The Báa nnilah Program: Results of a Chronic-Illness Self-Management Cluster Randomized Trial with the Apsáalooke Nation
Abstract
:1. Introduction
2. Materials and Methods
2.1. Quantitative Data Collection
2.2. Quantitative Data Measures
2.3. Qualitative Data Collection
2.4. Qualitative Data Analysis
3. Results
3.1. Quantitative Data Results
3.2. Qualitative Data Results
“I learned to take my health concerns more seriously and to ask questions of my health care providers when I have medical appointments. I feel more confident in improving my health”(tablet data).
“Learned I gained friendships, trust in those that we share some same experiences. It takes a community to learn & teach from each other”(tablet data).
“The program has opened my eyes towards my health along with my children’s health.”
“To take care of your family you need to take care of yourself first.”
“I gained a better sense of partnership with my wife on health issues.”
“I became more active with my family.”
“Improved eating and drinking habits, able to share this with extended family.”
“I’ve had a good experience with the program. It’s good to know that I’m not the only one that is [going] through the things I do. I was also able to share with my adult children the things I learned about managing my health. My two oldest sons have taken control of their weight issues and have lost weight. They are no longer on high blood pressure medication or diabetes medication! I hope to do the same.”
“I gained relationships with new people and created deeper bonds with people who are already in my life. I was able to hear the stories of other people who share my condition and feelings and learn that I’m not alone as I navigate my health issues.”
“I have a support outside the doc[tor]. I have made new friends and people in health.”
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Full Sample n = 211 | Intervention n = 104 | Waitlist n = 107 | ||||
---|---|---|---|---|---|---|
n | Mean ± SD or | n | Mean ± SD or | n | Mean ± SD or | |
Frequency (%) | Frequency (%) | Frequency (%) | ||||
Age at baseline | 205 | 52.09 ± 13.47 | 101 | 51.71 ± 12.55 | 104 | 52.46 ± 14.36 |
Sex—Female | 211 | 152 (72%) | 104 | 69 (66%) | 107 | 83 (78%) |
Marital Status | 211 | 104 | 107 | |||
Married/In marriage-like relationship | 102 (48%) | 56 (54%) | 46 (43%) | |||
Separated or divorced | 49 (23%) | 18 (17%) | 31 (29%) | |||
Widowed | 23 (11%) | 12 (12%) | 11 (10%) | |||
Single, never married | 36 (17%) | 18 (17%) | 18 (17%) | |||
Other | 1 (1%) | -- | 1 (1%) | |||
Education | 210 | 104 | 106 | |||
Eighth grade or less | 4 (2%) | 4 (4%) | -- | |||
Some high-school | 24 (11%) | 11 (11%) | 13 (12%) | |||
High-school graduate or diploma | 45 (21%) | 23 (22%) | 22 (21%) | |||
