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Gillies C, Blanchet R, Gokiert R, Farmer A, Thorlakson J, Hamonic L, Willows ND. School-based nutrition interventions for Indigenous children in Canada: a scoping review. BMC Public Health 2020; 20:11. [PMID: 31906984 PMCID: PMC6945607 DOI: 10.1186/s12889-019-8120-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 12/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background Indigenous children in Canada (First Nations, Inuit, and Métis) are disproportionately affected by nutrition-related chronic diseases such as obesity and diabetes. Comprehensive school-based nutrition interventions offer a promising strategy for improving children’s access to healthy foods and sustaining positive eating behaviors. However, little is known about school-based nutrition interventions for Indigenous children. The objectives of this scoping review were to identify school-based nutrition interventions for Indigenous children in Canada and describe their components. Methods The scoping review consisted of searches in seven peer-reviewed databases and a general web search for grey literature. Eligibility criteria were applied by two reviewers, and data were extracted and charted by one reviewer using components of the comprehensive school health approach (social and physical environment, teaching and learning, policy, partnerships and services) and additional components with relevance to Indigenous interventions (cultural content, Indigenous control and ownership, funding source, evaluation). Numerical and descriptive summaries were used to present findings. Results Thirty-four unique interventions met the inclusion criteria. The majority (97%) of interventions targeted the social and physical environment, most often by offering food programs. Over half of interventions also incorporated teaching and learning (56%) and partnerships and services (59%), but fewer included a policy component (38%). Many interventions included a cultural component (56%) and most (62%) were owned and controlled by Indigenous communities (62%). Finally, over half of interventions disclosed their source(s) of funding (59%), but less than half (41%) included an evaluation component. Conclusions The review suggests that school-based interventions for Indigenous children can be more comprehensive by incorporating culturally relevant nutrition education and professional development opportunities for teachers, written school nutrition policies, and activities that actively engage families and community members. The continued focus on Indigenous control and ownership and incorporation of content specific to individual communities may enhance cultural relevancy and sustainability of interventions. Furthermore, there is a need to increase intervention evaluation and the sharing of resources related to funding. These recommendations may be used by communities, as well as by researchers and professionals working with communities, in developing comprehensive school-based nutrition interventions to improve the eating behaviors of Indigenous children.
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Affiliation(s)
- Christina Gillies
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Rosanne Blanchet
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Rebecca Gokiert
- Faculty of Extension, University of Alberta, 10230 Jasper Avenue, Edmonton, AB, T5J 4P6, Canada
| | - Anna Farmer
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada
| | - Jessica Thorlakson
- University of Alberta Library, University of Alberta, Edmonton, AB, Canada
| | - Laura Hamonic
- University of Alberta Library, University of Alberta, Edmonton, AB, Canada
| | - Noreen D Willows
- Department of Agricultural, Food & Nutritional Science, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 2P5, Canada.
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Rasmus SM, Charles B, John S, Allen J. With a Spirit that Understands: Reflections on a Long-term Community Science Initiative to End Suicide in Alaska. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:34-45. [PMID: 31343758 PMCID: PMC6750997 DOI: 10.1002/ajcp.12356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This retrospective analysis of a long-term community-based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to indigenously drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup'ik region of Alaska. We examine more deeply the major episodes and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup'ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence into coalescing and transformation can occur.
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Affiliation(s)
- Stacy M. Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Billy Charles
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Simeon John
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - James Allen
- Department of Family Medicine and Biobehavioral Health & Memory Keepers Medical Discovery Team - American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth Campus, 624 E. 1st St., Suite 201, Duluth, MN 55805
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Tremblay MC, Martin DH, McComber AM, McGregor A, Macaulay AC. Understanding community-based participatory research through a social movement framework: a case study of the Kahnawake Schools Diabetes Prevention Project. BMC Public Health 2018; 18:487. [PMID: 29650020 PMCID: PMC5897940 DOI: 10.1186/s12889-018-5412-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP). METHODS This research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strategies included document (scientific and organizational) review (n = 51) and talking circles with four important community stakeholder groups (n = 24). RESULTS Findings provide an innovative and chronological perspective of the evolution of KSDPP as seen through a social movement lens, and identify intermediate outcomes associated with different dimensions of movement building achieved by the project over time (mobilization, leadership, vision and frames, alliance and partnerships, as well as advocacy and action strategies). It also points to areas of improvement for KSDPP in building its potential for action. CONCLUSION While this study's results are directly relevant and applicable to the local context of KSDPP, they also highlight useful lessons and conclusions for the planning and evaluation of other long-standing and sustainable CBPR initiatives. The conceptual framework provides meaningful benchmarks to track evidence of progress in the context of CBPR. Findings from the study offer new ways of thinking about the evaluation of CBPR projects and their progress by drawing on frameworks that guide other forms of collective action.
