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Completed Projects




Cancer Symptom Management

This R01 study is funded by the National Cancer Institute. The long-range goal of this project is to reduce or overcome barriers to cancer-related symptom management among American Indians (AIs). Little is known about the phenomena of cancer-related symptoms, their management, and barriers to care, or about the barriers faced by AI patients needing and/or seeking symptom management. Such cancer-related symptoms as fatigue, function, depression, and pain experienced by this population require clearer understandings in terms of definitions, cultural constructs of symptoms, decision-making strategies, barriers to care, provider referrals, and treatment for symptom management care. This is an innovative, interdisciplinary study using qualitative means to:

  1. clarify and define the cultural constructs of cancer-related symptoms,
  2. examine the pathways and mechanism of communication and treatment-seeking that AIs use for management of cancer-related pain and symptoms,
  3. gain an understanding of culturally-embedded meaning of cancer-related symptoms e.g., pain, fatigue, and depression, their conceptualization, cultural construct(s), patterns and strategies of their disclosure by AIs,
  4. develop and test a reproducible clinic-based, innovative, and culturally appropriate program to overcome barriers to care for AI symptom management that derive from AI cultural perspectives, and,
  5. identify symptom management decision-making strategies and barriers among AI cancer patient/providers.

The study designs culturally sensitive educational and resource materials to be used in the intervention phase of the project. Additional tools will include culturally appropriate instruments for measuring symptoms intended to improve AI knowledge of and access to cancer symptom management services.

The project develops and test a reproducible, clinic-based, culturally appropriate intervention to overcome barriers to the delivery of symptoms management for AIs. This intervention will be through a Talking Circles format which is a culturally meaningful method that has proven effective in previous studies.

Felicia Hodge, Principal Investigator


Colorectal Cancer Education and Awareness for Healthcare Providers Serving American Indians

This project is funded by the California Dialogue on Cancer (CDOC).  The long-range goal of this project is to educate healthcare providers serving California American Indians of the importance of early colorectal cancer screening/detection and culturally appropriate approaches to addressing the issue in the communities they work in.  Colorectal cancer (CRC) has the second highest death rate among cancer patients in the American Indian community.  With early detection, the survival rate for colorectal cancer can be as high as 90%.  However, the Indian Health Service (IHS) reports low screening rates for their patient population in California (33%).  Low screening rates and late diagnosis contribute to a poor 5-year survival rate for colorectal cancer.  This is an innovative, interdisciplinary study with specific aims to:

  1. create a colorectal cancer workshop/course for healthcare providers serving California American Indian communities to enhance provider knowledge of CRC screening, treatment, and culturally appropriate approaches for communicating with patients to improve screening and early detection;
  2. improve communication about colorectal cancer screening between health care providers and American Indian patients;
  3. disseminate culturally competent curriculum among tribal healthcare programs.

Felicia Hodge, Principal Investigator

Smoking Cessation

The goal of this project was to increase long-term smoking cessation in the service population of 18 American Indian clinics in Northern California through a reproducible clinic-based smoking cessation program. Focus groups were conducted to determine beliefs about tobacco, smoking, and culturally appropriate smoking cessation methods. The information gathered from the focus group was also used to prepare a videotape and a smoking cessation self-help guide to assist participants in quitting smoking.

Clinics were randomly assigned into control and intervention groups after being matched on size and location (urban/rural).

The primary care providers from the intervention group were trained in the use of the smoking cessation program modified for the American Indian population. After smoking cessation was initiated by patient and provider, follow-up reinforcement was provided by home visits from Community Health Representative (CHRs) or other clinic outreach workers. Program results show that the smoking cessation program was successful at reducing smoking prevalence within the target population.

Felicia Hodge, Principal Investigator


American Indian Women's Talking Circle (Cervical Cancer)

The long range goal was to evaluate the efficacy of the "Talking Circle" which is a culturally appropriate educational intervention method that was utilized on cancer screening and quality of life measures. The "Talking Circle" is a well-known method of intragroup communication in many Indian communities. The study targeted American Indian (AI) women aged 18-74 at risk for cervical cancer who attended eight targeted urban and rural clinics in Northern California.

