Progress 03/01/22 to 02/28/23
Outputs
Target Audience:We recruited12 Yup'ik parents in 7 of our partner communities to serve as citizen scientists and sharetheirperspectives on the unique conditions (i.e. socio-ecological factors) in remote Yup'ik communities that impact "eating in a good way". We worked with 9 Yup'ik Elders, who are considered critical knowledge holders, to understand how a traditional, subsistence way of life supports emotional, spiritual, mental, and physical health. We held a workshop with 9 Alaska Native parents that was designed to improve individual and community wellbeing using the traditional philosophies around subsistence that have guided Yup'ik life for generations. The workshop was delivered by 2 Yup'ik facillitators, 5 Yup'ik Elders, and 4 Yup'ik behvaioral health staff. Changes/Problems:We made two changes to elevate the cultural competency of our approach by better situating the intervention evaluation in the community culture and context. The expected outcome of these changes are enhanced engagement with parents, a more culturally grounded and sustainable intervention, and a framework that can be used in the design and evaluation of future interventions. These changes stem from 1) COVID travel restrictions that persisted through May 2022 and intermittently after that in our partner communities and 2) an opportunity to build up the cultural competency of our approach and address tribal priorities. The specific changes are as follows: 1) The objective is to develop a culturally-centered framework that can be used as a lens through which to evaluate the Tundra Gifts intervention. We are using the Our Voice Discovery Tool to give voice to primary caregivers' perspectives on the unique conditions (i.e. socio-ecological factors) in remote Yup'ik communities that impact "eating in a good way". 2) The objective is to critically and systematically evaluate the Tundra Gifts intervention through the lens of a Yup'ik conceptual framework using a participatory approach. We will convene a working group composed of parents, Yup'ik educators, and nutrition and education researchers. The aim of the workgroup meetings is to systematically evaluate the Tundra Gifts intervention using the Yup'ik conceptual model as a guide with a focus on the following broad topics: parent engagement, intervention content, intervention delivery. What opportunities for training and professional development has the project provided?We provided staff members from the Yukon Kuskokwim Health Research Corporation's research department a number of training and professional development opportunities, including the following: a presentation on how to write a research manuscript, training on how to code qualitative data with Atlas-TI, and other general research skills including community based participatory research approaches. How have the results been disseminated to communities of interest?Parents, Elders, and health corporation staff are considered key partners and results are continuously shared with them. What do you plan to do during the next reporting period to accomplish the goals?In the next reporting period, we plan to accomplish the following: We will continue recruiting parents from our remaining 6 partner communities to act as citizen scientists and participate in the Our Voice activity. We will critically and systematically evaluate the Tundra Gifts intervention through the lens of a Yup'ik conceptual framework using a participatory approach. We will convene a working group composed of parents, Yup'ik educators, and nutrition and education researchers. The aim of the workgroup meetings is to systematically evaluate the Tundra Gifts intervention using the Yup'ik conceptual model developed this past year as a guide with a focus on the following broad topics: parent engagement, intervention content, intervention delivery. To achieve our goal of enhancing local and regional capacity to prevent obesity among Alaska Native children, we plan to produce 3 short videos using footage from the parent training that focus broadly on how a subsistence lifestyle is at the core of health and well-being in Yup'ik communities. The videos will focus on the following: A description of why a decolonizing approach that draws on ancestral wisdom and a traditional, subsistence lifestyle is needed to successfully address health disparities, including childhood obesity, among Alaska Native People. An explanation of how teaching children about ancestral wisdom and the benefits of a subsistence diet must be approached with Yup'ik value of Qaruyun or Cultural Care (e.g. love, humor, through stories) An explanation of why the benefits of a subsistence lifestyle extend beyond physical health to mental, spiritual and emotional health. These videos will be used in a training with healthcare providers, defined broadly (e.g. dietitians, clinicians, public health practitioners, etc).
Impacts
What was accomplished under these goals?
