School of Nursing, Johns Hopkins University, 525 N Wolfe St., Baltimore, MD, 21205, USA.
Auckland University of Technology School of Clinical Sciences, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
BMC Public Health. 2023 Oct 25;23(1):2088. doi: 10.1186/s12889-023-16913-z.
While benefiting from strong cultural ties to family, land and culture Native Americans residing on reservations experience psychological distress at rates 2.5 times that of the general population. Treatment utilization for psychological health in reservation-based communities is low with access to culturally appropriate care lacking. Evidence suggests that for mental health treatment, Native Americans prefer culturally informed care that respects Native perspectives on health and well-being.
To decrease stress and promote well-being in tribal Head Start teachers we adapted and implemented a culturally focused intervention within a community-based participatory research framework using mixed methods. Feasibility and acceptability of the adapted 5-session curriculum was tested in a single arm intervention study with a sample of 18 teachers on the Fort Peck Reservation. Participants completed surveys at baseline and upon completion of the intervention. Within session observations and two post-intervention focus groups (n = 8, n = 10) were conducted to elaborate and explain the quantitative results eliciting participant experience of intervention effectiveness and feasibility, acceptably and appropriateness. Implementation outcomes were assessed quantitatively using the Acceptability of Intervention, Intervention Appropriateness, and Feasibility of Intervention measures.
Quantitively, attendance rate overall was 93% with no dropouts. Pretest/posttest surveys were analyzed using t-tests and Hedges g to measure effect size. Contrary to our hypothesis, self-perceived stress showed a small positive effect size, indicating that participants were more stressed post intervention. However, depression decreased, with tribal identity and resilience showing positive effect sizes. Content analysis for the qualitative data collected within session observations and post intervention focus groups revealed how lifetime traumas were affecting participants, providing some explanation for the increase in stress. Teachers reported that the sessions helped their psychological health and well-being, supporting feasibility of future interventions. Acceptability scored highest with a mean (SD) of 4.25 (.84) out of 5, appropriateness 4.18 (.86) and feasibility 4.06 (.96) supporting intervention to be acceptable, appropriate, and feasible.
Utilizing a culturally based intervention to buffer stress and support the well-being of reservation-based teachers showed promise in helping them recognize their cultural strengths, stress, and need for ongoing support. Implementation outcomes show that intervention scale-out is feasible.
尽管美洲原住民保留地居民与家庭、土地和文化有着密切的联系，但他们的心理健康问题却较为严重，其心理困扰的发生率是普通人群的 2.5 倍。在以保留地为基础的社区中，寻求心理健康治疗的人数较少，而且缺乏文化上合适的护理。有证据表明，对于精神健康治疗，美洲原住民更喜欢尊重他们对健康和幸福的看法的文化知情护理。
为了减轻部落“先普雷斯”教师的压力，促进他们的幸福感，我们在以社区为基础的参与性研究框架内，采用混合方法，改编并实施了一项以文化为重点的干预措施。我们在福克河保留地的 18 名教师中进行了一项单臂干预研究，测试了改编后的 5 节课程的可行性和可接受性。参与者在干预前和干预后完成了调查。在每次课程内观察和两次干预后焦点小组（n=8，n=10）中，我们进行了详细的讨论和解释，以阐明和解释定量结果，了解参与者对干预效果和可行性、可接受性和适当性的体验。使用干预接受度、干预适宜度和干预可行性测量来评估实施结果。
从数量上看，整体出勤率为 93%，没有辍学现象。使用 t 检验和 Hedges g 分析了预测试/后测试调查，以衡量效应大小。与我们的假设相反，自我感知压力显示出较小的正效应大小，表明参与者在干预后感到更有压力。然而，抑郁程度有所下降，部落身份和适应力也呈现出积极的效应大小。对课程内观察和干预后焦点小组收集的定性数据进行的内容分析揭示了终身创伤如何影响参与者，为压力增加提供了一些解释。教师们报告说，这些课程有助于他们的心理健康和幸福感，为未来的干预提供了可行性支持。接受度得分最高，平均（SD）为 4.25（.84），适宜度 4.18（.86），可行性 4.06（.96），支持干预是可接受的、适宜的和可行的。
利用基于文化的干预措施来缓解保留地教师的压力，支持他们的幸福感，这表明该干预措施有希望帮助他们认识到自己的文化优势、压力和对持续支持的需求。实施结果表明，干预措施的推广是可行的。
