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Table 2 Study characteristics

From: Barriers, frameworks, and mitigating strategies influencing the dissemination and implementation of health promotion interventions in indigenous communities: a scoping review

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Author/country

Study design

Sample (size)

Priority population

Stakeholders

Intervention/program topic area

D&I theory/framework

1

Barlow (2018) [16] (USA)

Case study

Choctaw (n = 220,000), Apache (n = 17,000), Kodiak (n = 226), & Native American Health Center (n = 7,200)

AI/AN mothers and infant caregivers

Indigenous home visitors; Staff from Urban Indian Center

Evaluation of the Tribal Maternal and Early Childhood Home Visiting (MIECHV) legislation supporting the delivery of home-visiting interventions in low-income AI/AN communities

None

2

Black (2018) [17] (USA)

Randomized controlled trial

AI/AN youth from program delivery sites in tribal communities (n = 16)

AI/AN youth

Tribal partners (funding agencies, academic institutions); Chief program officers; Program staff; Community advisory group

Implementation of a sexual health intervention for AI/AN youth.

CBPR

3

Jernigan (2020) [20] (USA)

Case study series

Community-based organization on major Hawaiian Islands (n = 30) (KaHOLO Project); indigenous adolescents (n = 200) across 10 urban communities across California (MICUNAY); 1,640 shoppers from Chickasaw Nation and Choctaw Nation of Oklahoma (THRIVE Study)

Native Hawaiians at risk of CVD and HT (KaHOLO Project); Urban Native American Youth (Motivational Interviewing and Culture for Urban Native American Youth-MICUNAY); shoppers from Chickasaw Nation and Choctaw Nation of OK (THRIVE Study)

Hula community; Native Hawaiian Health Task Force; Community members; Health care providers; Tribal government; Commerce; Health sectors

Assessment of three D&I case studies of NIH-funded intervention research to improve Native American Health (IRINAH)

CBPR (KaHOLO Project & MICUNAY); Reach, Efficacy, Adoption, Implementation, & Maintenance (RE-AIM) Framework (THRIVE study)

4

Counil (2012) [13] (Canada)

Qualitative

5 participants (Inuk leader; Inuk student; southern student; southern nutritionist; and southern researcher)

Inuit communities in Greenland & Northern Canada

Inuk leader; Inuk student; southern student; southern nutritionist; and southern researcher

Implementation of a reduction of the trans-fat content of food sold in Nunavik

None

5

Craig Rushing [12] (2018) (USA)

Pilot

50 states and 73 countries

AI/AN youth

Representatives from community-based organizations; Tribal health educators; advocates; teachers; school counselors; university partners

Assessing the reach and usability of the Healthy Native Youth website including culturally acceptable sexual health curricula

None

6

Douglas (2013) [18] (Canada)

Pilot

First Nation children with asthma and their caregivers (n = 13)

First Nation children with asthma in Canada

National advisory group; instructors; health professionals; academics with expertise in asthma education

Adaptation of the “Roaring Adventures of Puff Program” for First Nation Children with asthma

Knowledge-to-Action Framework

7

Gates (2013) [19] (Canada)

Case study

First Nations youth attending one school in Kashechewan, Ontario (sample size not specified)

First Nations youth

School administrators; university researchers; community key stakeholders

Lessons learned following the implementation of a school-based snack program for Native Youth

CBPR

8

Jernigan (2016) [20] (USA)

Cross-sectional

Key stakeholders in Oklahoma (n = 100) and California (n = 75)

AI stakeholders in two reservations (California and Oklahoma)

Community advisory board; university research center

Assessing obesity through policy and environmental approaches in two AI communities

CBPR

9

Jiang (2013) [21] (USA)

Quasi-experimental

Participants from AI/AN communities (n = 2,553)

80 AI/AN tribes served by 36 healthcare programs

IHS-contracted health programs; IHS hospitals/clinics; lifestyle coaches

Evaluation of the special diabetes program for Indians Diabetes Prevention

CBPR

10

Kaufman (2018) [22] (USA)

Cross-sectional

Stakeholders involved with sexual health and well-being of AI/AN youth (n = 142)

AI/AN youth

Expert task force (local technicians, CDC, IHS personnel, experts in HIV/STD)

Identification and assessment of the parameters facilitating the uptake of a sexual risk reduction EBI (RESPECT)

Diffusion of Innovation

11

Markham (2016) [10] (USA)

Randomized controlled trial

AI/AN youth (12-14 yrs.) from 13 urban (n = 13) & rural/tribal (n = 12) settings in AK, AZ, OR, ID, WA.

