Healthy Navajo K'é

Pregnancy Risk Assessment Monitoring System- Arizona PRAMS Project

December 29, 2021 Diné College and Northern Arizona University Season 1 Episode 5
Healthy Navajo K'é
Pregnancy Risk Assessment Monitoring System- Arizona PRAMS Project
Show Notes Transcript

PRAMS or Pregnancy Risk Assessment Monitoring System is a survey that is implemented by Arizona, New Mexico and Utah state PRAMS projects to assess health among mothers before, during and after birth. The Navajo Nation Department of Health uses PRAMS data collected from Navajo women living on and off the Navajo Nation in the three states to assess and guide health health policy and practice. More recently Diné College has worked with NM and AZ PRAMS to analyze data to set priorities in maternal health which are reported in the 2020 Navajo  Nation MCH Needs Assessment found on the Navajo Epidemiology website. 

In this episode,  hosts Amber-Rose and Shermaine discuss with special guests from the AZ PRAMS Program Evelyn Nieto, Ryan Benally, and Gina Herrera, about the importance of collecting this data to improve health outcomes. 

We encourage you to complete the PRAMS survey so we can better understand health experiences of mothers and their children especially on the Navajo Nation. 

Check out our social media pages!

Facebook: @Navajo Maternal and Child Health Project at Diné College

Instagram: @navajomch

Please email us if you have any questions, comments, or suggestions: navajomchproject@dinecollege.edu

This podcast was sponsored by the Arizona Department of Health Services through federal funding from the Health Resources & Services Administration, with support from the Navajo Native American Research Centers for Health (NARCH) Partnership between Diné College and Northern Arizona University through federal funding from the National Institute of Health’s National Institute of General Medical Sciences, award number S06GM142121. The views expressed are the sole responsibility of the program staff and do not necessarily reflect the views of the Arizona Department of Health Services or the United States Government.

Amber-Rose
Ya'at'eeh. Welcome to the MCH podcast where we discuss maternal and child health topics and provide strategies for improving the health of Navajo families. Amá dóó áłchíní ats’íís baa áháyá baa yadelti (Translation, we will be talking about the health of mothers and children).

Amber-Rose
Today, I, along with my co-host Sharmaine, will be discussing the topic of PRAMS, which is the pregnancy risk assessment monitoring system. Sharmaine, would you like to introduce yourself?  

Sharmaine
Yá'át'ééh. Shí éí Sharmaine Nelson yinishyé. Naaneesht'ézhi Táchii'nii nishłį́, Tó'áhani bashishchiin, Tséńjíkiní dashicheii, Kinyaa'áanii dashinalí. I am currently a senior at Northern Arizona University, majoring in Public Health. I am glad to be helping with this MCH podcast project for my internship. If you haven't already checked out our other podcast episode, we encourage you to listen to them. We have some great guest speakers who provide helpful information.  

 Amber-Rose
Yes, we do. So today, we'll be talking about the pregnancy risk assessment monitoring system, or PRAMS for short. It's a survey that is implemented by states including Arizona, New Mexico, and Utah. The survey asks questions about behaviors and experiences before, during, and after a woman gives birth.   

Sharmaine
The Navajo Nation Health Department works with these states to produce a report on Navajo mothers using prams data. This is also used in the 2020 Navajo MCH report to help guide our activities, including topics for this podcast. However, we know participation rates for Navajo women aren't as high for the survey. But hopefully, with this information, mothers and families will understand the importance of collecting and reviewing this data.  

Amber-Rose
Yes, this data helps state departments and even the Navajo Nation to understand what health needs must be addressed and guides funding, program planning, and other activities to support and promote the health of mothers and children.  

 Sharmaine
We invited special guests Evelyn Naito, Ryan Benally, Gina Herrera with Arizona PRAMS. Thank you for joining us today. Could you tell us a little about yourself and your roles with PRAMS?  

Gina 
Hi Sharmine. This is Gina Herrera. I'm the Arizona PRAMS manager/ coordinator out of Phoenix, Arizona.   

Evelyn
I am Evelyn Naito. I am the research associate and Spanish bilingual interviewer for the project.  

