Researchers from the University of Wisconsin School of Medicine and Public Health recently had their study on methods of stroke prevention in the Wisconsin Native American population published. This study can help researchers determine which stroke factors are prevalent in Wisconsin Native American populations and examine how education and wellness coaching at both community and individual levels affect the risk factors present in the community.
According to the study, titled “Methods in Stroke Prevention in the Wisconsin Native American Population,” researchers took different levels of measurements — health assessments, cognitive testing battery, detailed coaching program and clinical ultrasound for carotid arteries — to address stroke prevention. Carotid arteries are the blood vessels found on the neck that supply blood to the brain.
This study was possible through the support of different partnerships, especially through the Wisconsin Partnership Program. The initial stages of the study included 120 voluntary participants and focused on people ages 55 and older. But in the future, researchers hope they can expand the scope by adding different age groups, co-author and UW fourth-year medical student Hannah Cress said. With the variety in age groups, researchers can observe how interventions differ between age groups.
UW Native American Center for Health Professions assistant director Melissa Metoxen said the study looked specifically at the Oneida Nation, which is located near Green Bay, Wisconsin. The Oneida Nation has a population of approximately 1,700 people, and is one of the 11 federally recognized tribes in Wisconsin, Metoxen said.
Cress said her search for ways to connect with her heritage as a Native American led her to pursue this research.
One of the variables the research team looked at in this study was plaque instability, Cress said. Plaque, in this case, refers to the stiffening of the vessel and lipid deposits in the carotid artery. The instability in plaque can cause microvascular damage in the brain, leading to stroke-like symptoms.
Cress said other measurements the researchers looked at included cholesterol levels, blood biomarkers and blood pressure. These are variables that provide robust evidence of the contribution of plaque formation and stiffening of the arteries in Native American communities.
“One of the challenges when carrying this project is the idea to offer knowledge and expertise on stroke risk factors, but doing it in a culturally sensitive way,” Cress said.
The study employed a wellness coach who works at the Oneida Nation Health Center, Cress said. The research team who was in charge of the medical screenings like ultrasounds, enrollments and health screenings were in and out of the community often. But the wellness coach was a constant contact for the community, which provided the opportunity to gain trust and build relationships with the community.
Metoxen said she is a member of the Oneida Nation and works at the Tribal Engagement Office located in the Community Health Center. There, Metoxen’s role is to advocate for the improvement of the health and wellness of the tribal communities and support Native American students who want to pursue health-related professional programs in higher education.
Metoxen said she also played a role in assisting in the partnership between the university research team and the tribal community. Before any stroke prevention research could be conducted, a series of meetings had to occur to discuss the research and certain protocols had to be followed when working with tribal communities. Since Native American tribes are sovereign nations, any university faculty member or research team must receive approval via a vote before they develop a research study.
“Whoever is doing research, whether that’s faculty or institutions or whatever it may be, [they must] recognize the sovereignty of our tribal nations and [acknowledge and respect] the process that goes into that,” Metoxen said.
Metoxen said building a trusting relationship between the faculty members and the community is critical. Especially since the faculty members must be willing to understand, acknowledge, listen and respect what tribe leaders decide, as they decide what is acceptable in the community.
According to Metoxen, the community can benefit from prevention programs, but the community often only reaps benefits if involved organizations first establish a trustworthy partnership with it. In this case, the stroke risk factors study of Wisconsin Native Americans had more willing participants join the study because they understood health benefits through other lenses and trusted the researchers to help find ways to decrease stroke risk in the community.
Cress said other studies that had interventions with the Native American population are very limited. Her research team used the National Institute of Health Strong Heart Study as a model. This model study researched cardiovascular health in multiple Native American tribes through the University of Oklahoma. Since it is a model study, researchers can use it as a reference to further conduct research with Native American populations.
“Relationship was extremely, extremely important, and continuing to maintain that balance is probably the most important objective of the whole study, data aside,” Cress said. “Having this relationship and being a listener before we are problem solvers is really important. And involving the elderly very early on was really important.”
