A view from inside Arizona and New Mexico Indian country: pursuing a health career path

The stories of individuals working within the health system in Arizona and New Mexico Indian Country were examined to discover interests and needs related to their health career goals and advancement. The aims were: to identify what would be helpful to support educational and career progress; and to determine the barriers to advancement.

Community action research methodology was used. A semi-structured interview schedule administered by two of the investigators made up the qualitative interview portion of a two-part survey research design. This qualitative portion of the larger study is reported. Interviewees were chosen from health workers in Arizona and New Mexico Indian country who returned workplace-distributed questionnaires that indicated they were interested in career advancement. The interviewees were selected to be representative of the occupational background, work site, age, and cultural identity of those who returned the questionnaire. Investigators took notes by hand independently during interviews and reviewed both sets of notes simultaneously; the agreed on responses were entered as text data within 2 hours of the interviews. QRS Nudist software (QRS Software; Melbourne, VIC, Australia) was used to sort interview responses to each question in a successive fashion using a constant comparative method to identify key themes within and across questions.

Twenty-five personal interviews were conducted in community locations convenient to the interviewee between February and April 2003. The duration of the interviews was 30 min and 60 min. Eighty percent of interviewees were American Indian and 80% percent were women. Themes within interviewees' stories regarding barriers to advancement included: 'making ends meet', dealing with the educational system, uncertainty and inflexibility in the current work setting, and not wanting to disadvantage children by their career decision. Themes related to what participants said they needed included 'making sure the bills are paid', making sure their children were not negatively affected by their decision to further their education, and being sure of the worth of further education in the workplace. Several across-interview themes included pursuing many sequential incremental educational and career steps, many interruptions and failed attempts at pursuing advanced education, and informal, verbal information-gathering patterns when seeking career advancement information.

Barriers to career advancement and education arise from multiple sources. Supporting career advancement of community-rooted health workers in Indian Country will require partnership and collaboration across the education, health services, and community sectors. Financial management supports, workplace policies designed to support career-oriented education, consistent and accurate information regarding the educational process, and making courses more accessible will be necessary to support these non-traditional students. Health professions schools should regard their community-based graduates as ambassadors and provide them with ongoing accurate information, because they will be sought after to provide information to others. Innovative programs to assist in loan consolidation and financial management are needed to allow native health workers to be able to provide for their families should they wish to advance their careers. Collaboration across disciplines and programs in the education sector to support a limited set of prerequisite courses would help eliminate unnecessary or redundant courses.