The research that underlies evidence-based practices is often based on relatively homogenous study samples, thus limiting our ability to understand how the study findings apply in new situations as well as our understanding of what might need to be adapted. In a preliminary effort to address those gaps, the requirements for the Tribal Maternal Infant and Early Childhood Home Visiting Program (MIECHV) included the expectation that grantees design and implement rigorous evaluations to address local priorities and to help build the knowledge base regarding the use of evidence-based home-visiting programs in tribal communities. A priority that emerged across many Tribal MIECHV grantees was to determine the added benefit of the cultural adaptations that they were making to their home-visiting programs. While there is literature to describe recommended processes for making cultural adaptations to evidence-based programs themselves, there are very few guidelines for evaluating these adaptations. In this article, we review the varied evaluation approaches utilized by Tribal MIECHV grantees and provide three case examples of how evaluators and tribal communities worked together to articulate evaluation questions and choose appropriate and feasible evaluation designs. The lessons derived from these Tribal MIECHV evaluation experiences have implications for the role of the evaluator in diverse communities across the country evaluating home visiting and other evidence-based practices in settings characterized by unique cultural contexts.
CONTEXTUAL ISSUES FOR IMPLEMENTATION AND EVALUATION OF HOME-VISITATION PROGRAMS FOR AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES: AN INTRODUCTION TO THE TRIBAL MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM.
Home-visiting programs have become a key component of evidence-based services for pregnant women, new mothers, their infants, and their families. When Congress authorized the Maternal Infant and Early Childhood Home Visiting Program (MIECHV) in 2010, it set aside 3% of the $1.5 billion in funding to support home-visiting programs operated by tribes, Tribal MIECHV programs have been funded in 14 states and have served over 3,100 families, providing nearly 55,000 home visits to families at risk for poor child, maternal, and family outcomes. In this Introduction to the Special Issue of the Infant Mental Health Journal on the Tribal MIECHV initiative, we provide some key contexts of the work of the Tribal MIECHV grantees as well as an overview of the issues covered in the other articles.
Despite a growing body of critical scholarship in nursing, the concept of culture continues to be applied in ways that diminish the significance of power relations and structural constraints on health and health care. In this paper, we take a critical look at how assumptions and ideas underpinning conceptualizations of culture and cultural sensitivity can influence nurses' perceptions of Aboriginal peoples and Aboriginal health. Drawing on examples from our research, we examine how popularized assumptions about culture can shape nurses' views of Aboriginal patients. These assumptions and perceptions require closer scrutiny because of their potential to influence nurses' practice with Aboriginal patients. Our specific aims are to: (a) consider some of the limitations of cultural sensitivity in relation to health care involving Aboriginal peoples; (b) explore how ideas about culture have the potential to become problematic in nursing practice with Aboriginal peoples; and (c) explore the relevance of a 'critical cultural approach' in extending our understanding of culture in relation to Aboriginal peoples' health. We discuss a critical cultural perspective as one way of broadening nurses' understandings about the complexities of culture and the many facets of culture that require critical consideration. In relation to Aboriginal health, this will require nurses to develop greater critical awareness of culture as a relational process, and as necessarily influenced by issues of racism, colonialism, historical circumstances, and the current political climate in which we live.
Indigenous knowledge (IK) has the potential to complement the dominant epistemologies central to nursing curricula. Acknowledging IK as a thriving set of worldviews, we discuss how nursing educators might access and integrate IK in ways that are respectful and sustainable. IK is highlighted as an entry point for understanding concepts such as cultural safety, ethical space, and relational practice and as a strength-based approach to learning about Aboriginal people's health. As with any use of knowledge, consideration must be given to issues of ownership, misappropriation, institutional responsibility, Indigenous protocol, and the creation of partnerships. Recommendations are provided for educators wishing to explore how to incorporate IK into nursing curriculum. With appropriate partnerships, protocols, and processes in place, the incorporation of IK may provide educators and students an opportunity to explore divergent epistemologies, philosophies, and worldviews, thereby encouraging broader perspectives about the world, ways of being, various types of knowledge, and nursing care.
Single-case designs are typically used in classroom and clinical settings to assess the behavioral impacts of an intervention with an individual child. Using two illustrative case studies, this article describes the extension of this model to home-visitation programs serving tribal communities and examines the lessons learned throughout the process of adapting this approach. Our experience suggests that the benefits of using this design outweigh the associated challenges and allows researchers to expand the use of single-case designs to previously unexplored settings. Specifically, some of the benefits discussed include allowing for evaluative rigor in contexts with small samples, allowing everyone who qualifies to immediately participate, providing visual representations of the outcome-making the results more tangible and accessible to a broader audience, and allowing for a deep level of cultural sensitivity. The article also provides some general guidelines to address the practical challenges one may face when attempting to use single-case designs in novel ways within nonschool settings.