We conducted threeactivities that contribute to our understanding of the unique socio-ecological factors (positive and negative) in Yup'ik communities that impact healthy eating. Findings will form the basis of a conceptual framework that can be used in both the design and evaluation of interventions. A Yup'ik centered conceptual framework that more adequately attends to Yup'ik caregivers' lived realities and addresses root causes of health behaviors is an important step toward achieving health equity in these vulnerable communities. We used the Our Voice Discovery Tool to give voice to primary caregivers' perspectives on the unique conditions (i.e. socio-ecological factors) in remote Yup'ik communities that impact "eating in a good way". The Our Voice method brings forward community voice for health equity-focused, locally relevant positive change. We recruited 12 parents of Head Start students in 7 communities. These parents took photos in response to the guiding question: "What in your life supports your family eating in a good way? What in your life makes it challenging for your family to eat in a good way?" These questions were developed in consultation with the project Community Advisory Board and Head Start staff, and were designed such that participants could document everyday issues that impact getting, preparing, eating, and sharing food in a family setting. We held 5 discussions that allowed parents to share their photos, discover common themes, prioritize target areas for changes and brainstorm solutions. Data analysis from these discussions will be guided by family ecological model. Using a 3-step interactive process, we co- developed a conceptual model that supports teaching and learning of the Yup'ik way of life through subsistence activities and ancestral wisdom.In step 1, we held virtual meetings to strengthen the partnership and co-design the project. In step 2, we held seven "Elder trainings," each that were attended by three to nine elders who are considered critical knowledge holders. The trainings were designed to learn from Elders about how traditional practices, values and knowledge are linked to spiritual, emotional, physical and mental health. Audio recordings from two 2-day in-person Elder Trainings were translated, transcribed, and coded using Atlas-Ti using an open coding approach. In step 3, we shaped the framework through a series of (how many) in-person and virtual workgroup meetings. All findings were checked by Elders.Nine major themes emerged from the Elder trainings that informed the development of the conceptual model of health. To enhance local and regional capacity to prevent obesity among Alaska Native children, we held and video recorded a 2-day training for parents (n=9) that was co-delivered by Elders (n=5), staff from the Calricaraq program hosted by the Yukon Kuskokwim Health Corporation (n=4), and highly experienced Yup'ik facilitators (n=2). The goal of the training was to create a desire to practice a Yup'ik way of life and pass on that practice to children. Ultimately, the goal is toimproveindividual and community wellbeing using the traditional philosophies around subsistence that have guided Yup'ik life for generations.The training used stories and hands-on activities (e.g. hanging whitefish nets and cutting and preparing whitefish in a number of activities) to teach how traditional knowledge, practices and values promote holistic health among families and communities. Video recordings from the training will be used to show health care providers how and why healthy eating should be taught through the lens of subsistence.
Publications
- Type:
Journal Articles
Status:
Published
Year Published:
2022
Citation:
Hill CM, Paschall MJ, Koller KR, Day GM, Lee FR, O'Brien DM, King DK, Palmer L, Thomas TK, Bersamin A. Obesity Prevalence and Dietary Factors among Preschool-Aged Head Start Children in Remote Alaska Native Communities: Baseline Data from the "Got Neqpiaq?" Study. Child Obes. 2022 Dec 5. doi: 10.1089/chi.2022.0143. Epub ahead of print. PMID: 36473164.
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Progress 03/01/21 to 02/28/22
Outputs
Target Audience:We reached parents, Head Start staff and other community members through their involvement in our Community Advisory Board. This CAB met frequently over the year. In these meetings we discussed a number of data collection approaches and evaluation methods. Changes/Problems:COVID-19 continues to impact our efforts in our partnerYup'ik communities. The tribal health corporationsuspended all research to our partner communities starting in March 2020 to prevent the transmission of COVID-19 to these vulnerable communities. Although these restrictions were lifted by the health corporation in May 2021, tribal councils in communitiesappropriately implemented their own restrictions. In addition COVID surges in communities lead to frequent and often lengthy closures in the Head Start programs. Bandwidth in communities is poor and unreliable, posing additional challenges to working remotely. This uncertain climate made it difficult to plan any programming, whether remote or community-lead. We plan to focus on elevating our evaluation approach in the fall and have been meeting weekly to create multiple contigency plans that we hope will allow us to move forward regardless. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We have shared the results with our partner Head Start program and the local Alaska Native tribal Health Corporation that administers health care to our partner communities and oversees health research activities. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we will focus on elevating our evaluation approach to ensure that it is more congruous with a Yup'ik worldview and context. We plan to engage parents in our evaluation approach.
