Eliciting tribal preferences for community engagement in implementing the Cheyenne River Sioux's locally designed and financed public health system
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The Foundation initiative, Systems for Action: Services and Systems Research to Build a Culture of Health, was designed to form the evidence base for the public health services and systems research (PHSSR) needed to build a Culture of Health, by: (1) supporting PHSSR focused on advancing a Culture of Health and real-world applications of that research; and (2) establishing satellite centers throughout the United States that will provide additional capacity to identify, develop, and oversee new and emerging areas of research within the field.This study evaluates a novel mechanism for integrating the delivery of medical care, public health and social supports for the Cheyenne River Sioux Tribe (CRST). Like many racial and ethnic minorities, American Indians face disproportionately higher rates of disease and mortality. Compared to the general US population, the rate of diabetes in the American Indian/Alaska Native population is double and infant mortality rates are over 1.3 times higher. In South Dakota, infant mortality rates among American Indians are even higher, at almost double those found in the general US population. Poverty rates are high and access to services is limited. This initiative will implement the first locally designed and financed public health program for the people of the Cheyenne River Sioux Tribe. The Tribal Health Council's public health plan, named the Tasina Luta (or "Red Blanket"), was developed in response to lack of coordination, access, and limited utilization of services for approximately 8,000 CRST members living in rural South Dakota. Using a Community-Based Participatory Research approach, Texas A&M University and the Tribal Health Council of the CRST will: (1) elicit Tribal values and preferences regarding community engagement techniques to implement the Tasina Luta; (2) enhance program implementation through effective dissemination and promotion efforts that encourage community engagement and participation; (3) examine the relationship between an internally developed public health program within the CRST and external state and federal agencies in an environment with historically inconsistent collaboration; and 4) advance knowledge of how program diffusion is affected by the interplay of strong links among community members and somewhat weaker social ties with external contacts. Findings from this work could inform multiculturally inclusive public health programming in communities with strong social bonds.
