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A Framework for Culturally Relevant Online Learning: Lessons from Alaska’s Tribal Health Workers

Abstract

Culturally relevant health promotion is an opportunity to reduce health inequities in diseases with modifiable risks, such as cancer. Alaska Native people bear a disproportionate cancer burden, and Alaska’s rural tribal health workers consequently requested cancer education accessible online. In response, the Alaska Native Tribal Health Consortium cancer education team sought to create a framework for culturally relevant online learning to inform the creation of distance-delivered cancer education. Guided by the principles of community-based participatory action research and grounded in empowerment theory, the project team conducted a focus group with 10 Alaska Native education experts, 12 culturally diverse key informant interviews, a key stakeholder survey of 62 Alaska Native tribal health workers and their instructors/supervisors, and a literature review on distance-delivered education with Alaska Native or American Indian people. Qualitative findings were analyzed in Atlas.ti, with common themes presented in this article as a framework for culturally relevant online education. This proposed framework includes four principles: collaborative development, interactive content delivery, contextualizing learning, and creating connection. As an Alaskan tribal health worker shared “we’re all in this together. All about conversations, relationships. Always learn from you/with you, together what we know and understand from the center of our experience, our ways of knowing, being, caring.” The proposed framework has been applied to support cancer education and promote cancer control with Alaska Native people and has motivated health behavior change to reduce cancer risk. This framework may be adaptable to other populations to guide effective and culturally relevant online interventions.

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References

  1. 1.

    CDC/National Center for Health Statistics (2017) FastStats. In: Deaths Mortal. https://www.cdc.gov/nchs/fastats/deaths.htm. Accessed 9 Jun 2017

  2. 2.

    National Center for Chronic Disease Prevention and Health Promotion (2016) Chronic disease overview. https://www.cdc.gov/chronicdisease/overview/#ref2

  3. 3.

    Crook ED, Peters M (2008) Health disparities in chronic diseases: where the money is. Am J Med Sci 335:266–270

  4. 4.

    Institute of Medicine (US) Committee on Communication for Behavior Change in the 21st Century: Improving the Health of Diverse Populations (2002) Speaking of health: assessing health communication strategies for diverse populations. National Academies Press (US), Washington (DC)

  5. 5.

    Kelly JJ, Schade TL, Starkey BM, et al (2012) Cancer in Alaska Native People: 1969–2008: 40-year report. Alaska Native Tribal Health Consortium, Office of Community Health Services

  6. 6.

    Carmack AM, Schade TL, Sallison I, et al (2015) Cancer in Alaska Native people: 1969–2013, the 45 year report. Alaska Native Tumor Registry, Alaska Native Epidemiology Center, Alaska Native Tribal Health Consortium

  7. 7.

    Alaska Department of Health and Social Services Alaska’s Behavioral Risk Factors Surveillance System - Query Module. http://ibis.dhss.alaska.gov/query/result/BRFSS23/BRFSS_S/X5ADAY.html. Accessed 16 Jan 2018

  8. 8.

    Centers for Disease Control and Prevention (2017) Behavioral Risk Factor Surveillance System: Prevalence & Trends Data. https://www.cdc.gov/brfss/brfssprevalence/index.html. Accessed 5 May 2017

  9. 9.

    Alaska CHAP (2017) Alaska Community Health Aides - About CHAP. http://www.akchap.org/html/about-chap.html. Accessed 5 May 2017

  10. 10.

    Lengdorfer, Heidi, Topol, Rebecca, Raines, Richard (2017) Leading causes of death in Alaska, 2015. Health Analytics Unit of the Alaska Health Analytics and Vital Records Section

  11. 11.

    Cueva M, Lanier AP, Kuhnley R, Dignan M (2008) Cancer education: a catalyst for dialogue and action. IHS Prim Care Provid 33(1):1–5.

  12. 12.

    Cueva M, Kuhnley R, Cueva K (2012) Enhancing cancer education through the arts: building connections with Alaska Native people, cultures and communities. Int J Lifelong Educ 31:341–357

  13. 13.

    Wallerstein N, Bernstein E (1988) Empowerment education: Freire’s ideas adapted to health education. Health Educ Q 15:379–394

  14. 14.

    Israel BA, Schulz AJ, Parker EA, Becker AB, Allen A, Guzman JR (2008) Critical issues in developing and following community-based participatory research principles. In: Minkler M, Wallerstein N (eds) Community-based participatory research for health. Jossey-Bass, San Francisco, pp 56–73

  15. 15.

