Date of Award
August 2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Indigenous Health
First Advisor
Donald Warne
Abstract
Cardiometabolic diseases (CMD), encompassing conditions such as cardiovascular disease, diabetes, kidney disease and non-alcoholic fatty liver disease, present a significant health burden within American Indian and Alaska Native (AI/AN) communities. This dissertation, through the culmination of three products, including a scoping review, policy brief and strategic planning toolkit, seeks to understand and address CMD in tribal communities through an Indigenous lens. Product #1, Interventions for Cardiometabolic Health in American Indian and Alaska Native Communities: A Scoping Review, entails a thorough review of implemented CMD interventions targeting AI/AN communities to understand programmatic, clinical, and community-based prevention strategies. By synthesizing available evidence, this review aims to identify gaps, successes, and challenges in current interventions, providing insights for the development of effective and culturally tailored approaches. Using the framework by Arksey and O’Malley, and updated by Levac et al, a search was conducted using multiple databases. The review of existing evidence highlights gaps in knowledge and emphasizes the need for culturally tailored approaches, health education, and clinical strategies. The second product, Patient Navigation for Cardiometabolic Disease in Tribal Health Systems: Policy Strategies, Community Survey Findings, and Recommendations, provides insights from existing research and a community survey identifying prevalent challenges and providing recommendations for enhancing patient navigation within tribal communities. Recommendations from the brief include a standardized definition of the scope of practice of patient navigators in tribal communities, credentialing and certification for non-clinical patient navigators, strengthening patient navigation coverage to include clinical navigators, providing evidence-based metrics to assess the cost effectiveness, value and impact of patient navigation, improved funding mechanisms, coordinated models of healthcare and shared EHR systems, and the integration of patient navigator services with community based programs. The third product culminates in the creation of a toolkit designed specifically to assist tribes to develop strategic plans focused on CMD prevention and management. This toolkit utilizes the Indigenous worldview, and offers practical guidance, resources, and best practices for tribes to assess their unique needs, prioritize interventions, and implement evidence-based strategies to address CMD disparities comprehensively.
Recommended Citation
Medicine Bear, Heather, "Encompassing ‘Himdag’ (Indigenous Way of Life) to Address Cardiometabolic Disease in American Indian and Alaska Native Communities Through Research, Policy and Action" (2024). Theses and Dissertations. 6442.
https://commons.und.edu/theses/6442