Ryan
Hi, my name is Ryan Benally. I currently work with the PRAMS program. I work with them as a data manager and I have been with them for about two years now.   

Amber-Rose
Great. Thank you. It's nice to meet you all, and have you a part of our series on maternal and child health. Evelyn, can you talk about the purpose of PRAMS and Gina, if you'd like to add anything?  

Evelyn
Yes. So PRAMS is short for the Pregnancy Risk Assessment Monitoring System, and we're a joint project between the Arizona Department of Health Services and the Centers for Disease Control and Prevention. So the purpose of the project is to find out why some babies are born healthy, and others are not. Each month we ask one in 30 new mothers in Arizona to share their experiences before, during, and after pregnancy. And it is the only system in Arizona that provides data about pregnancy at the first few months after birth. So what we learn from PRAMS is used to help build programs that benefit moms and babies and the state.  

Gina
That was perfect. Thank you, Evelyn.  

Sharmine
Evelyn, can you tell us a little bit more about the questionnaire, the questions, the recruitment methods, incentives, and have questions changed since the pandemic?   

Evelyn
Yeah. So each month, like, I was saying we randomly select one in 30 new moms to share their experiences. They're randomly selected through a computer program using birth certificate files. So if a person is selected and completes the questionnaire, they receive a $30 gift card to Amazon or a voucher for $30 to Bashas, Food City, rallies. In the Survey, we ask a range of questions about anxiety and depression, pre-conception health, breastfeeding, home visiting, oral health and, well, baby and postpartum checkups. So since the pandemic, we have added two supplements to understand how the pandemic have changed the mother's pregnancy experience. Having to go virtual, you know, or and then also the COVID-19 vaccine and what role that might be playing during their experience.  

Amber-Rose
Awesome. I'm glad you were able to make those changes to the questionnaire or additions, should I say, because I'm sure a lot of women have experienced many different challenges during the pandemic to receive their prenatal care and then also postpartum care.  

Evelyn
They had to work really fast. And when I say they it was, it was a group of people, including our team, you know, reviewing these questions. They were implemented early on, and I don't remember the exact dates, but they were they came really quickly. And so we were able to then have that information faster, given that it was a pandemic. So it was really exciting that PRAMS can do that and shift fast to make sure that we're understanding the community's needs quicker.   

Gina
The pandemic really changed things a lot for everybody, and we're learning, you know, even on the questionnaire itself, people are able to comment, you know, their stories. We love to hear their stories. And to hear these stories are amazing because you have people, moms who are now stay-at-home moms. They're 100% their kids have been there 100%. They're sharing that, you know, with that. So thank you so much for allowing me to talk to an adult. You know, when we interview them over the phone or, you know, via survey. And they're so grateful to tell their story. And we're so grateful to hear it because we're hearing, you know, that people, I mean, they were only allowed to take one guest for them, you know, into labor and delivery or to go hear the heartbeat or, you know, there's so many stories that we're learning. And, you know, maybe to other people, it's not significant. But to epidemiologists like myself, that is significant, and to people in our future, it's significant because we're going to write books and stories about these types of stories. You know, of course, generic, we're not going to put anything that anybody can know who wrote this, but it really helps people. And also, you know, home visitation, you know, that is limited because of the pandemic. There's so many things that got limited. So we're learning so much from this data. And I just wanted to throw that out that it is so much more than what we planned on when we put out the COVID survey.  

Amber-Rose
Thank you for adding to that, Gina. You know, I think just the turnaround for getting these questions out and then also just the different ways this feedback can help improve, you know, getting back on track with our healthcare system after this pandemic is very valuable.  

Gina
Thank you. Yes, Yes.  

Amber-Rose
 Evelyn, how does collecting this kind of data help directly improve maternal health in Arizona?  

Evelyn
We are able to use the data to develop and implement new programs or modify existing programs to make sure that we're better fitting the needs of the community. We also use this information to monitor the progress of established health objectives, influence public health policy by working directly with policymakers to incorporate findings into the decision-making process. So providing input into legislative proposals, we also disseminate the research findings to the health communities so that they can incorporate the latest information into their standards of practice. I know we were able to recently have or listen in on a group of providers that learned that mothers weren't receiving, you know, information on prenatal vitamins, and right then and there, they were able to share information with each other too. Yeah, it's just really exciting, right, to know that the information that we're sharing directly impacts us.  

