Suchergebnisse

2020 Spring. ; Includes bibliographical references. ; The Oglala Lakota people of the Pine Ridge Indian Reservation have been plagued with poor kidney health due to political economic factors such as poverty, discrimination, unemployment, and limited food access. This poor health, exemplified in high rates of end-stage renal disease (ESRD), has created a population of patients that face daily challenges associated with dialysis treatment. Many of these patients would prefer kidney transplantation as treatment for their ESRD; however, a multitude of structural, institutional, educational, and biological barriers create obstacles that most find too difficult to overcome. This thesis explores the lived realities of dialysis patients on the Pine Ridge Indian Reservation and the structural challenges these patients face in accessing kidney transplantation. With dialysis patients often overlooked in terms of research and healthcare initiatives, this research provides the platform for patients to tell their stories, share their experiences, and advocate for their right to health and dignity. This applied anthropological research seeks to tackle the real-world issues of transplantation access among the Oglala Lakota population living on Pine Ridge. Therefore, the goal of this research is to both identify existing barriers as well as posit solutions that will help with the mediation of these barriers to improve access to kidney transplantation. Drawing on ethnographic methods such as participant observation and semi-structured interviews, this research attempts to provide an insider's perspective to dialysis challenges and the experiences of patients suffering from end-stage renal disease. This research focuses on three primary areas of interest. The first seeks to illuminate the dialysis patient experience, daily activities and limitations, and emotional responses to an end-stage renal disease diagnosis. This line of research serves as a window into the lives of dialysis patients, providing an emic or insider's perspective into the difficulties and challenges these individuals face. The second primary area of interest examines systems of belief and support present on the reservation represented by traditional Lakota belief systems and Christianity. Each of these systems functions to support patients during periods of hardship, but also plays an influencing role in healthcare decision-making. The third research focus explores the myriad barriers that inhibit access to kidney transplantation among the Oglala Lakota people. The distal and proximal barriers imposed on patients can be categorized as structural, institutional, educational, or biological, affecting patients in different areas and at different times in their lives. Using critical medical anthropology and structural vulnerability as the theoretical basis for data interpretation, the different structural levels of the healthcare system are examined. Each of these levels provides explanatory power regarding the regulation, influences, and pressures applied by the larger system on the individual. The critical medical anthropology approach also demonstrates a clear mismatch between the ideal transplantation process and the real-world capabilities of Oglala Lakota patients. To mediate identified barriers and align these mismatched systems, I provide specific recommendations for policy and practice that can be implemented to improve patient health and facilitate access to transplantation for those who seek it.

Includes bibliographical references. ; American Indian populations in the United States have, in recent years, been plagued by a diabetes epidemic of catastrophic proportions. On the Pine Ridge Indian Reservation, located in southwest South Dakota, discrimination, extreme poverty, rampant unemployment, limited access to healthy foods, and other factors have led the Oglala Lakota population to have the highest rates of End-stage renal disease (ESRD). Despite high rates of ESRD, American Indian populations have the lowest rates of kidney transplantation. This research explores the political economic barriers and cultural norms surrounding kidney transplantation as a treatment option for ESRD on the Pine Ridge Reservation.

Objectives
Asthma is one of the most prevalent chronic conditions affecting approximately 8.5% of children in Colorado. Our school-based asthma program (SBAP) has effectively improved asthma control and reduced asthma disparities among children but has been largely limited to the Denver area. We interviewed community stakeholders in 5 regions of Colorado to understand community needs for broader dissemination of SBAPs.


Methods
In-depth, semistructured key informant interviews were conducted with school nurses, parents, pediatric healthcare providers, public health professionals, and community resource organization representatives. Inductive and deductive analyses were informed by the practical, robust, implementation, and sustainability model, an implementation science framework.


Results
Participants (n=52) identified 6 types of needs for successful future implementation of our SBAP: (1) buy-in from stakeholders; (2) asthma prioritization; (3) improved relationships, communication, and coordination among school nurses, healthcare providers, and community organizations that address social determinants of health (SDOH) and children/families; (4) resources to address healthcare and SDOH needs and awareness of existing resources; (5) asthma education for children/families, school staff, and community members; and (6) improved coordination for School Asthma Care Plan completion. These needs mapped to a 3-tiered, progressive structure of foundational, relational, and functional needs for implementation success.


Conclusion
These 6 types of needs illuminate factors that will allow this SBAP to work well and program delivery approaches and implementation strategies that may need modification to be successful. Next steps should include tailoring implementation strategies to variations in local context to support fit, effectiveness, and sustainment.

Background
School-based asthma programs effectively address poorly controlled asthma and asthma disparities, especially when coupled with screening for and addressing social determinants of health (SDOH) needs. Existing screening tools are tailored to clinical settings; therefore, we sought to develop a community-based SDOH screening tool.


Design/Methods
We used a four-phase iterative design process to develop and pilot a community-based screening tool. We used a modified Delphi process to identify screening tool domains, identified validated items for inclusion, and developed an appropriate tool layout for populations with limited health/general literacy. Community advisory boards reviewed and refined a draft tool. Next, we conducted a qualitative pilot test of acceptability to parents and feasibility for staff in a community health center.


Results
Six domains are included in our SDOH screening tool: health care access, transportation, food insecurity, public benefits, housing, and utilities. In the pilot test, 41 screenings were completed, and 36 parents (16.7% Spanish speaking) provided feedback. Most families understood the purpose of the screening; felt that the questions were clear, appropriate, and quick to complete; and liked the pictures. The clinic's care coordinator expressed a preference for the pilot tool compared to their existing screening tool and recommended improvements to encourage honest reporting by patients.


Conclusion
This community-based screening tool addresses key SDOH needs that impact asthma and is acceptable to families. The next steps are to implement the tool in school-based asthma programs to support improvements in asthma outcomes and disparities by identifying and addressing families' unmet SDOH needs.