Impacts
What was accomplished under these goals?
1) Given the persiting challenges presented bytravel restrictions to our partner Alaska Native communities and frequent Head Start closures due to periodicCOVID surgeswe decided torecruitmore broadly for our Community Advisory Board (CAB) to help us strategize and maxamize resources in a very uncertain climate. The CAB includes Head Start staff, staff from the local Alaska Native Health Corporation, community members and an Elder. We have been meeting regularly to develop a plan that would allow us to enhace the cultural relevance of our evaluation of theTundra Giftsprogram. 2) The research team met regularly to discuss whether and how the intervention could be evaluated given that its delivery was cut short due to COVID and remote data collection posed a challenge. Our attempt to collect data over the phone had a 21% response rate. We had planned to pilot test data collection that would be facillitated by staff in communities, but frequent closures at our partner Head Start sites made this unfeasible. We analyzed data from our baseline data collection and drafted a manuscript that is currently under tribal review.
Publications
- Type:
Journal Articles
Status:
Published
Year Published:
2022
Citation:
Amanda K. Walch, Kathryn A. Ohle, Kathryn R. Koller, Lucinda Alexie, Flora Lee, Lea Palmer, Jennifer Nu, Timothy K. Thomas & Andrea Bersamin (2022) Impact of Assistance Programs on Indigenous Ways of Life in 12 Rural Remote Western Alaska Native Communities: Elder Perspectives Shared in Formative Work for the Got Neqpiaq? Project, International Journal of Circumpolar Health, 81:1, DOI: 10.1080/22423982.2021.2024679
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Progress 03/01/20 to 02/28/21
Outputs
Target Audience:We contacted all 144 primary caregivers enrolled in the study to participate in time point 2 data collection. We collected data from 29 children, which is a response rate of 21%. Changes/Problems:Tribal organizations suspended all research travel to our partner communties on March 12, 2020 to prevent the transmission of COVID-19 to these vulnerable communities.This suspension has remainedin place since then. The timining of the shut down coincided with the start of our time point 2 data collection. We modified our data collection protocol to allow us to collect data remotely. We recieved tribal approval of our modifications in May and began remote data collection soon after that. Due to the remote data collection, we were unable to collectphysical measurements including height and weight, veggie-meter readings, and hair samples (a biomarker for traditional food and sugar sweetened beverage intake). We requested a privacy waiver from the regional health corporation that allowed us to abstract height and weight from the child's medical record for a period of year. Remotely, we collected the 24-hour recall, survey data, and requested that the parents sign the medical release to allow us to abstract their child's height and weight. Despite significant effort, our remote data collection resulted in a very low response rate (21%). Stay-at-home orders also had a major impact on our abilitiy to continue to deliver the intervention. Our partner HeadStarts stopped holding the "family fun nights", which served as the venue for our interventions. Due to a surge in COVID-19 cases in communities, many HeadStarts such down entirely. In view of our limited success with remote data collection andour inability to continue delivering the intervention, we are revisioning our intervention and planning a fully remote program and evaluation. We are in the process of pilot testing the remote collection of the hair samples. We plan to implement the intervention this coming fall. What opportunities for training and professional development has the project provided?
Nothing Reported
How have the results been disseminated to communities of interest?We shared results with the regional health corporation's board of directors and human subjects committee, which includes both health care providers and communittee members. The health corporation is responsible for both overseeing research and health care delivery. What do you plan to do during the next reporting period to accomplish the goals?During the next reporting period we plan to implement and evaluate a fully distance delivered intervention. Our partner communities have been such down to outside travel due to COVID-19 since March 2020 and it is unclear whether and when travel will resume.
