Development of an integrated diabetes prevention program with First Nations in Canada

Abstract

SUMMARYType 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.

Prevalence and severity of household food insecurity of First Nations people living in an on-reserve, sub-Arctic community within the Mushkegowuk Territory

“…Collecting data with isolated communities is not without merit as each reserve has unique characteristics and many want local information to direct local policies and programmes (43)(44)(45) .…”

Retail food environments research in Canada: A scoping review

“…18,66 The earliest description of a food retail environment intervention was published in 2006. 67 It described the development of a multi-component diabetes prevention program in a First Nations community in Ontario that included a store component aimed at increasing the availability and promotion of nutritious foods. The findings of this intervention's impacts were mixed: frequency of healthy food acquisition improved among intervention residents compared with control residents, but no significant differences were found in BMI between groups.…”

Diabetes risk evaluation and microalbuminuria (DREAM) studies: ten years of participatory research with a First Nation’s home and community model for type 2 diabetes care in Northern Saskatchewan

“…Primary prevention is the ultimate goal for diabetes, yet despite current efforts (12)(13)(14), rates continue to rise (1). Until this goal is met, we must meet the challenge of managing the complications of diabetes and overcoming the barriers to care, which include geography, insufficient health human resources (10,15) and clinical inertia in adopting new evidencebased clinical practice guidelines (16).…”