COPE project has also helped reduce illiteracy in health and manage chronic diseases among the Navajo Nation. An essential aspect of the successful implementation of this project was the participation of community health representatives, who were recruited and hired from the community. Because the CHRs have been equipped with the cultural knowledge of the population, they have been able to guide patients into adopting appropriate behaviors about their health conditions and lifestyles, thus controlling chronic diseases. (Christopher et al. (2008). Nevertheless, the implementation of COPE has its drawbacks; for example, it has suffered from a lack of funding and staff and the presence of social determinants of health.

It is worth noting that the Healthy Children, Strong Families project results bring positive changes to children in Menominee Nation regarding health-related behaviors. Evidence shows that including cultural and traditional activities contributes greatly to increased family involvement and commitment to the program. It has succeeded in sensitizing families, especially through the intervention to encourage healthy eating and physical activities, and offer families the encouragement and resources they need to make the necessary changes for the better. Nevertheless, the results of the HCSF project have not been conclusively studied in terms of long-term obesity prevalence, and the efficacy of the interventions may differ as per additional ongoing community support and programs.

Conclusion

 Therefore, CBPR is effective in exploring ways of reducing health disparities among American Indians. The projects highlighted here show that it is crucial to incorporate cultural data and approaches into the studies and recognize the communities' potential as active participants in their health processes. Though the concentration, size, and range of the projects vary a lot, cultural consciousness and communal involvement remain the key success factors of these projects.

References

Blue Bird Jernigan, V., Wetherill, M. S., Hearod, J., Jacob, T., Salvatore, A. L., Cannady, T., ... & Buchwald, D. (2017). Food insecurity and chronic diseases among American Indians in rural Oklahoma: The THRIVE study. American Journal of Public Health, 107(3), 441-446.

Christopher, S., Watts, V., McCormick, A. K. H. G., & Young, S. (2008). Building and maintaining trust in a community-based participatory research partnership. American journal of public health, 98(8), 1398-1406.

Katz, J. R., Martinez, T., & Paul, R. (2011). Community-based participatory research and American Indian/Alaska Native nurse practitioners: A partnership to promote adolescent health. Journal of the American Association of Nurse Practitioners, 23(6), 298-304.

Rink, E., Knight, K., Ellis, C., McCormick, A., FireMoon, P., Held, S., ... & Adams, A. (2020). Using community-based participatory research to design, conduct, and evaluate randomized controlled trials with American Indian communities. Preventing chronic disease, 17, E143.

Sahota, P. C. (2010). Community-based participatory research in American Indian and Alaska Native communities. Washington DC: NCAI Policy Research Center.