Working with tribal populations to increase access to health information
Abstract
Improving health information access to tribal groups takes knowledge, understanding and awareness of cultural differences. The National Network of Libraries of Medicine (NN/LM) has been serving tribal populations since 1997. In this effective practice, the NN/LM staff, along with medical librarians in the Four Corners area, share "lessons learned" in working with Native American tribes. Claire Hamasu submitted this effective practice in January 2004.Issue
Working with Native American populations to improve health information access can be challenging because of cultural differences and geographical obstacles.Action
According to the National Network of Libraries of Medicine (NN/LM), lessons learned from service with tribal groups include the following:
1. Access to health information should be considered in context.- Tribal staff has pressing priorities and are very busy.
- Given lack of health services and limited resources, it is sometimes hard for tribal populations to see health information as a priority.
2. Do not assume that Internet access is pervasive.
3. Become knowledgeable about salient health issues and the use of health information in the community.- Learn from local health care providers what a community's needs are for communication/information tools.
- The best training occurs when the training coordinators meet with the community to discuss training needed and how it can be tailored to meet the community's needs.
- There are few culturally appropriate materials for Native Americans and even fewer tribal-specific materials.
- Indian Health Services (IHS) materials tend to be too generic.
- Materials developed by the tribe and in its own language are more useful than generic materials.
- Start with a specific health information goal - health information access is too general to explain without a specific information need.
- Partnerships should evolve naturally, rather than program staff trying to impose a service.
- Be willing to take the time to get to know people - personal contacts are very helpful when developing tribal relationships.
- It takes time to build rapport and trust - a one-year project is too short a time period to accomplish this goal.
- Working with tribal communities is intense and difficult to do from a distance - ideally the librarian lives nearby to participate in tribal events and appreciate tribal customs.
- Consider options for continuing projects, as relationship building is important and not always transferable to others.
- Know who the decision-makers are, and as much as possible about the local health care institutions.
- Conferences provide an opportunity to make contacts and maintain communication.
- Working through tribal leaders can be slow work.
- Time does not have the same urgency in Indian Country as it does in the academic environment.
- Factor in a very long lead-time when planning because it can take much longer than expected to get responses to email, mail, telephone and fax correspondence.
- Meeting times and subject matter often change due to personal or tribal needs.
- Once is not enough when inviting tribal health leaders to a workshop - issue multiple invitations and follow up. Remain persistent and constant in contacts with tribal health leaders; multiple invitations and follow-up to workshops demonstrate commitment.
- There are real differences in Indian Health Service clinics and tribal community health departments.
- Trainers need to be flexible and knowledgeable to tailor their courses to Native American populations.
- It helps to have a librarian who culturally sensitive and understands the community s/he is working with.
- Be willing to introduce yourself by talking about your heritage and family, not just your job.
- Do not be overly dependent on class participation when teaching because Native Americans can often be quiet in classes.
- Choose relevant illustrations - for example, introducing the Web by showing sites that American Indians would be interested in.
- Develop training to meet informational needs and collaborate with tribal entities to make training culturally relevant.
- Start large meetings with a blessing as long as participants are comfortable and an appropriate person leads it.
Context
The mission of the National Network of Libraries of Medicine (NN/LM) is to advance the progress of medicine and improve public health by: 1) providing all U.S. health professionals with equal access to biomedical information; and, 2) improving the public's access to information to enable them to make informed decisions about their health. The program is coordinated by the National Library of Medicine and carried out through a nationwide network of health science libraries and information centers.
The National Library of Medicine (NLM), located in Bethesda, Maryland, is the world's largest repository of biomedical health sciences information, and has eight regional offices that house medical libraries. These Regional Medical Libraries have worked with tribal groups since about 1997.
In 2003, medical librarians in the Four Corners area came together to discuss what they have learned over the past six years in working with different tribal groups, as they were beginning to see similarities that could assist others who were doing comparable outreach. According to one Associate Director of NN/LM, "These were lessons that we needed to learn in order to have effective communication. Over time these lessons were reaffirmed through a number of projects."
Major funding for this work comes from the National Library of Medicine and the Bill & Melinda Gates Foundation.
Outcome
These practices were developed from work with Native American Tribes in the Pacific Northwest and the Four Corners area through outreach projects conducted by the National Network of Libraries of Medicine and state university Health Sciences Libraries in each of the Four Corner states. These lessons will help librarians to partner with Native American populations.Posted On
April 8, 2004For More Information