AI/AN youth

Regional staff; site coordinators (teachers, counselors, nurses, wellness coordinators, and college students)

Assessing the impact of the internet in the delivery of evidence-based health programs

None

12

Martindale-Adams (2017) [23] (USA)

Randomized controlled trial

Caregiving dyads from a federal or Tribal health care program serving one of the 546 federally recognized Tribes, an Urban Indian Health program, or awardees of the ACL/AOA Native American Caregiver Support Program (NACSP)

AI/AN with Alzheimer’s disease or early dementia

Staff from tribal healthcare programs; public health nurses; community health representatives; university research center

Implementation of REACH (Resources for Enhancing Alzheimer’s Caregivers Health) for an EBI Alzheimer’s EBI

Implementation Process Model

13

Mokuau (2008) [24] (USA)

Qualitative

Native Hawaiian elders seeking health services at the National Resource Center established at the University of Hawaii

Native Hawaiian elders

University of Hawaii research center; congressional leaders; national leaders in Native elder health; leaders at the University of Hawaii; gerontologists; Native Hawaiian leaders in the community

Development of a National Resource Center for Hawaiian elders to decrease disparities in accessing health services

CBPR

14

Moleta (2017) [25] (USA)

Quasi-experimental

Community Health Workers (CHWs) (n = 46)

Community Health Workers in Native communities

Ulu network members; Center for Native and Pacific Health Disparities Research

Development, Implementation, and Evaluation of “Heart 101”, a cardiovascular disease training program in Hawaii

CBPR/Adult Learning Theory

15

Nadin (2018) [26] (Canada)

Quasi-experimental

7 client and family members; 22 healthcare providers

First Nation elderly people

Community care program staff; federal and provincial government; funding agencies; external resources; healthcare providers; elders; members of the Band council and administration

Process evaluation of a pilot implementation of a community-based palliative care program (Wiisokotaatiwin)

CBPR

16

Orians (2004) [15] (USA)

Multisite case study design

141 interviews with key informants and 16 focus groups (132 AI/AN eligible women)

AI/AN eligible women

Program site staff; tribal members; health educators; outreach workers

Assessment of the tribal programs’ implementation of the public education and outreach component of CDC’s National Breast and Cervical Cancer Early Detection Program

CBPR

17

Pei (2019) [28] (USA)

Qualitative

35 participants in the Parent-Child Assistance Program for fetal alcohol spectrum disorder

First nation communities enrolled in fetal alcohol spectrum disorder services

First Nation community; leaders; program staff; university research members

Assessment of mentors' perceptions of the impacts and suitability of a relational, trauma-informed, and community-based approach to service delivery in First Nation communities

CBPR

18

Rasmus (2019) [29] (USA)

Case Study

Alaska Native communities suffering from the burden of suicide and alcohol misuse (sample size not specified)

AN communities

Indigenous researchers; Zuni tribal members and teachers; local community advisory; advisory committee; tribal/university collaboration; elders

Development of an Indigenous knowledge theory-driven intervention to guide researchers in indigenous communities who seek to create Indigenously informed and locally sustainable strategies for the promotion of health and well-being

Theory of Change framework/Indigenous Knowledge and Cultural Logic Model of Contexts

19

Short (2014) [30] (Canada & USA)

Systematic review

10 Indigenous communities suffering from motor vehicle crashes (MVC)

Indigenous communities

Child restraint technicians; police officers; prenatal and child safety seat clinic staff; Head Start staff

Successful dissemination and implementation strategies used in the development and implementation of MVC interventions

None

20

Walters (2020) [31] (USA)

Case study series

Yappalli Choctaw Study: Choctaw women (sample size not specified); the Qungasvik (Toolbox) Prevention Approach: AN youth 12–18 years old (sample size not specified); KaHOLO Project: Native Hawaiian adults at risk of cardiovascular disease and hypertension (sample size not specified)

Native communities

Choctaw health leaders; non-Native support staff; Native allies; Choctaw community members; community and cultural leaders; Choctaw elders; research team; elders; hula members; teachers; community-based organizations; investigations from the University of Hawaii and Washington state; health providers; housing representatives; environmental departments; cultural leaders; knowledge keepers; youth; parents

Implementation strategies, indigenous worldviews, and protocols derived from five diverse community-based Native health intervention studies

Culturally grounded models of health promotion: original instructions; relational restoration; narrative-embodied transformation; and indigenous CBPR

21

Young (2017) [32] (Canada)

Case Study

15 Canadian Aboriginal communities

50 Canadian Aboriginal communities

Aboriginal children

Planning discussions on challenges and best practices to implement a children’s well-being assessment tool

None

  1. *Ind, individual; Inter, interpersonal; Org, organizational; Comm, community; Soc/Pol, society/policy
  2. **Level of SEM per Barrier Category: Social determinants of health in communities = Community/Society-Policy; Personnel Challenges & High Turnover = Organizational; Funding = Organizational; Lack of Integration with Cultural Values = Organizational/Community; Limited Retention and High Attrition = Intrapersonal/Organizational; Distrust = Intrapersonal/Interpersonal/Organizational; Technology Barriers = Organizational; Insufficient Evaluation Skills = Intrapersonal/Organizational; Climate Conditions = Intrapersonal/Organizational/Community/Society-Policy