Understanding how Indigenous culturally-based interventions can improve participants’ health in Canada (original) (raw)
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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.
Indigenous peoples in Canada have long suffered the disproportionate prevalence of Type 2 Diabetes Mellitus (T2DM) compared with the general population. While the Canadian government is currently making efforts towards addressing this health inequity, these have not been meaningful in engaging Indigenous peoples at the level of their perspectives of diseases, health and wellness. A literature review was conducted to explore the ways Indigenous health frameworks can be utilized to enhance the development of programs and initiatives aimed at addressing health inequities. Specifically, the Two-Eyed Seeing guiding principle was examined within the context of the Indigenous determinants of health to enhance the Aboriginal Diabetes Initiative (ADI). The recommendations proffered are centred around decolonizing Indigenous health by creating an ethical space were the strengths of both Western and Indigenous worldviews are utilized to improve the ADI and ameliorate the disproportionate prevalence of T2DM among Indigenous peoples in Canada.
Critique of a Community-Based Population Health Intervention in a First Nations Community (2016)
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 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.
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...
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.
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.
Health Education & Behavior, 2006
This article presents the impact results of a feasibility study in Canada for prevention of risk factors for diabetes in seven northwestern Ontario First Nations. Baseline and follow-up data were collected before and after the 9-month intervention program in schools, stores, and communities that aimed to improve diet and increase physical activity among adults. Regression analyses indicate a significant change in knowledge among respondents in intervention communities (p < .019). There was also a significant increase in frequency of healthy food acquisition among respondents in the intervention communities (p < .003). There were no significant changes in physical activity or body mass index in either intervention or comparison groups. The multi-institutional approach demonstrated promising results in modifying selected risk factors for diabetes First Nations communities.
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.