Participatory Processes Applied to Developing Culturally Appropriate Educational Material Among the Ngäbe-Buglé Women of Panama for Domestic Violence Prevention

The Ngabe-Bugle is the largest underserved indigenous population in Panama facing extreme health disparities compounded by structural, social, and cultural factors. Contributing factors to the poor health outcomes in this region include extreme poverty, low education, high maternal and infant mortality, alcohol use, and an increasing trend of domestic violence. The present intervention used community participatory processes to develop tailored material within the Ngabe-Bugle community and training health promoters to deliver health education to the most rural areas. There were 78 health promoters who were trained using the training-oftrainers approach. Promoters distributed the health messages to their communities using the tailored material, the main topic discussed being domestic violence. Almost 7,000 community members received health education, demonstrating increased knowledge and intent to act on information received. Future directions include further funding, research, and education of indigenous groups in Panama on domestic violence.Keywords: indigenous health; domestic violence; Panama; training of trainers; Ngabe-Bugle; community participatory processesHealth inequalities are considered to be the "leading health problem" in Latin America (United Nations Development Program, 2010), with the most affected population being the indigenous groups. There are more than 370 million indigenous people worldwide (Department of Economic and Social Affairs, 2009) represented by more than 400 different indigenous populations in Latin America and the Caribbean (Montenegro & Stephens, 2006). Each group follows different dialects, beliefs, and traditions presenting a challenge to public health. The 2010 United Nations Permanent Forum on Indigenous Issues explains that despite the diversity experienced by indigenous groups, the inequities remain constant across groups. This includes society's neglect and lack of protection of human rights, giving rise to diminished political representation and participation, economic marginalization, poverty, lack of access to social services including health and education, and discrimination. Education is crucial to the growth of women and has direct impact in health outcomes. For example, women with higher education present improved health indicators such as reduced infant mortality (by preventable causes) and ameliorated survival of children. Furthermore, women with basic levels of education face opportunities to improve the family and the community's income (Murray, 2009).Traditionally, disparate health outcomes have affected indigenous populations, and it has been well documented within Latin American and the Caribbean regions attributing this disparity to continuous poverty, lack of access to care, environmental changes, incidence of infectious diseases, poor nutrition, loss of traditional health practices, and change in diet and food availability (Pan American Health Organization, 1998). In addition, rights to traditional lands, territories, and natural resources are often central to the indigenous way of life (United Nations Permanent Forum on Indigenous Issues, 2010) but are continuously at risk because of effects of countries' growth and development, contributing to the continuous cycle of poverty (United Nations Development Program, 2010). Nonetheless, progress has been observed in such forums as the 2007 United Nations' Establishment of the Rights of Indigenous Peoples Worldwide outlining the declaration to maintain, protect, and develop their traditional medicine and health practices, cultural heritage, knowledge, and art as well as gain access to social and health services (United Nations, 2008).Indigenous Groups in PanamaThe Republic of Panama, located in Central America, is composed of of nine provinces, three indigenous comarcas or reservations with provincial status, and two comarcas with status of corregimiento or a subdivision of district. According to the 2010 national census, the Panamanian population totaled 3,405,813 people with 417,559 people identified as indigenous (212,451 men; 205,108 women), representing 12. …