Critique of a Community-Based Population Health Intervention in a First Nations Community (2016) (original) (raw)
Related papers
Revue interdisciplinaire des sciences de la santé - Interdisciplinary Journal of Health Sciences
Launched as a community-based partnership endeavour, the Sandy Lake Health and Diabetes Project (SLHDP) aimed to prevent diabetes in a First Nations community (FNC) in Toronto. With active engagement of the key stakeholders, SLHDP conducted a series of studies that explored public health needs, priorities, and the contexts. These led to the adoption of a variety of culturally appropriate health interventions, addressing several health determinants such as health education, physical environments, nutrition, personal health practices, health services, and FNC culture. SLHDP built reciprocal capacity for both the community stakeholders and academic partners, thus evolved as a model of population health intervention. The school components are being scaled-up in other parts of FNCs in Canada. This paper presents a critique from public health and medical anthropology perspectives and draws evidence-based recommendations on how such programs can do better.
Health Promotion International
There is increasing recognition that culturally-based diabetes prevention programs can facilitate the adoption and maintenance of healthy behaviours in the communities in which they are implemented. The Kahnawake School Diabetes Prevention Project (KSDPP) is a health promotion, community-based participatory research project aiming to reduce the incidence of Type 2 diabetes in the community of Kahnawake (Mohawk territory, Canada), with a large range of interventions integrating a Haudenosaunee perspective of health. Building on a qualitative, naturalistic and interpretative inquiry, this study aimed to assess the outcomes of a suite of culturally-based interventions on participants' life and experience of health. Data were collected through semi-structured qualitative interviews of 1 key informant and 17 adult, female Kahnawake community members who participated in KSDPP's suite of interventions from 2007 to 2010. Grounded theory was chosen as an analytical strategy. A theoretical framework that covered the experiences of all study participants was developed from the grounded theory analysis. KSDPP's suite of interventions provided opportunities for participants to experience five different change processes: (i) Learning traditional cooking and healthy eating; (ii) Learning physical activity; (iii) Learning mind focusing and breathing techniques; (iv) Learning cultural traditions and spirituality; (v) Socializing and interacting with other participants during activities. These processes improved participants' health in four aspects: mental, physical, spiritual and social. Results of this study show how culturally-based health promotion can bring about healthy changes addressing the mental, physical, spiritual and social dimensions of a holistic concept of health, relevant to the Indigenous perspective of well-being.
2020
Marie is a nurse and a member of the Bull Rapids First Nation. She is frustrated that there are no resources to help Indigenous people cope with the issue of chronic diseases such as type 2 diabetes, which is a major health issue in this community. Marie knows something needs to be done, so she undertakes research to determine whether there are any interventions that can help her community prevent, treat, and manage type 2 diabetes. During her research, she discovers Diabetes Alliance and the quality improvement strategy they have developed to empower Indigenous communities to create their own plans to combat diabetes. The purpose of this case is to give a brief overview of the colonial practices and the proximal, intermediate and distal determinants of health that have caused many of the health issues that occur today in Indigenous communities. It will also provide an opportunity for students to think critically about how chronic diseases can be addressed and what can be done to he...
Health Education Research, 2007
Epidemic rates of diabetes among Native North Americans demand novel solutions. Zhiiwaapenewin Akino'maagewin: Teaching to Prevent Diabetes was a community-based diabetes prevention program based in schools, food stores and health offices in seven First Nations in northwestern Ontario, Canada. Program interventions in these three institutions included implementation of Grades 3 and 4 healthy lifestyles curricula; stocking and labeling of healthier foods and healthy recipes cooking demonstrations and taste tests; and mass media efforts and community events held by health agencies. Qualitative and quantitative process data collected through surveys, logs and interviews assessed fidelity, dose, reach and context of the intervention to evaluate implementation and explain impact findings. School curricula implementation had moderate fidelity with 63% delivered as planned. Store activities had moderate fidelity: availability of all promoted foods was 70%, and appropriate shelf labels were posted 60% of the time. Cooking demonstrations were performed with 71% fidelity and high dose. A total of 156 posters were placed in community locations; radio, cable TV and newsletters were utilized. Interviews revealed that the program was culturally acceptable and relevant, and suggestions for improvement were made. These findings will be used to plan an expanded trial in several Native North American communities.
Politics of Culture in Urban Indigenous Community-Based Diabetes Programs
American Indian Culture and Research Journal
Diabetes has repeatedly been identified as a top health concern for indigenous peoples. 1 Although most indigenous people in North America today live offreservation, diabetes research has for the most part neglected urban indigenous communities and the significance of urbanization for indigenous peoples' health. 2 Urban indigenous health programs draw on broad funding strategies and resources that are largely developed and contingent on reservation-based experience and research results, even though reservation-based experiences are not analogous to those of indigenous peoples living in urban areas. In the urban setting, the social determinants of indigenous peoples' health are elaborated by a multiplicity of health care structures, knowledges, and practices; unique urban-adapted kinship and social networks; and demographic variables such as socioeconomic status and cultural diversities. These factors are particularly significant to urban indigenous peoples' experiences of diabetes and have à à à programs aimed at prevention and management which are based on local, participatory social research and experiences have been slow to develop in indigenous communities overall. 3 However, community-based approaches to diabetes have been in place for more than three decades within the urban indigenous community of Toronto, Canada. 4 This provides an opportunity to take a long view on the historical transformation of the politics of culture in the production of knowledge and practice within indigenous community-based diabetes programming in an urban setting.