    Cajete G (1994) Look to the mountain: an ecology of indigenous education. Kivaki Press, Durango

  16. 16.

    Prussing E (2014) Historical trauma: politics of a conceptual framework. Transcult Psychiatry 51:436–458. https://doi.org/10.1177/1363461514531316

  17. 17.

    Chavez V, Minkler M, Wallerstein N, Spencer M (2010) Community organizing for health and social justice. In: Cohen L, Chavez V, Chehimi S (eds) Prevention is primary: strategies for community well-being. Jossey-Bass, San Francisco, pp 87–112

  18. 18.

    Perkins DD, Zimmerman MA (1995) Empowerment theory, research, and application. Am J Community Psychol 23:569–579

  19. 19.

    Zimmerman MA (1995) Psychological empowerment: issues and illustrations. Am J Community Psychol 23:581–599. https://doi.org/10.1007/BF02506983

  20. 20.

    Cueva K, Revels L, Kuhnley R, Cueva M, Lanier A, Dignan M (2015) Co-creating a culturally responsive distance education cancer course with, and for, Alaska’s community health workers: motivations from a survey of key stakeholders. J Cancer Educ 32:426–431. https://doi.org/10.1007/s13187-015-0961-6

  21. 21.

    Case S, Jernigan V, Gardner A, et al (2009) Content and frequency of writing on diabetes bulletin boards: Does race make a difference? J Med Internet Res 11. https://doi.org/10.2196/jmir.1153

  22. 22.

    Chavez AF, Ke F, Herrera FA (2012) Clan, sage, and sky: Indigenous, Hispano, and Mestizo narratives of learning in New Mexico Context. Am Educ Res J 49:775–806. https://doi.org/10.3102/0002831212441498

  23. 23.

    Cueva M, Dignan M, Lanier A, Kuhnley R (2014) Qualitative evaluation of a colorectal cancer education CD-ROM for Community Health Aides/practitioners in Alaska. J Cancer Educ 29:613–618. https://doi.org/10.1007/s13187-013-0590-x

  24. 24.

    Doorenbos AZ, Demiris G, Towle C, et al (2011) Developing the native people for cancer control telehealth network. Telemed J E-Health 17:30–34. https://doi.org/10.1089/tmj.2010.0101

  25. 25.

    Locatis C, Gaines C, Liu W-L, Gill M (2009) Extending a blended education program to native American high school students in Alaska. J Vis Commun Med 32:8–13. https://doi.org/10.1080/17453050902821181

  26. 26.

    Galloway JM (2007) Pathways into health: Health professions education for American Indian and Alaska natives utilizing distance learning, interprofessional education, and cultural integration. J Interprof Care 21:3–4. https://doi.org/10.1080/13561820701634235

  27. 27.

    Hites LS, Granillo BS, Garrison ER, Cimetta AD, Serafin VJ, Renger RF, Wakelee JF, Burgess JL (2012) Emergency preparedness training of tribal community health representatives. J Immigr Minor Health 14:323–329. https://doi.org/10.1007/s10903-011-9438-9

  28. 28.

    Sanchez I, Gunawardena C (1998) Understanding and supporting the culturally diverse distance learner. In: Gibson CC (ed) Distance learners in higher education. Atwood Publishing, Madison

  29. 29.

    McLoughlin C (2000) Cultural Maintenance, Ownership, and Multiple Perspectives: features of Web-based delivery to promote equity. J Educ Media 25(3):229–241

  30. 30.

    Cueva K, Revels L, Cueva M, Lanier AP, Dignan M, Viswanath K, Fung TT, Geller AC (2017) Culturally-relevant online cancer education modules empower Alaska’s community health aides/practitioners to disseminate cancer information and reduce cancer risk. J Cancer Educ. https://doi.org/10.1007/s13187-017-1217-4

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Acknowledgements

This work is part of “Distance Education to Engage Alaskan Community Health Aides in Cancer Control,” supported by the National Cancer Institute of the National Institutes of Health (NIH), award R25CA186882. Theoretical understandings and manuscript preparation and submission were supported by NIH grant 3R25CA057711. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the views of the NIH.

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Correspondence to Katie Cueva.

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Cueva, K., Cueva, M., Revels, L. et al. A Framework for Culturally Relevant Online Learning: Lessons from Alaska’s Tribal Health Workers. J Canc Educ 34, 647–653 (2019). https://doi.org/10.1007/s13187-018-1350-8

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Keywords

  • Community-based participatory action research
  • Community health workers
  • Alaska Native
  • Health disparities
  • Program planning
  • Online learning
  • Health promotion