Gina
I agree with Evelyn. It's just amazing that, you know, up until now we're now our 2020 data is now we're able to share that. And we just started sharing with internal partners about what's happening, and to hear the buzz about what they're learning from the data and to see them actually put money and resources into where the numbers are, is exciting for me because I'm actually not from government. I come from a hospital background, and now that I am, I can see how they apply the funds. And what they do is they call together stakeholders and leaders to meet about the numbers. And you know, this needs to change, and this needs to change, and how can we change it? How can we put funds to this so that we allow resources available for, you know, oral health or dental with this insurance or this or that? And I'm, you know, we've already seen in a couple of months a huge difference in how people are trying to change policy to help our, you know, our Arizona moms, new moms, and families. So that's pretty exciting for us.  

Sharmaine
Ryan, what type of help programs or policies have been developed because of PRAMS?  

Ryan
 So one example that I can think of on top of my head is actually recently meeting with providers. And we learned that our data that women that were not receiving information on folic acid and they were able to improve on their patient education in their clinics, so that way they were made sure that all providers were covering this topic along with their patients. You know, just to make sure that everyone is, you know, keeping healthy and having, you know, a good process through this.  

Gina
That was a perfect example. Ryan, thank you.  

 Amber-Rose
And I'll just add that we were able to use the New Mexico and Arizona PRAMS data to write up the needs assessment report for the Navajo Nation covering Arizona and New Mexico. So it's very helpful in that way, and it helps to guide our planning of activities and what the funding that we were able to receive, which actually helps too. It includes this podcast. So awesome. It's really awesome. You know how data can impact change and different activities to improve health. So, Evelyn, are there some sort of barriers or challenges with getting this information that you are aware of?  

Evelyn
 Yeah, our current biggest, I think, challenges our response rates. So out of the surveys that we send out, because we do mail them out every month, we get back about 50% of them only. So we hope to see this number increase, especially in those populations that need it the most, you know, that need the most maternal health support. And we think that usually, you know, the reason moms are not responding is because they don't know who we are. They're unsure of who's getting this information because it does ask them to tell us the entire story of their pregnancy from the very beginning of it. And for some, that might be extremely personal information, and for others, it is easier to share. So we want them to know is that the information is coming to people that are listening and that want to make a change. We do everything we can from calling them. We have a every mom that does not send it back via e-mail within a certain amount of time. We start some phone calls and leave them messages will soon be trying to text these moms. So we are doing the most that we can to get these moms to respond to us. But it does take, I think, that support of other people asking pregnant women, you know, have you heard about PRAMS or seeing a poster up at their provider's office that's going to make the difference in our numbers. So that's our biggest challenge right now and what we're working on, and this podcast helps. So we're excited to be here.  

 Amber-Rose
Yes. And we also have included PSAs on the KNDN radio station and then also KTNN and both cover the Arizona, I believe, some parts of Utah and New Mexico, portions of the Navajo Nation. So these PSAs are encouraging women who might receive this envelope to complete the survey and in ways that it'll help improve health. So that's one way we're addressing that challenge.  

 Sharmaine
 Ryan, how can we ensure more participation from tribal communities?  

 Ryan
One main thing that comes to mind is continuing to build a good standing relationship between these state programs and tribal programs because sometimes they may not be on the same page. So I think being in that good standing is very important and also having good communication between one another. And that also goes all the way down. So like even being in communication with the moms. I know that we have, you know, some problems with and I can think of is like addresses. You know, I know that some participants, you know, on the reservation don't have physical addresses. So this is really an important option to capture the, you know, like P.O. boxes because, you know, we do mail stuff out to those addresses. And that way that you know, if these moms are selected, they are able to get the proper information that they want to participate in it. And I think it will also help them be more involved in the program. And also, I think that being educational also very important about our program. You know, like we mentioned earlier, a lot of people may not be familiar with our program. So I think it's very important to continue to educate and inform the tribal communities of what our program is and how it actually works. You know, so that way, you know, they can be a little bit more comfortable with what's going on and, you know, be more willing to work with us.  

