TECC-Case-Study-UIHS-25-0206

United Indian Health Services, Inc. 2023-2024 1-E-3 Material Development Process Case Study Summary

Inside

Introduction ................................. 1 Methods .................................... 2 Key Findings ................................ 4 Conclusion .................................. 6

Introduction In California, American Indian and Alaska Native (AI/AN) adults experience higher rates of tobacco use relative to adults of other ethnic/racial groups (158% vs 125% of those 18-64 years of age) AI/AN adults also face higher rates (274%) of recent secondhand tobacco and vape exposure relative to adults of other groups (227%) 1 To address health disparities related to commercial tobacco use and exposure, California Tobacco Prevention Program (CTPP)-funded projects including the Tobacco Education Clearinghouse of California (TECC), a project of ETR, work to engage with programs serving communities that face increased tobacco-related health risks The elevated tobacco-related risks for AI/ AN communities highlights the importance of the work being done by Tribal-serving organizations, including the NATIVE Tobacco

15.8%

12.5%

AI/AN Tobacco Use Rate Age 18-64

Other Ethnic/Racial Groups Tobacco Use Rate Age 18-64

project at United Indian Health Services, Inc (UIHS) Focusing on three educational posters intended for pregnant mothers and their families (see Figures 1–3, pages 2–3) that were developed during a 2021-2022 campaign, the information presented in this case study summary highlights key considerations, activities, and actors in UIHS’s educational material development and decision-making processes that are specific to their Tribal community

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1-E-3 Material Development Process Case Study Summary | United Indian Health Services, 2023-2024

Methods To understand the NATIVE Tobacco Project’s educational material development process, TECC staff conducted four in-depth interviews with three UIHS staff members A semi-structured interview guide with both specific and open-ended questions was employed during interviews to ensure the relevance of the data collected while also remaining flexible to novel themes relevant to participants’ experiences The interview guide focused on several topics, including: overall format of the materials, visual elements, written content, distribution of the materials, and lessons learned

Figure 1

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1-E-3 Material Development Process Case Study Summary | United Indian Health Services, 2023-2024

Figure 2

Figure 3

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1-E-3 Material Development Process Case Study Summary | United Indian Health Services, 2023-2024

Key Findings

Format

Visual Elements

Case study participants explained that posters are: + A “powerful” and longstanding format for promoting health messages among Tribal populations thanks to their visual focus and usability in low-tech environments + Adaptable for use across various mediums, including billboards, handouts, and social media, and they can be easily shared with non-Tribal organizations who serve Tribal populations (eg, county health department)

Case study participants shared that:

+ Canva is a user-friendly tool for creating posters + Using photos that feature local community members is a strength of the materials because they represent Tribal populations and are also recognizable and known by many community members, which increases interest, relevance, trustworthiness, and connection Viewers can see themselves in the materials and feel that their community believes in the messaging, making it more relatable and persuasive + Including Tribal designs and/or current traditional practices (eg, traditional rattle, Tribal blanket, woven baby basket) is impactful, and emphasizes that the materials were created specifically for Tribal populations and the messages are intended for them

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1-E-3 Material Development Process Case Study Summary | United Indian Health Services, 2023-2024

+ Language was chosen carefully, with special emphasis on ensuring respectfulness, relatability, and

empowerment, and not judgment nor negativity The team underscored that this was particularly important given the history of forcible removal of children and forced boarding school among Tribal populations Tribal leadership and community members played a key role in reviewing the language + Including relevant and actionable resources is crucial to campaign success This campaign included information on Kick It California’s quit resources, as well as UIHS clinic sites Community members interested in support could reach out for help accessing and navigating commercial tobacco cessation resources while also encouraging in-person engagement for more tailored support

Written Content

Case study participants highlighted that:

+ Effective messaging should be clear, concise, and reflect cultural norms For example, this set of posters focused on quitting commercial tobacco use during pregnancy while also underscoring the power that women hold as mothers Additionally, recognizing the cultural distinction between commercial tobacco and sacred tobacco is essential + The theme and use of the phrase “future generations” alluded to the passing down mothers in perpetuating cultural tradition Contextualizing the messaging within a generational framework indicates respect for Tribal grandparents and ancestors, who have provided care and teaching in the past, and those who are yet to be born of knowledge between generations, highlighting the foundational role of

“ We’re suggesting a healthier lifestyle and thinking about future generations. We’re acknowledging and honoring these people, these community members, even the littlest and tiniest ones in our community. ”

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1-E-3 Material Development Process Case Study Summary | United Indian Health Services, 2023-2024

Conclusion This case study on UIHS’ NATIVE Tobacco Project educational campaign focused on pregnancy and commercial tobacco use and highlights several best practices for educational material development While this work does not represent all Tribal populations in California, it provides guidance and best practices specific to UIHS’ local Tribal populations in Northern California that may be of value to others Woven throughout the development process were the voices, perspectives, and participation of the Tribal community, including UIHS staff, Tribal leadership, and community members* Their input and feedback helped ensure cultural relevance, respectfulness, and relatability of both the visual elements and written components of the educational materials Moreover, the inclusion of photos of local community members, rather than stock photos, helped

catch people’s attention and enhance engagement with the posters Details like the inclusion of Tribal designs, the focus on intergenerational connection, and distinguishing commercial tobacco from sacred tobacco were key considerations that helped tailor the materials to Tribal populations and underscore that these materials were made for them These posters resonate with the local community, demonstrate respectfulness, and convey a sense of empowerment to pregnant women to make a healthy lifestyle choice for themselves, their babies, and their community Overall, UIHS’ experience with developing these campaign materials offers an insightful learning opportunity for other commercial tobacco prevention projects and contributes to the evidence base for the importance of developing culturally relevant educational materials

* UIHS’s centering of the Tribal community in their educational material development process is informed by their organization’s purpose and core philosophy of Ko’lha koom’ ma. More details can be found on their website: https://unitedindianhealthservices.org/our-story/

Source 1. California Department of Public Health. (2024). Tobacco-Related Disparity Indicators Dashboard. https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/Pages/Tobacco-Related-Disparity- Indicators-Dashboard.aspx

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1-E-3 Material Development Process Case Study Summary | United Indian Health Services, 2023-2024