Adaptations of an RCT during COVID: Case Study in one Rural American Indian Community

Area of Science:

• Public Health
• Health Disparities
• Indigenous Health

Background:

• COVID-19 disproportionately impacts American Indian and Alaska Native (AI/AN) communities due to health disparities and social determinants.
• Tribal nations implemented strict policies (travel restrictions, lockdowns) to mitigate COVID-19 spread, affecting community programs and research.
• The Native CHOICES project, a trial for preventing alcohol-exposed pregnancies in an AI/AN community, faced challenges due to in-person intervention delivery being impossible.

Purpose of the Study:

• To describe the adaptation process of the Native CHOICES intervention during the COVID-19 pandemic.
• To provide recommendations for future public health programs operating in resource-limited settings during crises.
• To highlight the importance of community input in modifying health interventions.

Main Methods:

• The study team collaborated with the Community Advisory Board (CAB) and community staff.
• Input was used to adapt the in-person motivational interviewing intervention to a feasible and acceptable format.
• The adapted intervention respected tribal COVID-19 restrictions, likely involving remote or modified delivery.

Main Results:

• The Native CHOICES intervention was successfully adapted to continue during COVID-19 restrictions.
• The adaptation process prioritized community needs and tribal policies.
• Valuable insights were gained on modifying public health interventions for AI/AN communities during pandemics.

Conclusions:

• Adapting health interventions with community input is crucial for maintaining services during public health crises.
• Future public health programs must consider accessibility and resource limitations, especially in AI/AN communities.
• The experience provides a model for resilient public health program delivery in Indigenous communities.