Addressing Public Health in Indian Country
Introduction Storytelling is an important aspect of Indigenous evaluation. Stories “support the interpretation of the data” and stories are a traditional way of sharing what does and does not work (Tribal Evaluation Workgroup, 2013, p. 2). Stories allow participants to provide context to their experience. By incorporating stories into evaluation, participants are able to reflect on the relationship of activities to the anticipated outcomes or goals of their work (LaFrance and Nichols, 2009). The Tribal Epidemiology Centers (TECs) and the Network Coordinating Center (NCC) participate annually in a photo narrative project (a process similar to PhotoVoice). A brief narrative and 1-2 photos are submitted in response to the five Tribal Epidemiology Center Public Health Infrastructure (TECPHI) Program evaluation questions. The photo narratives are visualizations of TEC and NCC experiences in changes of capacity, infrastructure, and sustainability. They help “fill gaps” and provide context to performance measure data. ___________________________________________________________
Year 3 saw enormous advances for TECs and all TECs made significant progress in answering the TECPHI Program evaluation questions. TECs have increased their ability to collect and monitor data with continued growth of TEC staff and amplified knowledge through a variety of trainings. Diverse partnerships, both internally and externally, were established even while navigating the challenges of working virtually through a variety of platforms. The TECs were able to access more and better quality data to support health prioritization decision-making for T/TO/UIOs and COVID-19 response efforts. The TECs leveraged communication and marketing strategies to expand the reach of health related data and information and hugely increased production of communication materials to share with Tribal partners. The TECs continued to refine processes to deliver exemplary technical assistance and customer service. And finally, the TECs were nimble and flexible, and quickly able to expand skills to meet the immediate needs of their T/TO/UIOs during COVID-19 pandemic, further illustrating an answer to the question “What can TECs do now that they could not do before?” Special thanks to the Urban Indian Health Institute for their insight and advice. The TECPHI Program photo narrative project was inspired by the community participatory evaluation approach used with their awardees. ___________________________________________________________
References LaFrance, J., & Nichols, R. (2009). Indigenous evaluation framework: Telling our story in our place and time. Alexandria, VA: American Indian Higher Education Consortium (AIHEC). Tribal Evaluation Workgroup. (2013). A Roadmap for Collaborative and Effective Evaluation in Tribal Communities. Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services.
Evaluation Questions One overarching and four specific evaluation questions have been used to guide the TECPHI Program’s progress. The overarching evaluation question highlights the TECPHI Program’s main purpose – to increase capacity and strengthen infrastructure and sustainability of TECs: Overarching Question What can TECs do now that they were not able to do before TECPHI funding?
Evaluation Questions One overarching and four specific evaluation questions have been used to guide the TECPHI Program’s progress. The overarching evaluation question highlights the TECPHI Program’s main purpose – to increase capacity and strengthen infrastructure and sustainability of TECs: Overarching Question What can TECs do now that they were not able to do before TECPHI funding? EQ1 – Awareness To what extent has awareness of the services and expertise offered by TECs increased as a result of TECPHI activities?
Evaluation Questions One overarching and four specific evaluation questions have been used to guide the TECPHI Program’s progress. The overarching evaluation question highlights the TECPHI Program’s main purpose – to increase capacity and strengthen infrastructure and sustainability of TECs: Overarching Question What can TECs do now that they were not able to do before TECPHI funding? EQ1 – Awareness To what extent has awareness of the services and expertise offered by TECs increased as a result of TECPHI activities? EQ2 – Capacity To what extent has the capacity of TECs to collect and monitor data on health status of Tribal populations increased as a result of TECPHI funding?
Evaluation Questions One overarching and four specific evaluation questions have been used to guide the TECPHI Program’s progress. The overarching evaluation question highlights the TECPHI Program’s main purpose – to increase capacity and strengthen infrastructure and sustainability of TECs: Overarching Question What can TECs do now that they were not able to do before TECPHI funding? EQ1 – Awareness To what extent has awareness of the services and expertise offered by TECs increased as a result of TECPHI activities? EQ2 – Capacity To what extent has the capacity of TECs to collect and monitor data on health status of Tribal populations increased as a result of TECPHI funding? EQ3 – Technical Assistance To what extent has technical assistance been delivered by TECs to Area partners and organizations to develop capacity in the use of data for surveillance and epidemiology and health priority setting as a result of TECPHI funding?