Impacts
What was accomplished under these goals?
Objective 2: With our community partners, we began revisioningthe home focused intervention so that it can be fully-distance delivered starting in Fall 2021. Objective 3: We collected time point 2 data from 29 children using a modified data collection protocol that allowed us to collect data remotely. Given our limited success with the data collection, we started refining the data collection protocol that we will implement in the Fall.
Publications
- Type:
Journal Articles
Status:
Submitted
Year Published:
2020
Citation:
Alaska Native Elders' Perspectives on Changing Dietary Patterns in Rural, Remote Communities
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Progress 03/01/19 to 02/29/20
Outputs
Target Audience:We conducted 25 focus groups in 12 Yup'ik Alaska Native communities in southwestern Alaska. Specifically, we conducted12 focus groups with elders (n=66), 12 focus groups with parents (n=84), and 1 focus group with family advocates. We delivered a 3-day training to 14 Head Start staff including 6 family advocates and 6 teachers from our intervention communities and 2 regional managers. Family advocates are ideally positioned to deliver the interventionbecause they are trusted community members and they are already engaging parents on health topics monthly. The training focused on the following: 1) program goals, 2) role of the family advocate, 3) record keeping and 4) reviewing the family session curriculum. We collected baseline data from 155 children and 144 primary caregivers across our 6 intervention and 6 comparison communities. Changes/Problems:We were unable to deploy accelerometers as planned because of the tremendous challenge getting them between the communities. Yupi'k communities are located off the road system (travel between communities is exclusively by bush plane) and it simplywasn't feasbile to move them between communities in a reliable manner. Compliance with the 2-day food records was poor and posed too much of a burden on participants. What opportunities for training and professional development has the project provided?We delivered a 3-day training on the intervention to 14 Head Start staff including 6 family advocates and 6 teachers from our intervention communities and 2 regional managers. The training focused on 1) program goals, 2) role of the family advocate, 3) record keeping and 4) reviewing the family session curriculum. 3 MS students participated in data collection and recieved substantial training prior to data collection. How have the results been disseminated to communities of interest?Preliminary data from the focus groups were shared with the health corporation that oversees health care in the region. What do you plan to do during the next reporting period to accomplish the goals?We plan to continue the intervention and evaluation in the next reporting period.
Impacts
What was accomplished under these goals?
Objective 2: We conducted 25 focus groups in 12 Yup'ik Alaska Native communities in southwestern Alaska. Specifically, we conducted12 focus groups with elders (n=66), 12 focus groups with parents (n=84), and 1 focus group with family advocates.Results were used to design a culturally congruent home-focused intervention that includes the following: 1) interactive, family sessions that are designed to be delivered by Head Start staff to parents of 3-5 years old students. Sessions include a family meal; interactive activities designed to increase parents knowledge, skills, and self-efficacy around increasing vegetable and fruit intake (including tundra plants), replacing sugar sweetened beverages with water, and increasing active play; and goal setting. 2) A Facebook site designed to reinforce and extend concepts learned in the family sessions through bi weekly posts. 3) monthly gifts baskets that include materials and supplies chosen to facilitate behavior change. We delivered a 3-day training on the intervention to 14 Head Start staff including 6 family advocates and 6 teachers from our intervention communities and 2 regional managers. The training focused on 1) program goals, 2) role of the family advocate, 3) record keeping and 4) reviewing the family session curriculum. Objective 3: We collected baseline data from 155 children and 144 primary caregivers across our 6 intervention and 6 comparison communities.Baseline data included anthropometric measurements (height and weight) collected from children and parents; a 24-hour recall completed by parents on behalf of children; veggie-meter readings collected from children and parents; a socio-demographic questionnaire completed by parents; hair samples collected from children and parents to estimate the stable carbon and nitrogen isotope ratios, a biomarker of sugar-sweetened beverage intake; a survey measuring Knowledge, attitudes, self-efficacy and behaviors related to diet and physical activity completed by parents. Family advocates delivered 4 monthly sessions and the Facebook site is active.
