Capacity Building from the Inside Out: Adapting the CITI Ethics Certification Training Module “Assessing Risk and Benefits” for American Indian Community Researchers

This RETI mentored research project will develop a model to adapt and augment the Collaborative Institutional Training Initiative (CITI) human subject certification training curriculum. The model will describe the steps taken to adapt a CITI module to be culturally-responsive and user friendly for rural American Indian (AI) community researchers from Pacific Northwest tribal communities. An expert panel of AI academic and community researchers will prioritize focus areas; adapt and augment components from 1 to 2 CITI Social and Behavioral Sciences modules, highlighting cultural relevance (i.e. sovereignty), priorities and values. The Aims are: 1) in collaboration with Pacific Northwest tribal partners, define the process to produce a culturally relevant CITI human subject certification curriculum module; and 2) produce and evaluate the validity of the culturally-adapted module among 40 tribal members who: a) are 18 years or older; 2) have never taken the CITI training; 3) currently collaborate with an academic research partner or are interested in research; and, 4) reside on a reservation. Improving human subject training usability and cultural relevance for community partners will enhance HIV prevention research ethics practices.

American Indian and Alaska Native (AI/AN) tribal nations and communities have long experienced health disparities compared to other Americans. During the last half of the twentieth century, AI/AN population health status improved, though most gains stopped by the mid-1980s, and certain chronic and infectious diseases have worsened.¹ The etiology of AI/AN health disparities presents complex public health issues and includes social, biological, economic, cultural, and historical factors. Recognizing and addressing the mistrust that characterizes many AI/AN tribal nation and community attitudes towards research, medicine and public health, and ensuring community engagement in improving health outcomes remain critical to meaningfully addressing health disparities within these populations. Community based participatory research (CBPR) provides an appropriate orientation to promote this engagement. It challenges the longstanding scientific paradigm that knowledge creation is the exclusive domain of an academic elite and that inclusion of community participation alters an otherwise pristine process.² CBPR principles and methodologies can promote the development of culturally-centered health interventions; and support tribal/community research infrastructure and University capacity to engage with communities. The National Institutes of Health recognize CBPR as a valid and necessary research strategy for investigating and eliminating health inequities within AIAN communities, therefore developing accessible, usable, and culturally-responsive human subject training materials constitutes an imperative for ensuring HIV prevention research ethics practices.

The purpose of this RETI mentored research project is to adapt and augment the Collaborative Institutional Training Initiative (CITI) human subject certification training curriculum be to be culturally-responsive and user friendly for rural American Indian (AI) community researchers. A 16 member expert panel of AI academic and community researchers will identify and adapt components of the CITI Social and Behavioral Sciences modules, highlighting cultural relevance and differences (i.e. sovereignty).

Specific AIMS:

Aim 1) In collaboration with Pacific Northwest tribal partners, Indian health IRBs, and AI scholars, develop a model for culturally adapting the CITI human subject certification curriculum;

Aim 2) Pilot and evaluate the adapted curriculum module among 40 tribal members who: a) are 18 years or older; b) never taken the CITI training; c) currently collaborate with an academic research partner or are interested in research; d) reside on a reservation and e) has access to a computer and internet.

H1: As compared to those taking the standard CITI training module, rural AI taking the culturally-adapted CITI training curriculum will report:

a) The culturally-adapted module is more relevant and helpful in understanding human subject research process;

b) Higher confidence in their ability to contribute to the research process;

c) Better comprehension of the core elements;

d) Less time to complete the training modules.