Frontiers in Endocrinology, 2013
The Sandy Lake Health and Diabetes Project (SLHDP) was initiated in 1991 as a partnership between Sandy Lake First Nation and researchers interested in addressing the high rates of type 2 diabetes mellitus (T2DM) in the community. Following the expressed wishes of the community, the SLHDP has encompassed a variety of community-wide interventions and activities including: community surveys to document T2DM prevalence and risk factors, the Northern Store program aimed at increasing the availability and knowledge of healthy food options, a home visit program for the prevention and management of T2DM, a local diabetes radio show, a school diabetes curriculum for grades 3 and 4, a community-wide walking trail to encourage increased physical activity, youth diabetes summer camps, and a variety of community events focusing on nutrition and physical activity. Over the 22 year existence of the SLHDP, the community has taken ownership of the program and activities have evolved in alignment with community needs and priorities. This paper discusses the history, implementation, evaluation, and outcomes of the SLHDP and describes its sustainability. The SLHDP is a model of culturally appropriate participatory research that is iterative, with reciprocal capacity building for both key community stakeholders and academic partners.
Development of an integrated diabetes prevention program with First Nations in Canada
Health Promotion International, 2006
Type 2 diabetes mellitus is a major cause of morbidity and mortality among First Nations in Canada. We used multiple research methods to develop an integrated multiinstitutional diabetes prevention program based on the successful Sandy Lake Health and Diabetes Project and Apache Healthy Stores programs. In-depth interviews, a structured survey, demonstration and feedback sessions, group activities, and meetings with key stakeholders were used to generate knowledge about the needs and resources for each community, and to obtain feedback on SLHDP interventions. First Nations communities were eager to address the increasing epidemic of diabetes. Educating children through a school prevention program was the most popular proposed intervention. Remote communities had poorer access to healthy foods and more on-reserve media and services than the smaller semi-remote reserves. While the reserves shared similar risk factors for diabetes, variations in health beliefs and attitudes and environmental conditions required tailoring of programs to each reserve. In addition, it was necessary to balance community input with proven health promotion strategies. This study demonstrates the importance of formative research in developing integrated health promotion programs for multiple communities based on previously evaluated studies.
Objectives: To carry out a systematic review of interventions that have aimed at improving screening, treatment , prevention and management of type 2 diabetes and obesity-related chronic disease in Indigenous communities in Canada from 2008 to 2014, with the aim of identifying current best practices. Methods: A comprehensive literature review was carried out through an electronic database search using Medline, EMBASE, PubMED and Google scholar. Results: We identified 17 publications, comprising 13 evaluated interventions. Of them, 7 were school-based programs focused on children, 5 focused on adults, and 1 included both adults and children. Most interventions aimed at encouraging behaviour change, especially dietary change, but did little to address the underlying context of systemic marginalization and colonialism experienced in many Indigenous communities. Interventions focused on improving fitness were more effective than those aimed at dietary change. Overall, we found a range of successes among these interventions. Those that met with limited success reported that complex social issues and poverty presented challenges to effective intervention work in these communities. Participatory action research methods and community ownership of the intervention were found to be essential for project success. Conclusions: Diabetes-focused intervention research in Indigenous communities appears to be a low priority for Canadian funders and policymakers. More intervention research is urgently needed in these communities. To be effective, this work must take an approach that is historically deep and sufficiently broad as to enable the ideologic, policy and institutional changes necessary in order to achieve true equity. This will involve addressing colonialism, racism and social exclusion as broader determinants of health.
Social Science and …, 2003
Community public health interventions based on citizen and community participation are increasingly discussed as promising avenues for the reduction of health inequalities and the promotion of social justice. However, very few authors have provided explicit principles and guidelines for planning and implementing such interventions, especially when they are linked with research. Traditional approaches to public health programming emphasise expert knowledge, advanced detailed planning, and the separation of research from intervention. Despite the usefulness of these approaches for evaluating targeted narrow-focused interventions, they may not be appropriate in community health promotion, especially in Aboriginal communities. Using the experience of the Kahnawake Schools Diabetes Prevention Project, in Canada, this paper elaborates four principles as basic components for an implementation model of community programmes. The principles are: (1) the integration of community people and researchers as equal partners in every phase of the project, (2) the structural and functional integration of the intervention and evaluation research components, (3) having a flexible agenda responsive to demands from the broader environment, and (4) the creation of a project that represents learning opportunities for all those involved. The emerging implementation model for community interventions, as exemplified by this project, is one that conceives a programme as a dynamic social space, the contours and vision of which are defined through an ongoing negotiation process. r (L. Potvin). 0277-9536/03/$ -see front matter r 2002 Published by Elsevier Science Ltd. PII: S 0 2 7 7 -9 5 3 6 ( 0 2 ) 0 0 1 2 9 -6