Developing and Implementing a Culturally Consonant Treatment Fidelity Support Plan with the Apsáalooke Nation

Area of Science:

• Health intervention research
• Indigenous community health
• Treatment fidelity

Background:

• Treatment fidelity is underreported in health interventions, especially within Indigenous communities.
• Existing frameworks like the NIH Behavior Change Consortium (BCC) lack culturally specific strategies.
• This gap hinders accurate measurement and implementation of health programs in diverse settings.

Purpose of the Study:

• To develop and implement a culturally consonant treatment fidelity support plan for an Apsáalooke (Crow) Nation chronic illness self-management program.
• To adapt the BCC framework to incorporate Indigenous cultural values and relational accountability.
• To propose a new area of treatment fidelity centered on relationship building.

Main Methods:

• Adapted and expanded the BCC framework focusing on provider training and treatment delivery.
• Integrated Apsáalooke cultural values and relational accountability into fidelity strategies.
• Shifted the approach from monitoring facilitators to supporting them, termed 'Aakbaabaaniilea'.

Main Results:

• Developed a culturally consonant fidelity support plan tailored to the Apsáalooke community.
• Identified 'building and fostering relationships' as a critical fifth area of treatment fidelity.
• Demonstrated the importance of prioritizing 'how' an intervention is delivered over 'what' is delivered.

Conclusions:

• Fidelity to relational accountability is foundational for successful health interventions in Indigenous communities.
• The adapted BCC framework offers a model for developing culturally consonant fidelity strategies.
• This approach emphasizes the relational aspects of intervention delivery, promoting better health outcomes.