As a step toward health equity, many Native American and Native Communities have implemented evidence-based programs to address chronic disease self-management, behavioral health and fall prevention.
Several programs, like A Matter of Balance and EnhanceFitness have been successful adapted for Native communities.
Involving trusted partners is key to helping older adults older adults navigate and access community resources that help them overcome barriers to behavior change and successful health management.
In recent years, health care providers and systems, sometimes in collaboration with community-based organizations, have begun to explore and address the vital issue of health equity among older adults and adults with disabilities.
Bilingual/bicultural community health workers and representatives have been embedded in communities of color. Screenings to address social determinants of health, such as access to food, housing, and transportation, have become more prevalent. Growing, but still woefully insufficient, attention has been paid to the role of structural racism in health care outcomes.
Historically missing from much of this work is the voice of the community directly impacted. Today, there are increased calls to action for health care and community organizations to move beyond mere advisory groups of Black, Indigenous, and People of Color (BIPOC) patients and to instead create opportunities for diverse individuals to create and more greatly influence the care and services they receive. Among the communities where this is most critical are the 5 million plus American Indians, Alaskan Natives, and Native Hawaiians living in the United States. As an Indian Health Services fact sheet explains:
...lower life expectancy and the disproportionate disease burden” among these communities “exists perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences.”
How can evidence-based programs tackle health equity for older adults?
To address these issues of health equity in a way that amplifies the voices and power of Native persons, many communities have implemented evidence-based programs (EBPs) to address chronic disease, behavioral health, falls prevention and self-management, to name a few. According to the Evidence Based Leadership Collaborative, EBPs are those programs that have been rigorously tested in controlled settings, proven effective, and then translated into practical models so that they can be widely implemented in diverse community settings.
Many (but certainly not all) of these EBPs were initially designed and embedded in English-speaking, white communities with assumptions that overlooked cultural sensitivities.
In response to feedback from these diverse communities, many EBP developers and administrators have now undertaken the responsibility of adapting programs to be more culturally relevant and accessible. One common and essential core element of developing these adaptations, particularly as it relates to Native populations, is collaboration with Native individuals to develop, adapt, implement, and improve these programs. Much of this work, along with other best practices, has been compiled in resource guides such as:
- Successful Strategies & Lessons Learned from Implementing Evidence-Based Programs in American Indian, Alaskan Native, and Native Hawaiian Communities
- Engaging American Indian/Alaska Native/Native Hawaiian Adults in Chronic Disease Self-Management Education (ncoa.org)
- Engaging American Indian/Alaska Native Elders in Falls Prevention (ncoa.org)
- Improving Native American Health Using Evidence-Based Research (ncoa.org)
What evidence-based programs have been tailored to Native communities?
Among the evidence-based programs that have been successfully adapted for Native communities:
- Chronic Disease Self-Management Program (CDSMP), offered in small groups in-person (8 – 16 participants), using virtual platforms like Zoom (8 – 12 participants), through mailed toolkits and telephone communication (3 – 5 participants), or via independent study. The CDSMP’s Wisdom Warriors adaptation, developed by Native leadership, “offers culturally appropriate incentives to support tribal Elders with their self-management goals.”
- A Matter of Balance, a program designed to reduce the fear of falling and increase activity levels among older adults, offered both in-person and virtually, is being successfully implemented by the Gila River Indian Community Tribal Health Department’s Injury Prevention Program to address the high rate of elder falls in this Native American community (Elder Fall Prevention Injury (gricthd.org).
- EnhanceFitness, is an EBP with a goal of empowering older adults, regardless of their fitness levels, to lead healthy and active lives through in-person or remote exercise sessions. EnhanceFitness has been successfully implemented in many tribal settings across Washington, New Mexico, and other states. Hawai`i's Healthy Aging Partnership supported the rural island of Kaua`i to select, adapt, implement, and evaluate EnhanceFitness to increase physical activity among older adult residents (75% Asian/Pacific Islander [API]). The article and case study, “Replicating the EnhanceFitness physical activity program in Hawai`i's multicultural population, 2007-2010” (https://pubmed.ncbi.nlm.nih.gov/22440548/) details replication in indigenous populations in Kauai and Maui.
Trusted partnerships are key to successfully advancing health equity
While EBPs are tremendously beneficial tools in advancing health equity among Native populations, they are most effective when delivered in collaboration with local, community-based organizations and partners who have relationships of trust with the communities sought to be reached. These collaborations have proven successful in assisting older adults navigate and access other community resources (food, housing, income stability, transportation, etc.) that help them overcome the barriers to behavior change and successful health management. These partnerships among Native elders, local community-based organizations, evidence-based program developers, and health care partners form a strong collaboration to advance health equity for all.
Resources for further exploration:
- SOPHE’s “Arthritis and Healthy Aging” YouTube playlist.
- "Are Your Evidence-Based Health Resources Reaching Native Elders?"
- "What Evidence-based Health Promotion Programs work with Native Elders?"
- SMRC Fidelity Manual “Some Thoughts about Diversity” pages 13-18 https://selfmanagementresource.com/wp-content/uploads/SMRC_Implementation_and_Fidelity_Manual_2022.pdf
(NOTE: For purposes of this article, the term “Native American” includes: American Indian, Alaskan Natives, and Native Hawaiians.)
This project was supported, in part by grant number 90CSSG0048 and 90FPSG0051 from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.