Case 3 : Coming Together to Promote Change: Best Practices to Prevent, Treat, and Manage Type 2 Diabetes in Indigenous Communities in Canada

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 help improve the situation in Indigenous communities in Canada. This case gives students a chance to explore the concept of traditional knowledge, its importance to Indigenous communities, and how it can and should be incorporated into interventions. After reading this case, students will understand the historical events that have created the current health predicament in these communities. If students understand the issues that have caused the problem, it can help dispel any negative preconceptions that students may have of Indigenous people. This case provides an avenue for Indigenous students to discuss issues that actually impact them, their families and communities

National survey of indigenous primary healthcare capacity and delivery models in Canada: the TransFORmation of IndiGEnous PrimAry HEAlthcare delivery (FORGE AHEAD) community profile survey

Background: There is a significant deficiency of national health information for Indigenous peoples in Canada. This manuscript describes the Community Profile Survey (CPS), a community-based, national-level survey designed to identify and describe existing healthcare delivery, funding models, and diabetes specific infrastructure and programs in Indigenous communities. Methods: The CPS was developed collaboratively through FORGE AHEAD and the First Nations and Inuit Health Branch of Health Canada. Regional and federal engagement and partnerships were built with Indigenous organizations to establish regionally-tailored distribution of the 8-page CPS to 440 First Nations communities. Results were collected (one survey per community) and reported in strata by region, with descriptive analyses performed on all variables. Results were shared with participating communities and regional/federal partners through tailored reports. Results: A total of 84 communities completed the survey (19% response rate). The majority of communities had a health centre/office to provide service to their patients with diabetes, with limited on-reserve hospitals for ambulatory or case-sensitive conditions. Few healthcare specialists were located on-site, with patients frequently travelling off-site (> 40 km) for diabetes-related complications. The majority of healthcare professionals on-site were Health Directors, Community Health Nurses, and Home Care Nurses. Many communities had a diabetes registry but few reported a diabetes surveillance system. Regional variation in healthcare services, diabetes programs, and funding models were noted, with most communities engaging in some type of innovative strategy to improve care for patients with diabetes. Conclusions: The CPS is the first community-based, national-level survey of its kind in Canada. Although the response rate was low, the CPS was distributed and successfully administered across a broad range of First Nations communities, and future considerations would benefit from a governance structure and leadership that strengthens community engagement, and a longitudinal research approach to increase the representativeness of the data. This type of information is important for communities and regions to inform decision making (maintain successes, and identify areas for improvement), strengthen health service delivery and infrastructure, increase accessibility to healthcare personnel, and allocate funding and/or resources to build capacity and foster a proactive chronic disease prevention and management approach for Indigenous communities across Canada. Trial registration: Current ClinicalTrial.gov protocol ID NCT02234973. Registered: September 9, 2014