Preventing Stroke in the Oneida Nation

Supported by a grant from the Wisconsin Partnership Program, the Oneida Stroke Prevention Program is a tribal-academic partnership that addresses the urgent need to target stroke risk factors in Native populations, where stroke is a significant cause of death and disability.

Partners on the project include the Oneida Comprehensive Health Division, with support from the Oneida Business Committee, the Native American Center for Health Professions (NACHP) at the School of Medicine and Public Health, and a team of researchers and medical students led by Robert Dempsey, MD, professor and chair of the UW Department of Neurological Surgery. Carol Mitchell, PhD, associate professor, in the Division of Cardiovascular Medicine, Department of Medicine, serves as the co-principal investigator.

“Much of current stroke research focuses on patient outcomes after a major stroke, and people often don’t recognize other important factors, like the loss of cognition that comes from multiple small strokes. These outcomes — including loss of creativity, independence, and decision-making — are devastating and common,” said Dempsey. “We have been working closely with the Elder Council of the Oneida community. Addressing cognitive decline as a modifiable risk factor is of great importance to them This project looks at how to change these risk factors and specifically how intensive health coaching can help.”

Each month, Dempsey and a team of researchers, clinicians, and UW medical students travel from Madison to the Oneida reservation, located in northeastern Wisconsin. Tribal members are invited to participate in a health assessment to determine their stroke risk. Based on risk status, eligible participants are invited to join the two-year study and are connected with Amanda Riesenberg, Oneida Stroke Prevention Wellness Coach, hired through the project, for support in lifestyle changes that can reduce the risk of stroke and dementia.

This project has several goals at both at the population level and the individual level that focus on preventing stroke and vascular decline and reducing the unique biomarkers of at-risk patients.

The partners raise tribal awareness about the importance of modifying stroke risk factors, including hypertension, smoking, and diabetes. Culturally sensitive information is provided for people of all ages, including children, who receive material about identifying signs of stroke in elders as well as educating them about establishing healthy habits at an early age.

At the individual level, participants receive health history screenings and are evaluated for vascular cognitive decline, presence of prior stroke, and other cardiovascular disease risk factors and symptoms.

Riesenberg works with individuals who have been identified as high-risk for stroke. She focuses on cooking, dietary and exercise programs, and medication logs with the goal of achieving strict management of cholesterol levels, blood glucose, blood pressure, weight, diet, and exercise.

The bi-directional approach to this partnership has united the cultural expertise of the Oneida community with the clinical expertise of the research team.

“The team’s consistency and willingness to travel here each month, and the cultural humility with which they approach this project have been key to its success,” said Melissa Metoxen, NACHP assistant director and member of the Oneida Nation. The partners are committed to ensuring that the stroke prevention program is effective and culturally sensitive.

“We have much to learn from the tribe in terms of culture and their approach to holistic health care,” said Dempsey. “The Oneida community wants to learn how to disseminate what is learned here to benefit the broader Native American community as well.”