Publications
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Progress 03/01/18 to 02/28/19
Outputs
Target Audience:We formalized partnerships with 12 Yup'ik Alaska Native communities that are remote and off the road system, which is to say they are only accessible by bush plane. We shared our project goals with the tribal and city councils in each of the 12 communities and received their approval to move forward with our project. We held a training for Head Start family advocates, the majority of whom are Alaska Native, that focused on how to collect height and weight data from children. We formed a Yup'ik expert advisory committee that is working with us to co-develop our monthly interactive nutrition education sessions that will be delivered to primary caregivers. We trained 2 MS students to collect 24-hour recalls using NDSR. We trained 1 MS student to analyze qualitative data from focus groups. Changes/Problems:We began collaborating with the Alaska Native Health Consortium (ANTHC) who were funded by NIH for a study that is testing changes to head start lunches as an obesity prevention strategy in the same 12 communities with whom we are partnered.Our two separate but complementary studies will enrich the findings and through collaboration we can avoid contamination, confusion and measurement burden in the small Alaska Native communtiies. To that end a few adjustments to our original timelines and data collection strategies were made.We collaborated with ANTHC on the focus groups and were able to conduct focus groups in 12 communities, rather than our proposed four. Results from the focus groups are providing formative information from both our interventions. We are implementing the intervention a full year earlier and extending the evaluation period by a year. What opportunities for training and professional development has the project provided?We held a training for Head Start family advocates, the majority of whom are Alaska Native, that focused on how to collect height and weight data from children. We trained 2 MS students to collect 24-hour recalls using NDSR. We trained 1 MS student to analyze qualitative data from focus groups. How have the results been disseminated to communities of interest?Preliminary results of the focus groups have been shared with Head Start staff and with our Yup'ik expert advisory committee. What do you plan to do during the next reporting period to accomplish the goals?We plan to evaluate the effectiveness ofTundra Giftscompared to a delayed-intervention comparison group on child BMI z-scores and four behavioral outcomes (intake of vegetables and fruit, intake of sugar sweetened beverages, physical activity, and screen time); primary caregiver knowledge, attitudes, self-efficacy and behaviors related to healthy eating and an active lifestyle; and the home food and physical activity environment using a cluster randomized design. Baseline data collection will take place in April 2019. The intervention will be implemented in September 2019. Starting at this time we will begina comprehensive process evaluation of key indicators important to maximizing the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) ofTundra Gifts, that includes collection and analysis of quantitative data (i.e., number, % and representativeness of parent/child dyads; number, % and representativeness of participating Head Starts and Family Advocates) and qualitative data (i.e., program observation using fidelity checklists; program cost data; setting-level establishment of training and quality improvement protocols; and key informant interviews to understand facilitators, barriers, and sustained commitment to the program).
Impacts
What was accomplished under these goals?
Objective 1: We formed a Yup'ik expert advisory committee is co-developing our monthly sessions that will be delivered to primary caregivers of 3-5 year old children in Head Start. The advisory committee is currently composed of 5 members who represent community members, parents,WIC staff that serve Yup'ik clients, and staff working on other health promotion projects in Yup'ik communities. Objective 2: We are in the process of designing a culturally congruent home-focused intervention using a participatory process that is guidedby Barrera's 5 step Cultural Adaptation Framework. Given the unique social, cultural, and physical environment in Yup'ik communities, cultural adaptation is essential and this process allows us to leverage existing work while simultaneously creating an intervention that is distinctly Yup'ik. We have reviewedexisting evidence-based curriculum and programsto identify components appropriate for adaptation in light of our formative research. We conducted formative research (focus groups) the results of which we are using to inform the development of the intervention. We compelted adraft intervention framework that is servingas the basis of brainstorming sessions with our expert Yup'ik advosry committeewhose role is toensure that the intervention addresses normative beliefs, draws on traditional values and is congruent with a Yup'ik worldview.
Publications
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