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The Role of Alaska’s Tribal Health Workers in Supporting Families

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Abstract

Alaska’s Community Health Aides/Practitioners (CHA/Ps) are often the sole medical workers in their communities in rural Alaska, and are instrumental in providing healthcare services and education to otherwise underserved individuals. This qualitative study explored how CHA/Ps support healthy families. Six CHA/Ps from two rural communities in western Alaska were interviewed about their scope of practice, interactions with mothers, infants, families, and teens, relationship to other medical providers, and perceptions of their work. Using grounded theory, verbatim notes were analyzed in Dedoose software and coded by thematic and structural components. Interviewed CHA/Ps shared how the CHA/P program is a culturally relevant way to deliver healthcare, and talked about the challenges of the work, rewards, and suggestions for improvement. CHA/Ps described their unique role as the on-the-ground health and wellness resource in their communities, and talked about consulting with other medical professionals to provide better care for individuals in rural Alaska. CHA/Ps described that they provided prenatal care, patient education during pregnancy, emergency delivery services when necessary, well-child visits, and outreach to teens to give fluoride rinses, vaccinations, and education about issues such as sexual health and drugs/alcohol. CHA/Ps also talked about patient education as a primary responsibility, which also reduced patient load and prevented burn-out. The CHA/P program is a comprehensive and innovative approach to providing healthcare education and services that promotes healthy communities, including positive parent-infant interactions, child wellness, and teen decision-making. The program is a healthcare delivery model translatable to other tribal and limited-resource contexts.

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Abbreviations

CHAP:

Community Health Aide Program in Alaska

CHA/Ps:

Community Health Aides and Community Health Practitioners, who are the primary care providers in rural Alaska

CHAM:

Community Health Aide/Practitioner Manual

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Acknowledgements

We would like to acknowledge the Bristol Bay Area Health Corporation (BBAHC) for their cooperation, help in reaching out to study participants and advice throughout implementation of our project. We especially would like to acknowledge Lorraine Jewett, Rebecca Bouker and Carol Odinzoff for responding to our initial project questions and for connecting us to the appropriate Alaska Area Institutional Review Board (AAIRB) and BBAHC staff. Bonnie Green, Starla Fox and Nathalie Dull helped steer our project through the BBAHC Research and Ethics Committee review process and put us in touch with the Alaska Community Health Aide Program (CHAP) Field Coordinators, Sophie Noden and Marie Paul, who answered all our questions and were instrumental in referring us to potential study participants. We would also like to thank Professors Julie Boatright Wilson and Dennis Keith Norman of the Harvard Kennedy School of Government for help in conceptualizing the project and providing feedback and advice during implementation and writing. We would like to thank Tanya Jones for her advice in preparing our manuscript for publication. We would also like to graciously thank our study participants, who made time during their busy workdays to share their experiences and viewpoints with us. And, finally, we would like to acknowledge Professor Todd Radenbaugh at the University of Alaska Fairbanks, Bristol Bay campus and Michele Masely who introduced co-author Chernoff to the Bristol Bay region of Alaska and the richness of its people and communities.

Author Contributions

MC conceptualized and designed the study, conducted the interviews and preliminary data analysis, drafted the initial manuscript, and approved the final manuscript as submitted. KC contributed to the data analysis, reviewed and revised the manuscript, and approved the final manuscript as submitted.

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Correspondence to Miriam Chernoff.

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The authors declare that they have no conflict of interest relevant to this article to disclose.

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The authors have no financial relationships relevant to this article to disclose.

Informed Consent

Informed consent was obtained from study participants through reading a script over the telephone prior to the start of the interview. This procedure was approved by both the Alaska Area Institutional Review Board and the Bristol Bay Area Health Corporation’s Research and Ethics Committee.

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Chernoff, M., Cueva, K. The Role of Alaska’s Tribal Health Workers in Supporting Families. J Community Health 42, 1020–1026 (2017). https://doi.org/10.1007/s10900-017-0349-0

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