Communities from coast to coast to coast are discovering unique, local ways of providing relief for people living with diabetes thanks to a partnership between Western and Indigenous community leaders.
Based at the Schulich School of Medicine & Dentistry, the FORGE AHEAD project empowers community advocates and providers in Indigenous communities to take a leading role in designing and implementing local health-care initiatives. The project looks to assist Type 2 diabetes patients in these communities, which experience the double issue of higher rates of the chronic condition and less adequate care.
Early successes can be attributed to the emphasis on local expertise, explained Schulich professor Dr. Stewart Harris. Solutions are not uniform and what works for one community may not for another, as needs and concerns vary by province, community isolation level and population.
“The community members are the experts at knowing what will work within their contexts,” said Harris, the Principal Investigator for FORGE AHEAD.
During the project, the FORGE AHEAD team met with local community leaders and provided them with numerous tools, including readiness consultations, ongoing coaching and support, an online diabetes registry and clinical-tracking system. The team also hosted a series of workshops where communities could share ideas and best practices among each other in order to move their initiatives forward.
In total, nine Indigenous communities from coast to coast to coast completed the program, each with their own set of goals and interventions.
The results were significant. Researchers noted improvements in clinical indicators for diabetes, including blood glucose control, blood pressure and LDL cholesterol for high-risk patients. They also saw an increase in the number of patients who participated in important diabetes management services including improvements in foot examinations and screening for kidney disease.
After the introduction of FORGE AHEAD, Type 2 diabetes patents were 51 per cent more likely to have had at least three-quarters of the recommended services for diabetes care as outlined by the Clinical Practice Guidelines from Diabetes Canada.
“This project was about finding innovative ways for each community to address their priorities,” said Harsh Zaran, Program Coordinator for FORGE AHEAD. “It was about creating the space for each community to leverage the strengths they already have. We helped to keep the momentum going by providing support and guidance through the process.”
On Miawpukek First Nation, the only reserve on the island portion of Newfoundland & Labrador, the FORGE AHEAD model was used to implement a number of programs, including a lunch-and-learn sports program for youth to improve physical activity; a data collection system to monitor diabetes patients; and a series of initiatives with pregnant woman to increase awareness of gestational diabetes management from pre-natal to post-natal.
“There is no cookie-cutter approach that works for all communities,” said Cynthia Benoit, a Miawpukek social worker. “FORGE AHEAD empowered the community to develop a plan to increase health outcomes for persons with diabetes and were instrumental in making sure our plan was reflective in supporting what was best for the communities and the health centres.
“The team did not dictate what we should do as a community. Instead, they supported us to work on our priorities from a community perspective. They supported the clinical and community teams to develop action plans based on the activities we felt would be beneficial to community members and relevant to the community.”
The FORGE AHEAD team – which stands for TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery – will now build upon the success to create a toolkit that can be scaled across the country with Indigenous partners. The new program will launch in early 2020.