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Affiliation(s)
- Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Office of Education and Continuing Professional Development, Université Laval, 1050, de la Médecine, Pavillon Ferdinand-Vandry, 2881-F, Québec, QC, G1V 0A6, Canada.
| | - Debbie H Martin
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Alex M McComber
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Amelia McGregor
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada
| | - Ann C Macaulay
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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Salsberg J, Macridis S, Garcia Bengoechea E, Macaulay AC, Moore S. Engagement strategies that foster community self-determination in participatory research: Insider ownership through outsider championship. Fam Pract 2017; 34:336-340. [PMID: 28334802 DOI: 10.1093/fampra/cmx001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In order to maximize the benefits of community-based participatory research, effective ownership over the research process must be at least equally in the hands of the community. A previous social network analysis documented that the participatory research process shifted ownership from academic to community partners, but did not show what actions and strategies fostered this shift. OBJECTIVES This study follows the trajectory of a community-academic partnership and asks, from the perspective of the project stakeholders, which actions and strategies over the lifespan of the research led to the observed shift in ownership and decision-making from the original external academics to the community stakeholders? METHODS Qualitative description using inductive thematic analysis. One academic and five community stakeholders identified as central in a previous social network analysis, participated in retrospective, semi-structured interviews. RESULTS Actions deemed to have fostered the observed shift in ownership included: existence of a strong champion; stimulating 'outside' ideas; emergence of core people; alignment of project goals with stakeholders' professional roles; involving the right people; personal qualities of the champion; trust-building; and active use of participatory engagement strategies. CONCLUSION Although communities must take ownership over the research process to assure sustained action and change, a strong, trusted and accepted outside champion who actively enacts participatory engagement strategies can facilitate the participatory process and provide community stakeholders the time and support they need to achieve meaningful and sustained leadership roles. These findings have implications for how partnership research is designed and implemented, both in community and in clinical organisational settings.
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Affiliation(s)
- Jon Salsberg
- Department of Family Medicine, McGill University, Montreal, Canada.,Kahnawake Schools Diabetes Prevention Project (KSDPP), Kahnawake, Canada
| | - Soultana Macridis
- Kahnawake Schools Diabetes Prevention Project (KSDPP), Kahnawake, Canada.,Alberta Centre for Active Living, Faculty of Physical Education & Recreation, University of Alberta, Edmonton, Canada
| | | | - Ann C Macaulay
- Department of Family Medicine, McGill University, Montreal, Canada.,Kahnawake Schools Diabetes Prevention Project (KSDPP), Kahnawake, Canada
| | - Spencer Moore
- Arnold School of Public Health, University of South Carolina, Columbia, USA
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Jagosh J, Bush PL, Salsberg J, Macaulay AC, Greenhalgh T, Wong G, Cargo M, Green LW, Herbert CP, Pluye P. A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC Public Health 2015. [PMID: 26223523 PMCID: PMC4520009 DOI: 10.1186/s12889-015-1949-1] [Citation(s) in RCA: 302] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-Based Participatory Research (CBPR) is an approach in which researchers and community stakeholders form equitable partnerships to tackle issues related to community health improvement and knowledge production. Our 2012 realist review of CBPR outcomes reported long-term effects that were touched upon but not fully explained in the retained literature. To further explore such effects, interviews were conducted with academic and community partners of partnerships retained in the review. Realist methodology was used to increase the understanding of what supports partnership synergy in successful long-term CBPR partnerships, and to further document how equitable partnerships can result in numerous benefits including the sustainability of relationships, research and solutions. METHODS Building on our previous realist review of CBPR, we contacted the authors of longitudinal studies of academic-community partnerships retained in the review. Twenty-four participants (community members and researchers) from 11 partnerships were interviewed. Realist logic of analysis was used, involving middle-range theory, context-mechanism-outcome configuration (CMOcs) and the concept of the 'ripple effect'. RESULTS The analysis supports the central importance of developing and strengthening partnership synergy through trust. The ripple effect concept in conjunction with CMOcs showed that a sense of trust amongst CBPR members was a prominent mechanism leading to partnership sustainability. This in turn resulted in population-level outcomes including: (a) sustaining collaborative efforts toward health improvement; (b) generating spin-off projects; and (c) achieving systemic transformations. CONCLUSION These results add to other studies on improving the science of CBPR in partnerships with a high level of power-sharing and co-governance. Our results suggest sustaining CBPR and achieving unanticipated benefits likely depend on trust-related mechanisms and a continuing commitment to power-sharing. These findings have implications for building successful CBPR partnerships to address challenging public health problems and the complex assessment of outcomes.
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Affiliation(s)
- Justin Jagosh
- Centre for the Advancement of Realist Evaluation and Synthesis, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK.
| | - Paula L Bush
- Department of Family Medicine, 5858 Ch. de la Cote-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Jon Salsberg
- Department of Family Medicine, 5858 Ch. de la Cote-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Ann C Macaulay
- Department of Family Medicine, 5858 Ch. de la Cote-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Margaret Cargo
- University of Southern Australia, School of Population Health, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Lawrence W Green
- Department of Epidemiology and Biostatistics, University of California at San Francisco, Box 0981, UCSF, San Francisco, CA, 94143-0981, USA.
| | - Carol P Herbert
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
| | - Pierre Pluye
- Department of Family Medicine, 5858 Ch. de la Cote-des-Neiges, 3rd floor, Montreal, QC, H3S 1Z1, Canada.
