Anisnabe Kekendazone Network Environment for Aboriginal Health Research

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Prevention of diabetes and related conditions

Blueberries growing in La Romaine, Quebec. 
Photo credit: Vidal Lebrun, Havre St-Pierre, Quebec

In Aboriginal communities across Canada type 2 diabetes has become a prevalent health issue, particularly compared with non-Aboriginal communities. In 2011, the Public Health Agency of Canada reported the age-standardized rates of diabetes were 17.2% among First Nations living on-reserve, 10.3% among First Nations living off reserve, and 7.3% among Métis, compared to 5.0% in the non-Aboriginal population. Complications from diabetes are more frequent among Aboriginals than non-Aboriginals.

Socio-cultural, environmental, and lifestyle changes—including less physical activity and moving away from traditional foods—have contributed to this negative trend over the last half century. AK researchers are deeply involved in community-led initiatives to restore traditional ways that can help prevent diabetes and related conditions across Canada.

Traditional foodways and diabetes prevention

Foodways are culturally-specific ways of obtaining, preparing and sharing food.

Diet and related foodways (eating habits, methods of food collection, food sources, etc.) are preventable causes of type 2 diabetes. In many First Nations households, traditional food has been replaced by processed food. AK researchers are building up research that looks at the role of traditional diet and foodways in the prevention of type 2 diabetes. 

Visit our page on foodways or about traditional food and diabetes prevention to learn more.


Kahnawake School Diabetes Prevention Project


The Kahnawake School Diabetes Prevention Project (KSDPP) is a participatory research initiative based in this Mohawk community southwest of Montréal, which brings together community members and researchers at McGill in an effort to fight type 2 diabetes. AK-NEAHR fellows Jon Salsberg, Treena Delormier, Morgan Kahentonni Phillips, Jayne Murdoch, and Soultana Macridis have also done research in connection with the Kahnawake program.

To learn more, visit the KSDPP project page or see the related publications below. 


Aboriginal views on diabetes


In 2003, AK co-investigator George Haas facilitated a joint fuzzy cognitive mapping (FCM) workshop between the Mohawk Council of Akwesasne and researchers from the Institute of the Environment at the University of Ottawa (C. Scott Findlay and Brian Giles) to explore Aboriginal views on the causes of diabetes. A similar initiative in 2005 used FCM to compare conventional science and Aboriginal perspectives on diabetes with the Miawpukek First Nation of Conne River, in Newfoundland. Results from these workshops have shaped our research approach to Aboriginal foodways in Canada.

For more information about these two initiatives, visit our page on Aboriginal views on diabetes.



Cargo M, Delormier T, Levesque L, McComber A, Macaulay AC. Community capacity as an "inside job": Evolution of perceived ownership of a university-Aboriginal community partnership. American Journal of Health Promotion 2011; 26(2), 96-100.
The authors assessed the evolution of perceived ownership of a university-Aboriginal community partnership in Kahnawake, Québec. They surveyed community partners involved in influencing decision making in the Kahnawake Schools Diabetes Prevention Project (KSDPP), using a measure of perceived primary ownership subjected to linear trend analysis. KSDPP staff were perceived as primary owners at the initial stage of the research partnership and sharing ownership with Community Advisory Board members at later stages. Trend tests indicated greater perceived ownership for board members and declining ownership for KSDPP staff over time. Academic partners were never perceived as primary owners. Although the project was community driven from the beginning, it took several years for the grassroots community board to take responsibility from KSDPP staff, which indicates the need for sustained funding to build grassroots community capacity.

Macridis S. Children’s Active Transportation to School: the role of parental perceptions, social connections and the neighbourhood environment in the success of a walking school bus program. Masters Thesis, Queen’s University 2011.
During the 2010-11 school year, the Kingston, Frontenac and Lennox & Addington Public Health agency partnered with Lancaster Drive Public School to develop a Walking School Bus Program. This study explores parental concerns and attitudes towards their children’s use of active transportation, perceptions of the social and built environment, and how these may affect parental willingness to allow their children to participate in the bus program. A low response rate did not allow comparisons of pre- and post-test results. Therefore, the author uses the pre-test data as a pilot study to evaluate the methods, tools, and feasibility of a future multi-school study. Even with low statistical power, attitudes of parents whose children had already used active transportation to school were significantly associated with willingness to use the program. This did not happen with parents of children who used inactive transportation. There were significant correlations between parental willingness and certain components of parental social network. User partners and other agencies can use these results to address barriers to the bus program and to advocate for improvements in the community infrastructure.

Giles B, Haas G, Šajna M, Findlay CS. Exploring Aboriginal Views of Health Using Fuzzy Cognitive Maps and Transitive Closure: A Case Study of the Determinants of Diabetes. Canadian Journal of Public Health September/October 2008: Vol. 99, No. 5.
This study demonstrates how fuzzy cognitive maps may be used to extract, present and compare Aboriginal perspectives, using the determinants of diabetes as a case study. Participants from the Mohawk Community of Akwesasne and the Miawpukek First Nation in Conne River created fuzzy cognitive maps (FCMs) detailing their views of “the causes of diabetes in their community”, through a group mapping session. Comparison of FCMs revealed significant heterogeneity in the perspectives of diabetes. The Akwesasne participants focused heavily on social, traditional and spiritual factors, while Conne River participants placed more importance on direct personal and lifestyle factors. There was, however, a core of strong, validated determinants related primarily to healthy diet and physical activity.

