1. “Through it all, I kept my
Changes in Stage of Readiness After Exposure to "Sharing the Gift of Life"
“Through it all, I kept my
faith in Lakota.”
135th Annual Meeting of the American Public Health Assoc.
November, 2007
Nancy L. Fahrenwald Funding source:
Associate Professor HRSA, DOT R390T01211
South Dakota State University
1 of 15 1

2. Exec. Dir., SD Lion’s Eye Bank Arliss Keckler
Christine Belitz, BS
Exec. Dir., SD Lion’s Eye Bank
Arliss Keckler
Tribal Outreach Specialist
SD Lion’s Eye Bank
Manoj Sharma, MBBS, PhD
Associate Professor,
Health Prom. & Ed.
U. of Cincinnati
Woope Claymore, age 16
Cheyenne River
Lakota Sioux Tribe

3. Kidney Transplant Recipient
Background :
For American Indians & Alaska Natives (AI/AN) there is a dire need for kidney transplantation.
Consent rates for donation among AI/AN people are low.
Few donation outreach interventions designed for AI/AN people.
No known empirical tests of interventions.
Kidney Transplant Recipient

4. “If you give, you get back tenfold.”
Purpose:
To test a theory-based intervention for organ and tissue donation among reservation dwelling AI adults .
“If you give, you get back tenfold.”
Specific Aim: To determine whether the intervention produced changes in intention
to serve as an organ or tissue donor.

5. Donated his kidney to his father.
Methods:
community-based quasi-experimental pre/post-test design
Setting/participants:
4 Northern Plains reservations: All participants adults were adults (N=1850, 58% women).
Snowball sampling technique.
Donated his kidney to his father.

6. SD Indian Reservations, Trust Lands, and Tribal Headquarters73 14 90
240 44 18 75 65 63 20 79
168 34 53 49 47
273
1806 45 26
251 50
1804 37 25 22 27 10
127 15
158
101
139 30
324 13 32 19 11 38
271
253
239
14A
385 16
16A 71
471 87
407
391 40 89 85
212 12 83
183
281 42
115 46 52 48
262 36
Sturgis
Deadwood
Rapid City
Buffalo
Bison
Timber Lake
Dupree
Pierre
Selby
McIntosh
Philip
Ft. Pierre
Murdo
Martin
Springs
Hot
Custer
White River
Winner
Kennebec
Chamberlain
Ipswich
Aberdeen
Leola
Britton
Webster
Sisseton
Milbank
Watertown
Lake
Clear
Hayti
Clark
Redfield
Miller
Highmore
Huron
Plankinton
Wessington
Woonsocket
DeSmet
Brookings
Flandreau
Salem
Howard
Sioux Falls
Canton
Parker
Armour
Alexandria
Yankton
Vermillion
Olivet
Elk Point
Onida
Gettysburg
Faulkton
Mound City
Tyndall
Burke
Belle Fourche
Lake Andes
144 43
247
134
224
Gann Valley
Mitchell 29
Madison 81 28
123 17
Lawrence
Standing Rock
Cheyenne River
Rosebud
Pine Ridge
Lower Brule
Crow Creek
Tribal Headquarters
Agency
Ft. Thompson
Eagle Butte
Marty
Ft. Yates, ND
Sisseton
Yankton
Reservation Sites: Pine Ridge, Rosebud,
Cheyenne River, Sisseton Wahpeton

7. Cheyenne River Lakota Sioux Tribe
Theoretical Framework
Cultural context:
Story-telling & Gift giving
Transtheoretical Model:
Stages of readiness
Self-efficacy
Pros/Cons
Processes of Change
Gary Bad Warrior, Jr.
Cheyenne River Lakota Sioux Tribe

8. Behavioral Intervention:
“Wakic' unpi Wiconi” “Sharing the Gift of Life”
Modeled after MOTTEP Strategies
Culturally-tailored print materials, video &
social marketing strategies
Promote organ/tissue donation at community
gatherings, worksites, churches, pow-wow’s
& other events
Educational programs for community groups
and post-secondary education programs

9. Cornea Transplant Recipient, Christine Janis, Oglala Lakota Tribe
Measures:
Pre/post stage of readiness to become an organ or tissue donor
# of donor cards signed coupled with verification of family notification
Driver’s license designation as an organ donor
# of target population donor referrals and donors
“The giving of oneself is just the ultimate way of saying thank you for being created.”
Cornea Transplant Recipient, Christine Janis, Oglala Lakota Tribe

10. Data Analysis Aim 1: Change in Donor Intent
McNemar's test of significance for dependent samples
compare pre- and post-intervention stage of motivational readiness.
participants categorized as stage non-progressed or stage progressed (progressed one or more stages)

11. RESULTS Aim 1: Changes in Donor Intent*
43% (n= 681) no change; 57% (n=899) progressed in stage of change, 0 regressed in stage. Change in donor intent from pre- to post-intervention was significant, χ2 (1) = 18.32, p <.05*

12. Donor Designation: Preparation or Action Stage of Change

13. Limitations Single-group design No demographic data collected
Paul High Elk, Double Cornea
Transplant Recipient, 1959 & 1968
Cheyenne River , Lakota Sioux Tribe
Limitations
Single-group design
No demographic data collected
Verification of family notification is problematic
Time required for community-based participatory research
Sisseton - Wahpeton Oyate Tribe 15

14. Recommendations and Needs for Further Research:
Measurement issues
Collect demographic data
Hire outreach people from each tribe
Target a younger adult population
Critical need for more intervention research
Wakic' unpi Wiconi - Sharing the Gift of Life - Wakic' unpi Wiconi - Sharing the Gift of Life - Wakic' unpi Wiconi - Sharing the Gift of