Gina
Ryan, thank you. Ryan is such a great resource. You know he is, Ryan, I'm sorry. I may not know exactly the area, but I know the Window Rock area. You're from there. He's Navajo, and he always helps. Like sometimes, you know, it will give a very weird address, and we don't know if it's going to get there. And Ryan is such a good resource. Yes, it will. It will go through this and that. And, you know, even our rewards, we want her to know what rewards to give to that community when they fill out a packet or, you know, answer one of our interviews, you know, and Ryan was such a good resource, so. So thank you, Ryan. We're so fortunate to have him on our team in the bureau.  

Amber-Rose
So it's very true. Ryan, I agree with what you mentioned about building relationships with tribal communities and just overall informing community members about the PRAMS project. We'll go on to our last question. So and anyone can answer this, what is the takeaway message for our audience listening to this?  

Evelyn
I guess we want people to know that the information, you know, with more information, we can better understand the needs of the community. So it's important that we participate in these types of surveys, should a mom receive a purple package with their survey, know that it is coming from a 100% confidential source and we want every mom who gets it to have the opportunity to share their story and do it confidently, knowing that we're listening and that we want to make a difference. It also helps if providers, you know, maybe share materials or talk to moms about this packet that they might receive. So that we start to raise that awareness.  

 Gina
Thank you, Evelyn. So true. And I just want to add that right now, I don't know about anybody else, but I'm getting some many robocalls on my phone. It is just incredible. And you don't know who to trust. And then here we are, making phone calls as well. And then they don't know who to trust when to pick up. So I know it's going to be hard, you know, the great thing is our phone numbers are listed on the website so they can look it up and make sure that we're not robo calls. But this is the one time to pick up your phone when we call them because we really, really, really want to help the Navajo Nation. We truly, there's truly a need for us to all come together and give them resources and the things they need and for them to be able to be up there in the light of what's needed in that community. I feel like they're left out sometimes and I want them up there. I would love for us to study them a little bit more. And when I say study them, study the things that they need. Do they need more dentists? Do they need more doulas? Do they need more funding for a lactation? You know what it is? I mean, I'm just saying, speaking from my area, I know that everything I mentioned is probably not the way that they choose, but we don't know that I would love to learn about the culture, to be able to share what needs they want for them to be able to tell their story and say, This is what we need more of, but we can't help without that information. We don't know what we don't know. So the takeaway message for me would be somehow know that the whole purpose in us collecting information and asking them questions, which again we don't keep with names, is to learn what is needed in that area. So my takeaway message that I would love to share is that please share your story with us. When you get a purple packet, please fill it out. If you have questions, you are always welcome to contact me. My name is all over the information in the packet and my phone number and call me and ask me anything. And if there's something you don't feel comfortable answering, you don't have to answer it. We do need a date of birth. So just because we need to know that it's a new mom and the baby is of age, but other than that, you cannot fill out questions. You don't feel comfortable. 

 Amber-Rose
Thank you, Gina. And Evelyn, Ryan, would you like to add to that?  

 Ryan
Sure. A takeaway message that I kind of come off from the PRAMS program, you know, in connection with the Navajo Nation as well as the other tribal communities that there is that, you know, I think it's important that, you know, we get to see how these moms, you know, go through their pregnancy journey, you know, before, during and after. You know, we tend to be looked at as a much smaller community and often overlooked. So I think it's important, you know, that in just this little way that, you know, we can reach out to them, and they can reach back to us and we can see what, you know, how their health care is going, how we can help them get further along assistance. You know, so I think that it helps to bring light to the issue with Native American moms and families in general about, you know, keeping them healthy and making sure that, you know, these babies are born healthy and to healthy families and live a healthy life going forward.  

 Amber-Rose [00:21:07] Awesome. Thank you all for the work that you do and then also for joining us today. We really appreciate your time and all the valuable information you provided.

Ahé'hee. Thanks for listening to the MCH podcast. For more information about the Navajo MCH Project, please visit us on Facebook at the Navajo Maternal and Child Health Project at Diné College.