Native American Interest Group on Nov 2, 2014 Mayo Crisp Lecture Hall, Mayo Clinic- Rochester, MN.

1. Assessing Health Priorities of Tribal Health Directors with Surveys: Lessons from a pilot study?
Jon Tilburt, MD,
Mayo Clinic
Native American Interest Group
Mayo Clinic, Rochester, MN November 3, 2014

2. Where’s the bullet ?

3. You cain’t say!
Our knowledge limited by the tools we use to gather information

4. John Tarpley, MD
“You see what you look for; you diagnose what you know.”

5. Bottom Line: Survey Methods
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are a crucial research tool
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to prepare for change
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can help avoid focusing on pet topics
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can be used to link potential partners
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can help honor sovereignty, BUT
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Come with biases, assumptions & values
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that must be acknowledge
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can’t be substituted for listening
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tell only part of the study

6. Objectives
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Moving toward change
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Change and “pet topics”
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Research, sovereignty, & change
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Merits & Mischief of surveys
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Experience using surveys

7. Change

8. Moving toward Change
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Change requires
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building on partner assets
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building on what’s already going on
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sustained energy
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local champion
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capacity
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Must acknowledge
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competing priorities
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Opportunity costs

9. Change and “Pet Topics”

10. Pet Health Topics
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Cancer screening
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Heart disease
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Immunizations
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HIV
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Education
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Maternal/Child health
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Addiction
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PTSD

11. Men’s Health

12. www.menshealthnetwork.org

13. Men’s Health
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An important topic
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Policy opportunities
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Grass roots efforts ongoing
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Just a “pet topic”, priority, or something else

14. nativemenshealth.org

15. Researcher Challenge
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Go for what is fundable
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Go for what is important, for change

16. Research, Sovereignty, & Change
In order to meaningful research that leads to community change researchers need to be able to
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Ask
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Listen
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Link
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Bond
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Submit
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Sell
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Persevere

17. How about a survey?

18. Survey Merits & Mischief
Survey methods are a powerful (but limited) social science tool to build toward change

19. Estimating What Is

20. Features of the Method Itself
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Discrete number of carefully worded items
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Closed ended
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High-level summaries for distracted audiences
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A high-level snap shot
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Quantitative
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At one moment in time

21. Survey Merits
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Quick
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Cost-effective
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More “generalizable”
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Great “snap shot”
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Fit “national” scale

22. Survey Mischief
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Only as good as question
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Often close-ended less curiosity

23. Surveys can’t measure
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Meaning
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Motivation
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Complex behaviors/relationships
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Nuance

24. Are surveys strong or weak?

26. Can surveys facilitate change?
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Asking
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Listening
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Linking
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Bonding
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Submitting
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Selling
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Persevering

27. Experience

28. Beyond “Pet Topic” Research
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Men’s health & local Indian health leadership priorities?
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Opportunities to ask leaders, link expertise, priorities & capacity?
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Can we ask without “leading the witness”
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? platform to convince funding bodies (sell)

29. Motivating Question
How does men’s health fit with tribal leadership priorities?

30. Bottom Line Answer:
It depends on how you ask

31. Survey “Native Community Health Needs & Research Interests”
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Spring 2014
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448 ITU directors
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Topic: men’s health, health priorities, working w/ researchers,
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372 with known emails
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103 bounced back (leaving 269)
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Mayo Clinic IRB #13-005953 (exempt)
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87/269 (32% “cooperation rate”)
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87/448 (19% “response rate”)

32. Priorities Assessment (top 5)
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Men’s Health as an issue
We want to know which health issues are of greatest concern in your community.
For the list of broad health issues below, please select one issue for each of the five priorities on which your community intends to focus or grow programs in the coming 3-5 years (Indicators of priorities might include areas of relative anticipated personnel or budgetary growth, for example.)
Priority #1 (please choose one)
Tobacco Cancer screening Diabetes  Obesity  Suicide Addiction and its Consequences Men's health Women's health Public safety  Access to basic dental services  Social assistance issues  Adapting to health care reform  access to clinical trials  Domestic violence Sexual abuse  Other

33. Men’s Health Contents
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Men’s Health as a strategy
For each priority . . . “Please rate the importance of gender targeted approaches for each priority” (very, somewhat, not important)
•Evidence of Men’s health investment
–existing men’s health programs
–Offender re-entry or Veteran programs

34. Other Survey Contents
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Biggest Challenge implementing priorities (free text)
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Specific Issues (Major, somewhat, not a challenge)
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Funding deficiencies; Bureaucratic constraints; Community leadership issues; Community unrest/resistance; Lack of trained staff
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Working with Researchers (+/-)
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Perceived Capacity

35. Other Survey Content
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Attractiveness of starting something new with researchers
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Confidence that research could lead to change
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Examples of success (free text)
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Years in current position, stressfulness of work environment, interested in discussing further.

36. Men’s Health Activity (n=87)
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Men’s health: 31% (27/80)
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Veteran re-integration: 12% (10/87)
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Offender re-entry: 18% (16/87)

37. Top Health Issues
1.
Diabetes (61/87)*
2.
Alcohol/Substance Abuse (59/87)
3.
Mental Health (52/87)
4.
Obesity (49/87)
5.
Addiction (30/87)
6.
Cancer Screening (20/87)
…
19. Men’s Health (9/87)

38. Framed as an “issue” . . .
Men’s health is high on priority list of a few Indian health leaders’

39. What if its framed as a “strategy”?

40. Gender-based Strategy
“Please rate the importance of gender targeted approaches for each priority” (very important)
•Priority #1 -- 25/87
•Priority #2 -- 33/87
•Priority #3 -- 25/87
•Priority #4 -- 25/87
•Priority #5 -- 30/87

41. Framed as a “strategy” . . .
Men’s health may be an important means for achieving Indian health leader priorities in many cases

42. Men’s Health in Indian Country: “Issue” or “Strategy”?

43. Working with Researchers

44. Challenges (major challenge)
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Funding deficiencies (63/87)
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Lack of trained staff (25/87)
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Bureaucratic constraints (22/87)
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Community leadership issues (19/87)
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Community unrest/resistance (17/87)

45. Experience, Capacity, Enthusiasm
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“Usually/Always positive” experience working w/researchers (55/87)
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“Lots of/Sufficient/a little bit of” capacity to take on a research project in a priority area (42/87)
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“Very/Somewhat attractive” (80/87) to take on research program with outreach component in priority area.

46. Experience Summary
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Few responding ITU leaders have something going in men’s health
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Men’s health as an “issue” high priority for a few
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Gender tailored “strategies” to achieve other priorities, promising
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Useful, but challenging tool

47. Surveys ≠ Change
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Asking
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Listening
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Linking
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Bonding
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Submitting
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Selling
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Persevering

48. Asking & Linking
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Avoid familiarity bias (new relationships?)
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Open up a conversation
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Readiness & capacity

49. Acknowledgements
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Funding: Mayo Clinic Office of Health Disparities Research
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Alex Fiksdahl, MA (Analyst)
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Men’s Health Network
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AZ Men’s Health Coalition
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Indian Health Service
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Wes Petersen, Judith Kaur, Christi Patten, Steve Alberts,
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Phil, Ouran, Pat, Monte, Bryce

50. Thank You
tilburt.jon@mayo.edu