Evaluation Questions One overarching and four specific evaluation questions have been used to guide the TECPHI Program’s progress. The overarching evaluation question highlights the TECPHI Program’s main purpose – to increase capacity and strengthen infrastructure and sustainability of TECs: Overarching Question What can TECs do now that they were not able to do before TECPHI funding? EQ1 – Awareness To what extent has awareness of the services and expertise offered by TECs increased as a result of TECPHI activities? EQ2 – Capacity To what extent has the capacity of TECs to collect and monitor data on health status of Tribal populations increased as a result of TECPHI funding? EQ3 – Technical Assistance To what extent has technical assistance been delivered by TECs to Area partners and organizations to develop capacity in the use of data for surveillance and epidemiology and health priority setting as a result of TECPHI funding? EQ4 – Partnerships To what extent have partnerships between TECs and Area partners and organizations been enhanced or established as a result of TECPHI funding?
Overarching Question What can TECs do now that they were not able to do before TECPHI funding?
Thanks to TECPHI funding, the Alaska Native EpiCenter was able to use infrastructure built in the first two years of TECPHI to stay connected virtually when the COVID-19 global pandemic forced the entire department to work from home. Thanks to TECPHI, we already had tools like Zoom, Slack, and Trello in place to efficiently and effectively shift our work virtually. The infrastructure we built over the past few years allowed us to connect and share information no matter where we work.
Photo Narrative – Year 3
EQ1 – AWARENESS To what extent has awareness of the services and expertise offered by TECs increased as a result of TECPHI activities?
Alaska Native EpiCenter staff continue to participate in Alaska’s State Health Improvement Plan, Healthy Alaskans 2030 (HA 2030). TECPHI Year 3 coincided with the first official year of the HA2030 initiative. Participating from HA2030’s beginning allowed TECPHI staff to expand the data and evaluation services offered to this important partnership between the Alaska Native Tribal Health Consortium and the State of Alaska. These expanded services and expertise mean HA2030 will now have an evaluation for the first time, giving the initiative the opportunity over the next ten years to continually receive feedback to help improve the health and well-being of all Alaskans.
Photo Narrative – Year 3
EQ2 – CAPACITY To what extent has the capacity of TECs to collect and monitor data on health status of Tribal populations increased as a result of TECPHI funding?
In TECPHI Year 3, the Alaska Native EpiCenter worked collaboratively with ANTHC’s Injury Prevention program to produce the Alaska Native Injury Atlas - 3rd Edition. Thanks to TECPHI, this report utilized data resources not previously available. This resulted in a more robust report that provided greater depth and detail than earlier editions.
Photo Narrative – Year 3
EQ3 – TECHNICAL ASSISTANCE To what extent has technical assistance been delivered by TECs to Area partners and organizations to develop capacity in the use of data for surveillance and epidemiology and health priority setting as a result of TECPHI funding?
In TECPHI Year 3, Alaska Native EpiCenter continued its partnership with ANTHC’s Dental Health Aide Therapy (DHAT) program. For each year of TECPHI, EpiCenter staff have provided introductory public health, epidemiology, and evaluation training to DHAT cohorts. This year, due to the COVID-19 global pandemic, the training successfully pivoted last minute from in-person to virtual with zero issues. Moving the training successfully to a virtual setting was only possible because of the strong partnership built in TECPHI’s first years.
Photo Narrative – Year 3
EQ4 – PARTNERSHIPS To what extent have partnerships between TECs and Area partners and organizations been enhanced or established as a result of TECPHI funding?
The Alaska Native EpiCenter continues to focus on enhancing its relationships with key stakeholders from its Scientific Advisory Council (SAC). Thanks to the partnerships we have built with SAC members over the years, when the COVID-19 global pandemic occurred, we were still able to collect valuable feedback from our SAC stakeholders by conducting phone interviews and completing an interview summary report for internal department use. While we typically hold an annual in-person SAC meeting, EpiCenter staff noted how the report collected additional background information typically not collected during the in-person meetings. Programs stated the information in the report would be useful in enhancing our partnerships with Tribal and non-Tribal organizations.
Photo Narrative – Year 3