The specific aims were to: 1) increase cancer prevention knowledge levels, establish positive attitudes toward screening activities, and reduce risk factor behavior, 2) increase the proportion of women receiving cervical cancer screening at recommended intervals in AI clinics, 3) increase the percentage of postmenopausal AI women who receive regular cervical cancer screening, and, 4) increase the percentage of AI women who receive appropriate follow-up services for abnormal pap examinations.

The Talking Circles were instrumental in understanding health care beliefs and behaviors as well as identifying barriers to cervical cancer screening. Initial reports from the participants indicate that health-related information is accepted and acted on when coupled with meaningful information in a culturally sensitive manner. Changing health behavior practice in a culturally acceptable manner has the potential to save lives and improve the health status of Indian women.

Felicia Hodge, Principal Investigator



Pathways to Health (Breast Cancer)

The goal of the Pathways to Health project was to develop and implement a culturally sensitive educational program aimed at reducing breast cancer mortality and morbidity among American Indian women in California.

The project was designed to increase American Indian women's breast cancer awareness, early detection, treatment knowledge levels, and to provide awareness and culture sensitivity for health professionals with American Indian patients. Findings discussed initial focus group results concerning belief in breast cancer risk, barriers to cancer screening and treatment, culturally sensitive issues, and illness beliefs.

Felicia Hodge, Principal Investigator


Cancer and Employment

This pilot study was funded by the National Cancer Institute to the University of Arizona Cancer Center. The goal of the project was to identify cancer related issues associated with employment among the Fond du Lac tribal members residing in Northern Minnesota.

Katheryn Coe, Principal Investigator
Catherine Marshall, Investigator
Felicia Hodge, Investigator

  Colorectal Cancer Education and Awareness for Providers & American Indians

This project was funded by the California Dialogue on Cancer (CDOC).  The goal of the project was to promote early symptom recognition by both the healthcare providers at American Indian clinics and stations, and the American Indian patients who attend these clinics. Focus groups were conducted in American Indian health centers in Northern and Southern California to obtain input and feedback on the development of project materials. We developed a poster (on-screening) and brochures (on prevention and diagnosis) for both providers and patients, which were disseminated throughout California. 

Felicia Hodge, Principal Investigator

  Southwest American Indian Collaborative Network (SAICN)

This project is funded by the National Cancer Institute to the Inter-Tribal Council of Arizona, Inc. Dr. Kathryn Coe is the Principal Investigator. The aim of SAICN is to eliminate cancer health disparities among American Indians. The core partners in the project have both local and regional programs and activities. This proposal envisions a regional program with the following aims:

  1. further develop a core organizational infrastructure to support community-based participatory activities and effective partnership between communities, cancer prevention/care delivery system, and research discovery/development system at many levels to increase and sustain delivery of beneficial interventions;
  2. strengthen existing partnerships and create new partnership with communities that suffer cancer health disparities and create opportunities to work with other organizations with an interest in reducing health disparities;
  3. strengthen existing collaborations with Cancer Information Services and establish and formalize collaborations with three additional NCI programs;
  4. increase the utilization of beneficial interventions to reduce cancer health disparities and perform community-based participatory educational activities that reduce cancer health disparities by increasing cancer education and community use of beneficial cancer interventions;
  5. leverage SAICN activities by obtaining funding from various sources for community-based participatory activities. To accomplish these aims and provide direction, synergy, and coordination, four core services will be formed: administration, outreach, research, and training and education, each of which will include a community-based evaluation program.

Kathryn Coe, Principal Investigator
Felicia Hodge, Co- Investigator



Diabetes Evidence-Based Research (Management)

This project was funded via a sole-source contract from the Centers for Disease Control.The goal of project was to produce evident-based manuscripts from a large NINR intervention study among the Winnebago and Sioux tribes on diabetes and associated chronic illnesses.

