Collaborative implementation of a community-based exercise intervention with a partnering rural American Indian community

Abstract

Background

The prevalence and socioeconomic burden of childhood obesity and diabetes has increased rapidly in the United States in the last 30 years. American Indians have the highest prevalence of type 2 diabetes among newly diagnosed youth in the country. Contributing factors include environmental, behavioral, and genetic components. Some American Indian tribal communities have explored innovative ways to combat this epidemic including collaborations with academic centers on community-based research.

Method

From 2012 to 2017, the University of Oklahoma Health Science Center and the Choctaw Nation of Oklahoma partnered on a National Institutes of Health–funded project to determine if financial incentives would elicit an increase in physical activity in Native youth. This was a community-based behavioral intervention for overweight or obese American Indian youth ages 11–20 living in a rural community at risk for developing diabetes.

Results

Tribal leaders and staff identified culturally appropriate strategies to aid implementation of the trial in their community. Their identified implementation strategies helped standardize the study in order to maintain study integrity. The mutually agreed strategies included co-review of the study by tribal and University research review boards (but designation of the Choctaw Nation review board as the “Board of Record”), training of community-based staff on research ethics and literacy, standardization of the informed consent process by videotaping all study information, creation of a viable and culturally appropriate timeline for study implementation, adapting tribal wellness center operations to accommodate youth, and development of effective two-way communication through training sessions, on-site coordination, and bi-monthly conference calls.

Conclusion

In an effort to partner collectively on a randomized clinical research trial to combat childhood diabetes, tribal leaders and staff implemented strategies that resulted in a culturally appropriate and organized community-based behavioral intervention research project.

Keywords

Collaborative research community-based research physical activity intervention clinical study implementation American Indian youth

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References

Ogden

Carroll

Lawman

, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA 2016; 315(21): 2292–2299.

Lamb

Ogden

Carroll

, et al. Association of body fat percentage with lipid concentrations in children and adolescents: United States, 1999-2004. Am J Clin Nutr 2011; 94(3): 877–883.

Schwimmer

Pardee

Lavine

, et al. Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease. Circulation 2008; 118(3): 277–283.

Ford

Zhao

, et al. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents. Diabetes Care 2009; 32(2): 342–347.

Narayan

Boyle

Thompson

, et al. Lifetime risk for diabetes mellitus in the United States. JAMA 2003; 290(14): 1884–1890.

Department of Health and Human Services, Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States 2014, http://www.thefdha.org/pdf/diabetes.pdf (accessed 25 July 2018).

McLaughlin

Traditions and diabetes prevention: a healthy path for Native Americans. Diabet Spect 2010; 23(4): 272–277.

Kaufman

Dicken

Williams

Measuring access to healthful, affordable food in American Indian and Alaska native tribal areas. Econ Inform Bull 2014; 131, https://www.ers.usda.gov/webdocs/publications/43905/49690_eib131_errata.pdf?v=42103 (accessed 26 June 2018).

Choctaw Nation of Oklahoma. State of the nation’s health report obesity focus edition 2012. Durant, OK: Choctaw Nation Health Services.

10.

Choctaw Nation of Oklahoma. State of the nation’s health 2010: an addendum report. Durant, OK: Choctaw Nation Health Services.

11.

Ogden

Carroll

Kit

, et al. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014; 311(8): 806–814.

12.

Chadwick

Copeland

Daniel

, et al. Partnering in research: a national research trial exemplifying effective collaboration with American Indian Nations and the Indian Health Service. Am J Epidemiol 2014; 180(12): 1202–1207.

13.

Short

Chadwick

Cannady

, et al. Using financial incentives to promote physical activity in American Indian adolescents: a randomized controlled trial. PLoS ONE 2018; 13(6): e0198390.

14.

Holkup

Tripp-Reimer

Salois

, et al. Community-based participatory research: an approach to intervention research with a Native American community. ANS Adv Nurs Sci 2004; 27(3): 162–175.

15.

Burhansstipanov

Christopher

Schumacher

SA.

Lessons learned from community-based participatory research in Indian country. Cancer Control 2005; 12(Suppl. 2): 70–76.

16.

Short

Teague

Fields

, et al. Lower resting energy expenditure and fat oxidation in Native American and Hispanic infants born to mothers with diabetes. J Pediatr 2015; 166(4): 884–889.

17.

Lee

Welty

Fabsitz

, et al. The strong heart study. A study of cardiovascular disease in American Indians: design and methods. Am J Epidemiol 1990; 132(6): 1141–1155.

18.

Jernigan

Jacob

; Tribal Community Research Team and Styne D. The adaptation and implementation of a community-based participatory research curriculum to build tribal research capacity. Am J Public Health 2015; 105(Suppl. 3): S424–S432.

19.

Locke

EA.

Toward a theory of task motivation and incentives. Organ Behav Hum Perform 1968; 3(2): 157–189.

20.

The University of Oklahoma Human Research Participant Protection IRB Policies and Standard Operating Procedures (SOPs: IV). Statement of Authority and IRB of Record. 9 September 2016 https://compliance.ouhsc.edu/Portals/1061/HRPP/assets/documents/Policies/00_SearchableSOP.pdf?ver=2019-01-22-135752-943 Accessed: January 30, 2019.

21.

United States Department of Health and Human Services: The Office for Human Research Protections. Database for Registered IORGs and IRBs, Approved FWAs, and Documents. #IRB00004293 https://ohrp.cit.nih.gov/search/irbsearch.aspx (accessed 30 January 2019).

22.

Jimison

Sher

Appleyard

, et al. The use of multimedia in the informed consent process. J Am Med Inform Assoc 1998; 5(3): 245–256.

23.

Ryan

Prictor

McLaughlin

, et al. Audio-visual presentation of information for informed consent for participation in clinical trials. Cochrane Database Sys Rev. Epub ahead of print 23 January 2008. DOI: 10.1002/14651858.CD003717.pub2.