Jacob, M., Poole, M., Gonzales, K., Jim, H., Duncan, G., & Manson, S. (2015). Exploring an American Indian Participatory Medical Model. Journal of Participatory Medicine, 7, e8.

Abstract

American Indians suffer disproportional disease burden from chronic conditions such as Type 2 diabetes (hereinafter “diabetes”). In response to this health crisis, the United States Congress implemented the Special Diabetes Program for Indians (SDPI), a community-based demonstration project to help patients prevent diabetes and reduce risk for cardiovascular disease. This paper describes how intervention case managers at one SDPI site, the Yakama Healthy Heart Program (YHHP), conceptualized culturally responsive intervention strategies, and patient, system, and cultural factors that impact participation in the SDPI intervention.

Methods: Thematic analyses of qualitative data derived from focus groups comprised of three categories: retained participants, non-retained participants, and intervention case managers. 

Findings: Recommendations to inform an American Indian participatory medical model include: 1) reciprocity of individuals and systems must be implemented throughout all levels and for the duration of the intervention; 2) community champions need to serve as intervention leaders; and 3) institutional structures must promote relationship building between providers and patients within a community and cultural context. Our findings indicate that the unique structural qualities and community-engaged retention strategies of YHHP are critical to ensuring strong case manager-patient relationships, recruitment, and retention.