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Incidence rates for some infectious diseases in NA/AIs have decreased, serious disparities related to infectious diseases continue. Adekoya, Truman and Landen (2015) have noted that incidence rates for invasive pneumonia, acute hepatitis C, West Nile virus, and shigellosis are higher in NA/AI than in whites. Additionally, incidence rates for gonorrhea is 4.2 times higher and Chlamydia trachomatis is 3.7 times higher—in NA/AI than in whites. And it was noted that the disparity in gonorrhea rates for American Indians/Alaska Natives in 2014 was larger in the Midwest than in the West, Northeast, and South (CDC STD surveillance, 2014).
Background:
A mixed-method study was conducted from October 2014- June 2015. Participants were recruited by purposeful sampling—228 adult men and women, self-identified as Native American or Alaska Natives—from six Pow wows and one community event that were located throughout Indiana. These gatherings were Intertribal—i.e. any tribal affiliation was welcome.
Paper surveys were completed by all 228 participants. Of the participants, 25 persons from the 228 pool were invited to participate in one-on-one interviews with the P.I.
Findings:
Of the 228 participants recruited, 56% were female, 40% were male and 4% were Two Spirit. Ages ranged from 18- 81 years, with a mean age of 48.1 years (SD 15). There were over 50 different tribal affiliations noted. Regarding general health ratings-76% of the participants rated their health as good or excellent. It was noted that there were no significant differences in age for participants’self-reported health rating.
Vaccine and screening acceptance: When questioned regarding offering vaccinations at POW wow settings, a majority 69% (N=158) viewed it as a valuable health service, even though over half of the participants did not seek or receive influenza or hepatitis B vaccination. Nearly 40% would accept vaccines, with those willing to accept being significantly younger than those who would decline [p=.04 to p=.001, depending upon the vaccine]. It was noted that 62% of participants supported confidential health screening and care. It was also noted that 37% stated they would participate in confidential health screenings, if offered.
Qualitative interviews were conducted with 25 of the participants who had also completed the survey. Participants ranged from 24 to 76 years, with 9 men, 13 women and 3 two-spirit. There were 21 tribal affiliations noted in the interview population. The interviews were audio-recorded and transcribed verbatim. Three major themes emerged with analysis of findings: Community as a part of health and life; discretion, modesty and privacy as a part of Native American life; and culturally relevant, trustworthy and open opportunity for access to confidential health screening and care without coercion. More than 75% of the participants spoke of the Native American community as important to their life and health—it was considered an integral hub of their daily lives. The second theme of discretion and privacy—was noted to be paramount for over 90% of the persons interviewed—related to any type of healthcare screening. Finally, over half spoke of the importance of providing health screening that was accurate, open to all and not coercive (i.e. without a powerful assertiveness for involvement in screening)—and again linked to privacy and trust.
Conclusions:
It is our conclusion that with appropriate planning and community support, Native American sponsored cultural events are seen as acceptable locations for communicable disease preventive services. It was noted that while older individuals perceive a lower risk than younger participants, a majority of the participants considered the POW wow gathering as an appropriate location for discreet, confidential health screening and educational services.