Felicia Hodge, Principal Investigator


Diabetes Wellness: American Indian Talking Circles

This research study was funded as a Minority Supplement to "Diabetes Wellness: American Indian Talking Circles," from the National Institute of Health, National Institute of Nursing Research (2000-2002). The goal of the project was to design, implement, and evaluate a community-based health care model targeting American Indian adults residing on the reservations in the states of Nebraska and South Dakota. One of the aims of the study was to incorporate culturally appropriate approaches to type 2 diabetes prevention and control.

Talking Circles were utilized to obtain data and as an educational tool. The findings reveal that participants provided a holistic worldview on the topic of diabetes, e.g., how it affected their life as a whole, their self, family, and community, as well as describing the experience of the Talking Circle. This study also revealed that two tribes can effectively participate in a replicable yet culturally specific intervention targeted to improve knowledge and management of type 2 diabetes. Talking Circles are a culturally desirable tool for encouraging people to really talk to each other, listen to each other, and support each other.

Felicia Hodge, Principal Investigator



Native Nutrition Circles

The goal of this program was to assess nutritional deficiencies and improve dietary behavior. The Native Nutritional Circles project utilized the "Talking Circle" as a culturally-appropriate intervention method that included American Indian stories and an educational health curriculum. The target population was American Indian female homemakers at 8 urban and rural clinics in California. The first year of the project focused on the development of educational materials including an instructional video, curriculum, and nutritional guide. In years two and three, the "Talking Circle" intervention was implemented. The last year of the project consisted of data analysis and evaluation of the project.

Felicia Hodge, Principal Investigator



Organ Donation and Transplantation

This project was funded by the University of Minnesota. A workshop on organ donation and transplantation in 2005 among the Sioux and Ojibwe of Northern Plains area resulted in manuscripts on the need for cultural competence in this area.

Felicia Hodge, Principal Investigator


Veterans Disability

This project was funded by UCLA. The aim of the project was to provide analysis of secondary data examining the source, extent and impact of trauma resulting from disabling wounds received by American Indian veterans.

Felicia Hodge, Principal Investigator



Environment Risk Assessment

This project is funded through the University of California, Los Angeles (UCLA) Institute of American Cultures, Research Grant Program in Ethnic Studies. The long-range goal of the project is to reduce the environmental threats (personal and community-wide contaminants) contributing to health disparity issues among a rural American Indian community in California. The two-phases of the project are assessment and research development collaboration. The study is coordinated within a structured approach completed under the following specific aims:

  1. risk assessment of contamination and threats to health through laboratory assays of potential contaminants, and,
  2. development of an action plan addressing environmental contamination reduction thereby reducing health disparities among tribal members.

Felicia Hodge, Principal Investigator


   Obesity and Body Image

This project was funded by UCLA. The long-range goal of the project is to reduce the risk and prevalence of obesity through education and better understanding of the cultural constructs of body image and body health. Body image is an important aspect of weight reduction/loss. Obesity has been identified as a serious problem among American Indians. The project examines the process of body imagery among indigenous populations and reports on body image results of focus groups among indigenous and tribal groups.

The study has the following specific aims:

  1. to assess the risk factors associated with obesity and high weight among adolescents and adult American Indians, and
  2. to better understand the cultural constructs of body image and body health through an inductive process of exploration and fact finding.

Felicia Hodge, Principal Investigator



Wellness Circles

The goal of this five-year project was to design, implement, and evaluate a community-based health care model for American Indian (A/I) families that incorporated culturally appropriate approaches to primary and secondary disease prevention. The project targeted only rural reservation tribal communities. It assessed the impact of culturally relevant health care strategies in terms of participation, timeliness of health-seeking behaviors, frequency of crisis-oriented, care-seeking behavior and appropriateness, and acceptability of care.

Felicia Hodge, Principal Investigator

  Post Traumatic Stress Syndrome

This project is funded through the University of California, Los Angeles (UCLA). The long-range goal of the project is to examine the factors associated with post traumatic stress among American Indian populations.

The study has the following specific aims:

  1. to assess the risk factors associated with post traumatic stress among adolescents and adult American Indians, and
  2. to better understand the cultural constructs of stress through an inductive process of exploration and fact finding.

Felicia Hodge, Principal Investigator

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