At least some technical/vocational school or some college | 66 (31%) | 34 (33%) | 32 (30%) | |||
Associate’s degree | 40 (19%) | 16 (15%) | 24 (23%) | |||
Bachelor’s degree | 18 (9%) | 11 (11%) | 7 (7%) | |||
Post-graduate/professional degree | 13 (6%) | 5 (5%) | 8 (8%) | |||
Annual household income at baseline | 208 | 104 | 104 | |||
Under USD 10,000 | 68 (33%) | 36 (35%) | 32 (30%) | |||
USD 10,000–USD 14,999 | 29 (14%) | 16 (15%) | 13 (13%) | |||
USD 15,000–USD 24,999 | 41 (20%) | 20 (19%) | 21 (20%) | |||
USD 25,000–USD 34,999 | 29 (14%) | 16 (15%) | 13 (13%) | |||
USD 35,000–USD 49,999 | 22 (11%) | 8 (8%) | 14 (14%) | |||
USD 50,000–USD 74,999 | 9 (4%) | 3 (3%) | 6 (6%) | |||
USD 75,000–USD 99,999 | 7 (3%) | 4 (4%) | 3 (3%) | |||
USD 100,000 and higher | 3 (1%) | 1 (1%) | 2 (2%) | |||
Insurance or health coverage | 211 | 104 | 107 | |||
Medicare/Medicaid | 124 (59%) | 60 (58%) | 64 (60%) | |||
Private Insurance | 23 (11%) | 17 (16%) | 6 (6%) | |||
Indian Health Service | 95 (45%) | 45 (43%) | 50 (47%) | |||
Food assistance programs | 210 | 103 | 107 | |||
Yes | 116 (55%) | 63 (61%) | 53 (50%) | |||
Self-reported ongoing illness(es) | 211 | 104 | 107 | |||
Diabetes | 120 (57%) | 68 (65%) | 52 (49%) | |||
Arthritis | 71 (34%) | 36 (35%) | 35 (33%) | |||
Heart disease | 20 (10%) | 12 (12%) | 8 (8%) | |||
Blood pressure | 117 (56%) | 61 (59%) | 56 (52%) | |||
Asthma/Lung disease/COPD | 29 (14%) | 16 (15%) | 13 (12%) | |||
Cancer | 12 (6%) | 7 (7%) | 5 (5%) | |||
Chronic pain | 73 (35%) | 34 (33%) | 39 (36%) | |||
Other | 53 (25%) | 27 (26%) | 26 (24%) | |||
Number of illness(es) | 211 | 2.35 ± 1.25 | 104 | 2.51 ± 1.32 | 107 | 2.19 ± 1.17 |
Number of miles to the clinic | 197 | 18.91 ± 19.63 | 96 | 20.93 ± 21.08 | 101 | 17.00 ± 18.04 |
Number of doctor visits in the past 4 months | 197 | 4.13 ± 6.35 | 100 | 4.69 ± 8.18 | 97 | 3.55 ± 3.56 |
Number of people in the household | 200 | 4.82 ± 2.65 | 97 | 5.09 ± 2.75 | 103 | 4.57 ± 2.53 |
Intervention | Waitlist Control | |||
---|---|---|---|---|
Outcome Measures | T1 Mean ± SD | T2 Mean ± SD | T1 Mean ± SD | T2 Mean ± SD |
Physical Test | ||||
TUG Mean | 20.83 ± 5.43 | 19.32 ± 5.07 | 20.39 ± 5.30 | 19.25 ± 4.27 |
Balance (mBESS Total) | 13.41 ± 6.33 | 14.29 ± 7.24 | 13.81 ± 6.60 | 12.62 ± 6.57 |
6 min walk | 1260.23 ± 287.70 | 1338.83 ± 276.47 | 1298.85 ± 265.40 | 1356.41 ± 319.59 |
Health Surveys | ||||
SF12—Physical Health | 44.99 ± 10.91 | 42.19 ± 11.35 | 45.05 ± 9.74 | 42.33 ± 9.99 |
SF12—Mental Health | 47.06 ± 10.74 | 49.42 ± 11.02 | 46.58 ± 10.74 | 49.15 ± 10.8 |
Depression—PHQ-9 | 5.29 ± 5.88 | 5.44 ± 6.07 | 7.22 ± 7.47 | 6.21 ± 6.16 |
PROMIS—Satisfaction with Social Roles and Activities | 53.62 ± 10.11 | 53.15 ± 10.87 | 54.03 ± 9.62 | 53.73 ± 9.57 |
