Wendy F. Mencer’s Dissertation Proposal Defense

Sustainable Health Provider OUD Assessment and Management in Rural AI/AN Communities: Prevention, Treatment, and Recovery approaches.

The United States is in the grip of an Opioid use disorder pandemic, demanding responsive healthcare services. Native Americans (NA) have experienced the most significant increases in OUDs. Opioid-related overdose mortality rates than any other population group in the country (Joshi et al., 2018) and are twice as likely to face unmet treatment needs than the US general population (Chartier & Caetano, 2010), indicating that NA experience a greater burden and present the greatest need for SUD/OUD treatment (Gryczynski & Johnson, 2011). In seeking healthcare services, NAs who live in rural areas and on reservations may experience a lack of cultural safety and security, which would harm their recovery from OUD for many NAs (Skewes & Blume, 2019).

In the context of healthcare provision, cultural safety refers to a basic understanding of patient-centered care, including the factors that threaten or disempowers the cultural identity and well-being of individuals from diverse backgrounds. By showing respect, recognition, and acceptance, helps to ensure that culture-based behaviors are not threatened. Cultural safety includes understanding that wrongful healthcare practices affect the individual, the family, and the community (Ramsden, 1993). Cultural security goes beyond personal change to include change on a systemic level which attempts to incorporate wider diversity. Cultural security is a commitment to the principle that the nature and processes of health services in the healthcare system will not compromise the cultural rights, values, and expectations of minority culture customs (Gubhaju et al., 2020). The perspectives of healthcare providers are critical to developing effective implementation strategies for SUD.

Knowledge of substance use can and often does affect their diagnoses, prescribing decisions, and care plans (McNeely et al., 2018). SUDs are greatly under-treated in the specialty addiction treatment system and under-recognized in medical settings (Rehm et al., 2016). Many of the barriers in SUD treatment, prevention, and recovery exists at the healthcare provider level, including lack of education and financial reimbursement, fear of losing patients, current workload, lack of time, lack of preventive services necessary, availability and lack of knowledge, slow adaptation to evidenced-based treatments, and not core to the job description (Anderson et al., 2014; Roche & Freeman, 2004; Saunders et al., 2019). The lack of trained healthcare service providers is a major barrier to OUD management in general but much more so with rural communities (Lister et al., 2020). Therefore, we need to understand where this lack of training exists to provide the necessary interventions to correct it.

Dissertation Chair: Dr. Elias Mpofu

Committee Members: Dr. Denise Catalano, Dr. Stan Ingman, Dr. Gayle Prybutok

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Tuesday, December 07, 2021 - 10:00am to 11:00am
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