Strategies for Community Engaged Measurement Development in Evaluating Translation Research Initiatives

Introduction: The process of community engaged measurement development identified reasons conventional measures of alcohol abuse and suicide risk are problematic (e.g., contextual factors, cultural beliefs, and ethical issues). This finding represented a challenge for translational research and resulted in a process of intensive community member involvement in measurement development. For example, one challenge unique to working in rural Alaska communities relates to small sample sizes. A majority of communities have declared themselves “dry,” meaning possession of alcohol is illegal. Therefore, acknowledging drinking in small populations poses risks through potential identification in an illegal activity by age and the local option law. Youth reported reluctance to answer direct questions about alcohol use truthfully, and posed possibilities to cause harm in dissemination that could stigmatize communities and potentially cause vulnerable community members to self-stigmatize. 

Methods: These concerns led to development of alternative outcome measures to evaluate the prevention programs being implemented in these communities. Umyuangcaryaraq, a Yup’ik word translatable as “reflecting,” is one component of a broader cultural value of awareness of interconnections and of the resulting consequences of one’s actions.  As an alternative way to assess alcohol use, Reflective Processes taps an element of awareness about the potential negative consequences of alcohol use.

Our measurement development collaborations also described local concerns about asking their youth first person questions about suicide because such intrusive questioning can represent a violation of this respect. In response to these concerns, we instead emphasized cultural beliefs and experiences that make life enjoyable, worthwhile, and provide meaning for young people, and developed a construct, Yuuyaraqegtaar, Reasons for Life. This provided a second culturally appropriate ultimate outcome variable which taps beliefs and experiences that make life enjoyable and worthwhile, and could serve as a protective factor for risk of suicide.

Through a multi-year partnership with members of these communities, we elicited community input to develop items to measure these constructs. We then tested these instruments psychometrically, as part of our program of intervention research to reduce suicide and alcohol use disorder risk.

Results: We present Item Response Theory analyses and other psychometric data on these two resulting instruments and lessons learned from this multi-year process.

Conclusions: This presentation will describe the collaborative approach with local community members and the resulting scientifically rigorous development of alternative constructs and culturally adapted measures.