PROMIS—Self-Efficacy for Managing Symptoms | 49.33 ± 9.64 | 48.28 ± 9.41 | 48.15 ± 9.37 | 47.33 ± 8.36 |
PROMIS—Emotional Support | 52.71 ± 9.65 | 53.20 ± 8.95 | 51.65 ± 11.09 | 53.45 ± 9.23 |
PROMIS—Positive Affect and Well-Being | 56.32 ± 7.92 | 57.82 ± 8.22 | 56.37 ± 8.98 | 57.40 ± 8.37 |
PROMIS—Physical Function | 44.94 ± 8.81 | 45.57 ± 9.09 | 45.49 ± 8.74 | 45.78 ± 8.53 |
PROMIS—Self-Efficacy for Managing Emotions | 48.18 ± 9.13 | 49.80 ± 9.32 | 48.28 ± 9.84 | 49.38 ± 9.90 |
PROMIS—Self-Efficacy for Managing Social Interactions | 46.57 ± 8.57 | 47.10 ± 8.59 | 47.44 ± 9.74 | 47.86 ± 8.94 |
Patient Activation Measure | 69.31 ± 17.73 | 67.39 ± 21.09 | 65.5 ± 16.41 | 70.62 ± 19.83 |
Group a | Baseline Age | Sex b | Educational Level c | Number of Illnesses | Attendance | Intervention | Time from Baseline | Time by Group | ||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Some High-School | High-School Diploma | Some Technical School | At least some college | |||||||||
TUG Mean | 1.959 (0.911) * | 0.166 (0.030) *** | −1.620 (0.825) | 0.357 (1.264) | −0.967 (1.108) | −0.909 (1.173) | −2.304 (1.295) | 0.084 (0.311) | −0.042 (0.195) | 1.048 (0.582) | 0.001 (0.001) | −0.006 (0.002) *** |
mBESS Total | 0.838 (1.439) | 0.189 (0.038) *** | 0.097 (1.047) | 2.061 (1.597) | 1.086 (1.417) | 0.680 (1.477) | 0.619 (1.653) | 0.352 (0.397) | −0.248 (0.254) | 2.004 (1.158) | 0.011 (0.003) *** | 0.009 (0.003) ** |
6 min walk | −86.753 (64.318) | −8.738 (2.054) | 74.761 (57.127) | 53.354 (89.058) | −11.997 (76.687) | −1.870 (81.099) | 70.891 (89.007) | −6.441 (22.245) | −8.153 (13.582) | −23.006 (48.364) | −0.077 (0.108) | −0.168 (0.138) |
SF-12 Physical | 1.236 (1.415) | −0.099 (0.049) * | 1.774 (1.370) | 2.430 (2.120) | 2.407 (1.942) | −0.366 (2.092) | 3.539 (2.311) | −2.702 (0.514) *** | 0.358 (0.341) | −0.147 (0.921) | 0.005 (0.002) * | −0.002 (0.003) |
SF-12 Mental | 2.524 (1.620) | 0.001 (0.054) | 2.708 (1.501) | 0.852 (2.336) | 1.196 (2.134) | −0.584 (2.282) | 2.172 (2.528) | −1.788 (0.574) ** | 0.656 (0.386) | 0.421 (1.032) | 0.007 (0.003) ** | −0.004 (0.003) |
PHQ-9 | 0.232 (1.005) | 0.010 (0.036) | −0.793 (1.000) | −0.952 (1.568) | −1.246 (1.345) | 1.519 (1.450) | −1.309 (1.571) | 0.311 (0.375) | −0.444 (0.228) | 0.124 (0.564) | 0.002 (0.001) | 0.001 (0.002) |
Physical Function | −2.067 (1.298) | −0.198 (0.049) *** | 2.912 (1.384) * | 2.355 (2.174) | 0.910 (1.851) | 0.522 (2.010) | 1.510 (2.157) | −2.486 (0.517) *** | 0.452 (0.308) | 0.452 (0.649) | 0.001 (0.001) | 0.002 (0.002) |
SEMS | −0.322 (1.471) | −0.058 (0.051) | −0.494 (1.449) | 1.810 (2.273) | 1.678 (1.932) | 0.074 (2.091) | 2.811 (2.245) | −1.430 (0.540) ** | −0.083 (0.321) | −0.398 (0.991) | 0.002 (0.002) | 0.001 (0.003) |
