Urgent attention is needed to address the significant disparities between whites and American Indians (AIs) in age at death for those with chronic illness (CI). In our state of Montana, AIs die 14 years earlier for those with heart or kidney disease, 12.5 years for those with diabetes, and 11 years for those with cerebrovascular disease. Existing programs addressing CI management, which can lead to lower mortality rates and a higher quality of life, fail because they are not consonant with the AI culture. To address this failing, we developed Baa nnilah, an innovative and unique program to improve capabilities for CI management among Apsalooke (Crow) Indians in Montana. The study is based on methods and findings from a 19-year community-based participatory research (CBPR) partnership between the Apsalooke Nation and Montana State University. Baa nnilah translates to advice or instructions for life that are received from others, often in a story form. The method is centered on Apsalooke cultural values. The content is based on our conceptual framework of influencers of CI management gleaned from preliminary interview data. The measured outcomes flow directly from the conceptual framework and intervention content. Baa nnilah is a group intervention comprised of 10 groups of 11 tribal members: a trained Mentor leader, who is considered a successful manager of his/her CI, and 10 mentees, who are not managing their illness well. Each 11-member group will meet 7 times covering content and using methods that include a mini-discussion, talking circle and skill-building activity. Using a CBPR approach, we will pursue the following SPECIFIC AIMS:
AIM 1 : Refine and strengthen the community-based, culturally appropriate Baa nnilah intervention and study protocol.
AIM 2 : Test the effects of the intervention versus usual care using a wait-list control group effectivenes trial among 200 randomly assigned AI men and women 25 and older who have CI on the Apsalooke Reservation. Outcomes, measured at 6 and 12 months post-intervention, include quality of life, satisfaction in and participation with social roles and activities, social isolatin, patient activation, health care relationship, physical function, and depression. Our mixed-methods design includes a qualitative evaluation of fidelity and acceptability immediately post-intervention. Baa nnilah can serve as an important model for other communities and tribal nations looking to improve CI health disparities and has implications for management of acute conditions.

Public Health Relevance

This purpose of this study is to improve chronic illness (CI) management among Apsalooke (Crow) Indians in Montana through a community-based intervention. American Indians experience high rates of health disparities, including disparities i CI prevalence rates, hospitalization rates, and mortality rates, yet little research exists on effective methods for ameliorating these disparities. This project will add to the existing science of health disparities by using a community-developed and culturally centered intervention as a vehicle for change and a community-based participatory research approach in a partnership between a university and an American Indian Nation.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZMD1)
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Jean-Francois, Beda
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Montana State University - Bozeman
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United States
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