Webb Kellie, Posey Sadie, Hirchak Katherine, Beamon Emily, Milligan Kelley, Wagon Sharon, Fatupaito Bethany, Kelley Allyson
Doya Natsu Healing Center, Eastern Shoshone Tribe, Fort Washakie, WY, United States.
Allyson Kelley & Associates PLLC, Sisters, OR, United States.
Front Public Health. 2025 Aug 22;13:1608429. doi: 10.3389/fpubh.2025.1608429. eCollection 2025.
Engaging community members in the process of documenting health inequities is the first step in addressing public health challenges. This paper presents the community-driven adaptation process and results for the Tool for Health and Resilience in Vulnerable Environments (THRIVE) assessment, a social justice and equity-focused screening tool, in one reservation-based American Indian community in the US.
Using principles of community-engaged research (CER) and community-based participatory research (CBPR), the authors describe the importance of co-creating data collection tools with community members to document the social and structural determinants of health. Authors describe a step-by-step approach to document inequities; this includes (1) recognizing the need to document inequities, (2) identifying existing tools to measure inequities, (3) adapting tools and piloting them with members of the community, (4) refining the tool based on community feedback, and (5) administering the tool to address needs identified.
Survey data from the THRIVE assessment and community-engaged process ( = 100) documented the social and structural determinants of health. The community-adapted THRIVE assessment examined the underlying factors of people, places, and opportunities that contribute to health inequities in the community. Results from this work show that the adapted THRIVE tool has high psychometric reliability ( = 0.957) and that community members feel strong about factors related to people and vulnerability, as well as factors related to place and equitable opportunities. The authors discuss future work and actions they will undertake to address community-identified concerns through community-based programs like complementary alternative medicine, harm reduction via mobile outreach, employment readiness and job training, sober housing, culturally centered treatment, and voucher-based programs to meet basic needs. The process presented underscores the importance of involving American Indian community members in co-creating data collection tools that represent the community's needs and interests. This intersectional, holistic approach aims to enhance community conditions and achieve the highest possible health and well-being for American Indian communities.
让社区成员参与记录健康不平等现象的过程是应对公共卫生挑战的第一步。本文介绍了在美国一个以保留地为基础的美国印第安社区中，以社区为主导的针对脆弱环境中的健康与恢复力工具（THRIVE）评估的调整过程及结果，THRIVE评估是一种以社会正义和平等为重点的筛查工具。
作者运用社区参与研究（CER）和基于社区的参与性研究（CBPR）原则，阐述了与社区成员共同创建数据收集工具以记录健康的社会和结构决定因素的重要性。作者描述了记录不平等现象的逐步方法，包括：（1）认识到记录不平等现象的必要性；（2）确定衡量不平等现象的现有工具；（3）调整工具并在社区成员中进行试点；（4）根据社区反馈完善工具；（5）运用该工具满足已确定的需求。
来自THRIVE评估和社区参与过程（n = 100）的调查数据记录了健康的社会和结构决定因素。经社区调整后的THRIVE评估考察了导致社区健康不平等现象的人、地点和机会等潜在因素。这项工作的结果表明，调整后的THRIVE工具具有较高的心理测量可靠性（α = 0.957），社区成员对与人及脆弱性相关的因素以及与地点和公平机会相关的因素感受强烈。作者讨论了他们未来将开展的工作和行动，以通过基于社区的项目解决社区确定的问题，这些项目包括补充替代医学、通过移动外展减少伤害、就业准备和职业培训、戒酒住房、以文化为中心的治疗以及满足基本需求的代金券项目。所介绍的过程强调了让美国印第安社区成员参与共同创建代表社区需求和利益的数据收集工具的重要性。这种交叉性的整体方法旨在改善社区状况，为美国印第安社区实现尽可能高的健康和福祉。