EMSU | −0.422 (1.774) | 0.007 (0.054) | −1.172 (1.459) | 2.640 (2.269) | 2.445 (2.007) | 0.627 (2.112) | 0.424 (2.386) | −0.134 (0.556) | 0.222 (0.370) | 0.494 (0.930) | 0.002 (0.002) | 0.001 (0.002) |
SEME | −0.670 (1.591) | 0.007 (0.055) | −0.094 (1.506) | 2.211 (2.357) | 1.223 (2.039) | 0.894 (2.185) | 1.562 (2.393) | −0.830 (0.568) | 0.036 (0.354) | 0.255 (0.868) | 0.003 (0.002) | 0.003 (0.002) |
PAWB | −1.134 (1.449) | −0.013 (0.050) | 0.001 (1.370) | 2.439 (2.143) | 1.527 (1.858) | 0.715 (1.991) | 2.120 (2.183) | −0.336 (0.517) | 0.224 (0.323) | −0.033 (0.770) | 0.001 (0.002) | 0.001 (0.002) |
SESI | −1.216 (1.515) | −0.003 (0.053) | −1.666 (1.469) | 4.342 (2.302) | 3.732 (1.977) | 1.872 (2.128) | 2.694 (2.310) | −0.272 (0.551) | −0.069 (0.337) | 0.537 (0.899) | 0.002 (0.002) | 0.001 (0.002) |
SATS | −1.782 (1.581) | 0.007 (0.058) | 0.026 (1.617) | 2.957 (2.537) | 0.105 (2.167) | −0.614 (2.345) | −1.443 (2.527) | −1.766 (0.605) ** | 0.371 (0.363) | 0.478 (0.873) | 0.001 (0.002) | 0.001 (0.002) |
PAM | −1.621 (3.102) | −0.179 (0.097) | −2.907 (2.723) | 4.237 (4.266) | 9.071 (3.649) * | 3.653 (3.919) | 10.284 (4.257) * | 0.590 (1.016) | 1.145 (0.627) | 1.994 (2.345) | 0.014 (0.007) * | −0.009 (0.007) |
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Held, S.; Feng, D.; McCormick, A.; Schure, M.; Other Medicine, L.; Hallett, J.; Inouye, J.; Allen, S.; Holder, S.; Bull Shows, B.; et al. The Báa nnilah Program: Results of a Chronic-Illness Self-Management Cluster Randomized Trial with the Apsáalooke Nation. Int. J. Environ. Res. Public Health 2024, 21, 285. https://doi.org/10.3390/ijerph21030285
Held S, Feng D, McCormick A, Schure M, Other Medicine L, Hallett J, Inouye J, Allen S, Holder S, Bull Shows B, et al. The Báa nnilah Program: Results of a Chronic-Illness Self-Management Cluster Randomized Trial with the Apsáalooke Nation. International Journal of Environmental Research and Public Health. 2024; 21(3):285. https://doi.org/10.3390/ijerph21030285
Chicago/Turabian StyleHeld, Suzanne, Du Feng, Alma McCormick, Mark Schure, Lucille Other Medicine, John Hallett, Jillian Inouye, Sarah Allen, Shannon Holder, Brianna Bull Shows, and et al. 2024. "The Báa nnilah Program: Results of a Chronic-Illness Self-Management Cluster Randomized Trial with the Apsáalooke Nation" International Journal of Environmental Research and Public Health 21, no. 3: 285. https://doi.org/10.3390/ijerph21030285
APA StyleHeld, S., Feng, D., McCormick, A., Schure, M., Other Medicine, L., Hallett, J., Inouye, J., Allen, S., Holder, S., Bull Shows, B., Trottier, C., Kyro, A., Kropp, S., & Turns Plenty, N. (2024). The Báa nnilah Program: Results of a Chronic-Illness Self-Management Cluster Randomized Trial with the Apsáalooke Nation. International Journal of Environmental Research and Public Health, 21(3), 285. https://doi.org/10.3390/ijerph21030285