Giles BG, Findlay CS, Haas G, LaFrance B, Laughing W, Pembleton S. Integrating conventional science and aboriginal perspectives on diabetes using fuzzy cognitize maps. Social Science and Medicine 2007 Feb; 64(3): 562-76.
There is concern among Aboriginal communities in Canada that conventional approaches to the treatment of diabetes are ineffective in part because they fail to recognize the local Aboriginal perspective on the causal determinants of diabetes. Here, the authors use fuzzy cognitive mapping as a technique to represent and compare Canadian Aboriginal and conventional science perspectives on the determinants of diabetes as contained in published articles drawn from a search of Medline and PubMed (1966-2005). The FCM allows for a detailed description of the complex system of culture, spirituality and balance at the root of the Aboriginal view. It also highlights how, for these less tangible factors, it is possible to identify more concrete stressors and outcomes which are amenable to management and monitoring. This comparison of conventional and Aboriginal views also demonstrates the potential for FCM as a technique to extract, compare and integrate perspectives of different knowledge systems into health management and policy.

Salsberg J, Louttit S, McComber AM, Fiddler R, Naqshbandi M, Receveur O, Harris SB, Macaulay AC. Knowledge, Capacity and Readiness: Translating Successful Experiences in CBPR for Health Promotion. Pimatisiwin: A Journal of Indigenous and Aboriginal Community Health 2007; 5(2).
The authors explore the interrelationship between capacity building, community readiness and intercommunity knowledge translation. They examined two longstanding projects for the primary prevention of type 2 diabetes in Aboriginal communities, aiming to translate the lessons learned from those experiences into capacity for diabetes prevention in a third Aboriginal community. Reviewing external factors with the PRECEDE-PROCEED model of health promotion reveals that readiness for change requires both intra- and extra-community enabling factors, including expertise from other communities, federal health service funding, available research and intervention funding, and availability of external partners. These resources do not address the health issue directly, but rather build capacity for the community to address it. The authors found that an internally ready community, with an enabling, resource-rich external environment, can translate the knowledge from other successful community experiences to develop its own capacity for diabetes prevention.

Cargo M, Salsberg M, Delormier T, Desrosiers S, Macaulay AC. Understanding the social context of school health promotion program implementation. Health Education 2006; 106(2), 85-97.
The authors carried out a qualitative study to identify schoolteachers' role in implementing the Kahnawake Schools Diabetes Prevention Project (KSDPP), a locally governed Kanienke:háka (Mohawk) community-based diabetes prevention program. They interviewed 30 teachers, two administrators and one physical education teacher across four intervention years. They found that, in implementing KSDPP objectives, teachers adopted, to varying degrees, the roles of teaching the health education curriculum, enforcing the school nutrition policy, role modelling healthy lifestyles, and encouraging healthy lifestyles. Taken together, these roles point to a high-order role of teachers taking responsibility for enabling healthy lifestyles in their children, which is congruent with a holistic approach to health. The findings suggest that social context (i.e. teachers' roles) should be taken into account to implement health promotion program. Teachers would benefit from interventions that predispose, enable, and reinforce their capacity to adopt and apply health promotion roles.

Macaulay AC, Ing A, Salsberg J, McGregor A, Saad-Haddad C, Rice J, Montour L, Gray-Donald K. Community-based participatory research: sharing results with the community. An example of knowledge translation from the Kahnawake Schools Diabetes Prevention Project. Progress in Community Health Partnerships: Research, Education and Action 2007; 1(2), 143-152.
The authors documented lessons learned from sharing results of the Kahnawake Schools Diabetes Prevention Project (KSDPP) with the community, and analyzing feedback from attendees. Through qualitative analysis of discussions and open-ended comments, the researchers categorized comments about KSDPP, the program results, the community, and lifestyle habits. Lessons learned included the time needed to develop and make the presentations, the importance of using community knowledge to guide the experience, ways of attracting an audience and the use of feedback from those attending the presentations. The authors used community feedback to improve interventions and finalize interpretation of the results.

Lévesque L, Cargo M, Salsberg J. Development of the Physical Activity Interactive Recall (PAIR) for Aboriginal Children. International Journal of Behavioral Nutrition and Physical Activity 2004, 1:8.
Aboriginal children in Canada are at increased risk for type 2 diabetes. Given that physical inactivity is an important modifiable risk factor for type 2 diabetes, prevention efforts targeting Aboriginal children include interventions to enhance physical activity. These types of interventions require adequate assessment of physical activity patterns to identify determinants, detect trends, and evaluate progress towards intervention goals. The authors aimed to develop a culturally appropriate interactive computer program to self-report physical activity for Kanien'kehá:ka (Mohawk) children that could be administered in a group setting. This was an ancillary study of the ongoing Kahnawake Schools Diabetes Prevention Project (KSDPP).


Macaulay AC, Harris SB, Lévesque L, Cargo, Ford E, Salsberg J, et al. Primary prevention of type 2 diabetes: Experiences of two Aboriginal communities in Canada. Canadian Journal of Diabetes. 29(4) December 2003.
In Canada, the national age-adjusted rate of type 2 diabetes mellitus in Aboriginal peoples is 3 to 5 times higher than in the general population. There is an urgent need for culturally appropriate community-based primary prevention programs to reduce this epidemic. This paper describes the similarities and differences in design, intervention and evaluation between two successful and ongoing primary diabetes prevention projects in Canada: in the Kanien’kehá:ka (Mohawk) community of Kahnawake, geographically close to Montreal, Québec, and in the isolated Oji-Cree community of Ne gaaw saga’igan (Sandy Lake) in Northwestern Ontario. Both projects initiated a collaboration to elucidate their successes, developing a comprehensive picture of "best practice" and developing methods to measure intervention activities and incorporation of local traditions. They used this knowledge to inform local prevention practices and to partner with other Aboriginal communities for diabetes prevention.




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