Improving Chronic Illness Management With the Apsaalooke Nation: The Baa Nnilah Project

Experimental: Intervention arm

There are no devices or drugs used in this trial. The treatment is the same for the intervention arm and the wait-list control arm. The treatment is group trial of 7 meetings designed to improve chronic illness self-management. The name of the treatment is baa nnilah.

Behavioral: baa nnilah

7 meetings in the community led by a trained community facilitator

Experimental: Wait-list control arm

There are no devices or drugs used in this trial. The treatment is the same for the intervention arm and the wait-list control arm. The treatment is group trial of 7 meetings designed to improve chronic illness self-management. The name of the treatment is baa nnilah.

Behavioral: baa nnilah

7 meetings in the community led by a trained community facilitator

SF-12 - Physical Health

The SF-12 is a set of 12 questions regarding function in physical and mental health domains. We changed question 2 to encapsulate moderate activities more applicable to our study population. Activities deleted were bowling and playing golf and activities added were carrying a small child, walking for exercise, or round dancing/push dancing (Native American traditional dances). Participants responded to questions about their physical and mental health, especially regarding the degree of limitation experienced, using varying response categories (i.e., 3, 5, or 6-point Likert scale, or yes/no format). A Physical Component Summary (PCS) score and a Mental Component Summary (MCS) score were computed and normalized based on an algorithm developed by Farivar, Cunningham, and Hays (2007), which used an oblique factor solution for item weights. PCS and MCS scores range from 0 to 100, with higher scores indicating better physical and mental health functioning, respectively.

SF-12 - Mental Health

The SF-12 is a set of 12 questions regarding function in physical and mental health domains. We changed question 2 to encapsulate moderate activities more applicable to our study population. Activities deleted were bowling and playing golf and activities added were carrying a small child, walking for exercise, or round dancing/push dancing (Native American traditional dances). Participants responded to questions about their physical and mental health, especially regarding the degree of limitation experienced, using varying response categories (i.e., 3, 5, or 6-point Likert scale, or yes/no format). A Physical Component Summary (PCS) score and a Mental Component Summary (MCS) score were computed and normalized based on an algorithm developed by Farivar, Cunningham, and Hays (2007), which used an oblique factor solution for item weights. PCS and MCS scores range from 0 to 100, with higher scores indicating better physical and mental health functioning, respectively.

Patient Health Questionnaire-9

The PHQ-9 is a widely used instrument to measure symptoms of depression. This set of 9 questions asked participants to respond to statements pertaining to their mental health in the preceding 2 weeks. The score range for the instrument is 0-27, with higher scores correlating with higher levels of symptoms of depression. Additionally, there is 1 question, not scored, rating difficulty of problems.

PROMIS Satisfaction With Social Roles and Activities

Patient Reported Outcome Measurement Information System (PROMIS) measure. This 8-item form was used to assess the participant's satisfaction with and ability to participant in social roles and activities, using a 5-point Likert scale. NIH PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric a score of 40 is one SD lower than the mean of the reference population. A score of 60 is one SD higher than the mean of the reference population. Higher scores equal more of the concept being measured.

PROMIS Self-Efficacy for Managing Symptoms

Patient Reported Outcome Measurement Information System (PROMIS) measure. This 8 item form was used to assess the participant's confidence in their ability to manage symptoms of chronic illness and prevent them from interfering from activities of daily living, using a 5-point Likert scale. NIH PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric a score of 40 is one SD lower than the mean of the reference population. A score of 60 is one SD higher than the mean of the reference population. Higher scores equal more of the concept being measured.

PROMIS Emotional Support

Patient Reported Outcome Measurement Information System (PROMIS) measure. This 8-item form was used to assess the participant's perception of availability of trusted individuals in their life to provide emotional support, using a 5-point Likert scale. NIH PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric a score of 40 is one SD lower than the mean of the reference population. A score of 60 is one SD higher than the mean of the reference population. Higher scores equal more of the concept being measured.

PROMIS Positive Affect and Well-being

Patient Reported Outcome Measurement Information System (PROMIS) measure. This 8-item form was used to assess the participant's recent sense of well-being and agreement with positive outlook and experience of life, using a 5-point Likert scale. NIH PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric a score of 40 is one SD lower than the mean of the reference population. A score of 60 is one SD higher than the mean of the reference population. Higher scores equal more of the concept being measured.

PROMIS Physical Function

Patient Reported Outcome Measurement Information System (PROMIS) measure. This 8 item form was used to assess the function of upper/lower extremities, core, and ability to perform activities of daily living, using a 5-point Likert scale. NIH PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric a score of 40 is one SD lower than the mean of the reference population. A score of 60 is one SD higher than the mean of the reference population. Higher scores equal more of the concept being measured.

PROMIS Self-efficacy for Managing Emotions

Patient Reported Outcome Measurement Information System (PROMIS) measure. This 8 item form was used to assess the participant's current confidence to manage emotional distress and stressful situations core, using a 5-point Likert scale. NIH PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric a score of 40 is one SD lower than the mean of the reference population. A score of 60 is one SD higher than the mean of the reference population. Higher scores equal more of the concept being measured.

PROMIS Self-efficacy for Managing Social Interactions

Patient Reported Outcome Measurement Information System (PROMIS) measure. This 4 item form was used to assess the participant's current confidence in being able to access support in processing emotions and health problems, and obtain assistance with transportation and problem solving, using a 5-point Likert scale. NIH PROMIS measures use a T-score metric in which 50 is the mean of a relevant reference population and 10 is the standard deviation (SD) of that population. On the T-score metric a score of 40 is one SD lower than the mean of the reference population. A score of 60 is one SD higher than the mean of the reference population. Higher scores equal more of the concept being measured.

Patient Activation Measure

PAM assesses self-management related health knowledge, skills, and confidence. Developed by Insignia Health as a 22-item measure and shortened to 13 questions, with the short form validated to assess patient knowledge, skill and confidence for self-management of health conditions. We used the 13-item measure. Insignia Health's proprietary survey scoring algorithm produces a PAM Score along an empirical, interval-level scale from 0-100 with higher scores indicating higher patient activation.

Modified Timed Up and Go

The TUG test is physical test that assists in screening and measurement of balance deficits in older adults, which correlates with increased fall risk, and has been validated across populations. In this physical test, participants sit in a chair with feet flat on the ground and back against the chair. A timer is started as they leave the chair, and continues as they pace 3 meters, execute a 180 degree turn and just as they touch the chair again, the timer is stopped. Due to an error in communication between a consultant who assisted with this measure and the research team, the distance that individuals walked during this test was modified from 3 m to 10 m, therefore prior validation data may not apply.

Modified Balance Error Scoring System

The original Balance Error Scoring System (BESS) involved firm and padded surface balance testing in 3 positions, to assess static balance and was validated across study populations. The mBESS only utilizes firm surface data and demonstrated better intertester reliability and validity. During this physical test, a staff member counts how many times participants help themselves to regain balance in 20 seconds. The mBESS involved 3 positions, depicted below. Participants stood with hands on hips and eyes closed, balancing for 20 s in 3 standing positions: a double-leg stance, a single-leg stance, and tandem stance. Test observers counted up to 10 errors per stance, including opening eyes, taking hands off hips, stepping, putting a hand out to a chair or wall, or making other large corrections, which led to a stance score ranging from 0 to 10 with a maximum total of 30. Participants who could not complete a position for balance reasons, were given a score of 10.

6-minute Walk

Serves as a corollary for physical function and cardiovascular performance.Participants walked at a comfortable pace for six minutes and their distance was recorded in feet.