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BACKGROUND: In Michigan between 2006 and 2008, the Native American feto-infant mortality rate was 2.3 times greater than the white reference rate. The Michigan PRAMS survey samples too few Native women to analyze risk factors for feto-infant mortality. As a result, the Michigan Department of Community Health initiated a parallel Native American PRAMS.
METHODS: A partnership between the Michigan Department of Community Health, the Inter-Tribal Council of Michigan (ITCM), the Great Lakes Inter-Tribal Epidemiology Center, and Michigan State University developed a Michigan Native American PRAMS survey. The Michigan PRAMS survey was modified for the Native population by adding questions about parental tribal affiliation, tribal health service utilization, racism, and social determinants of health. The survey sampled all 2,588 women who gave birth to a Native infant in 2012, and additional funding allowed data collection for 2013 births. Outreach activities to increase response rates include: utilizing a logo that would resonate with the Native community, developing a factsheet for clinicians, obtaining a letter of endorsement from ITCM, creating a media campaign, and offering an online survey option to mothers delivering in 2013.
RESULTS: For the first time, a Native American PRAMS survey was implemented in Michigan, with a response rate of 52% in 2012. The survey results will provide state-specific information describing health experiences of Native mothers and infants. Additionally, a revised definition of “Native infant” doubled the number of mothers eligible to be sampled. The increased sample size may allow calculation of estimates specific to tribal service areas, if requested by tribes.
CONCLUSIONS: The Michigan PRAMS survey did not capture necessary information about Native health experiences due to inadequate sample sizes, no response options for tribal locations of care, and no information about experiences with discrimination. By implementing a parallel survey, this project was able to add relevant questions and adequately sample the population of interest. The collaboration between the state health department and tribal organizations was critical to developing and implementing a culturally relevant survey.