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Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner‐Brown J, Krause LK. Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database Syst Rev 2015; 2015:CD009905. [PMID: 26075988 PMCID: PMC10656573 DOI: 10.1002/14651858.cd009905.pub2] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models. OBJECTIVES To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations. SEARCH METHODS We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014). SELECTION CRITERIA Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias for each study. MAIN RESULTS Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported. AUTHORS' CONCLUSIONS Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.
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Affiliation(s)
- Laurie M Anderson
- University of WashingtonDepartment of Epidemiology, School of Public HealthP.O. Box 357236SeattleWAUSA98195‐7236
| | - Kathryn L Adeney
- Washington State Institute for Public PolicyEpidemiology and Public Health110 Fifth Avenue SE, Suite 214SeattleWAUSA98504
| | - Carolynne Shinn
- New Hampshire Department of Health and Human ServicesNew Hampshire Division of Public Health ServicesConcordNew HampshireUSA03301‐3852
| | - Sarah Safranek
- University of WashingtonHealth Sciences Library1959 NE Pacific StreetSeattleWAUSA98195‐7155
| | - Joyce Buckner‐Brown
- Centers for Disease Control and PreventionNational Center for Chronic Disease Prevention and Health Promotion, Division of Community Health, Research Surveillance & Evaluation Branch4770 Buford Hwy NE, Mailstop K81AtlantaGeorgiaUSA30341
| | - L Kendall Krause
- Bill & Melinda Gates FoundationEpidemiology and Surveillance DivisionSeattleWAUSA
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Pearson CR, Duran B, Oetzel J, Margarati M, Villegas M, Lucero J, Wallerstein N. Research for improved health: variability and impact of structural characteristics in federally funded community engaged research. Prog Community Health Partnersh 2015; 9:17-29. [PMID: 25981421 PMCID: PMC4804466 DOI: 10.1353/cpr.2015.0010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Although there is strong scientific, policy, and community support for community-engaged research (CEnR)-including community-based participatory research (CBPR)-the science of CEnR is still developing. OBJECTIVE To describe structural differences in federally funded CEnR projects by type of research (i.e., descriptive, intervention, or dissemination/policy change) and race/ethnicity of the population served. METHODS We identified 333 federally funded projects in 2009 that potentially involved CEnR, 294 principal investigators/project directors (PI/PD) were eligible to participate in a key informant (KI) survey from late 2011 to early 2012 that asked about partnership structure (68% response rate). RESULTS The National Institute on Minority Health & Health Disparities (19.1%), National Cancer Institute (NCI; 13.3%), and the Centers for Disease Control and Prevention (CDC; 12.6%) funded the most CEnR projects. Most were intervention projects (66.0%). Projects serving American Indian or Alaskan Native (AIAN) populations (compared with other community of color or multiple-race/unspecified) were likely to be descriptive projects (p<.01), receive less funding (p<.05), and have higher rates of written partnership agreements (p<.05), research integrity training (p<.05), approval of publications (p<.01), and data ownership (p<.01). AIAN-serving projects also reported similar rates of research productivity and greater levels of resource sharing compared with those serving multiple-race/unspecified groups. CONCLUSIONS There is clear variability in the structure of CEnR projects with future research needed to determine the impact of this variability on partnering processes and outcomes. In addition, projects in AIAN communities receive lower levels of funding yet still have comparable research productivity to those projects in other racial/ethnic communities.
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Abstract
BACKGROUND The medical research enterprise depends on public recognition of its societal value. In light of evidence indicating public mistrust, especially among minorities, inadequate enrollment as well as diversity of research participants, and poor uptake of findings, medical research seems to fall short of sufficient public regard. Community engagement in medical research, with special attention to minority communities, may help to remedy this shortfall by demonstrating respect for the communities in practical ways. APPROACH We provided 3 case examples that illustrate how specific approaches to community-engaged research can build trust between researchers and communities, encourage participation among underrepresented groups, and enhance the relevance as well as the uptake of research findings. DISCUSSION A common attribute of the specific approaches discussed here is that they enable the researchers to demonstrate respect by recognizing community values and interests. The demonstration of respect for the communities has intrinsic ethical importance. CONCLUSIONS The 2 potential outgrowths of demonstrating respect specifically through community engagement are (1) the production of research that is more relevant to the community and (2) the mitigation of asymmetry in the researcher-community relationship. We summarized practical resources available to researchers who seek to incorporate community engagement in their research.
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Affiliation(s)
- Jessica K. Holzer
- Postdoctoral Fellow, Yale University School of Public Health Department of Health Policy and Management
| | - Lauren Ellis
- PhD student in the Bioethics and Health Policy Track, Johns Hopkins University Bloomberg School of Public Health Department of Health Policy and Management, and Berman Institute of Bioethics
| | - Maria W. Merritt
- Associate Professor, Johns Hopkins University Berman Institute of Bioethics and Bloomberg School of Public Health Department of International Health
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Jull J, Stacey D, Giles A, Boyer Y. Shared decision-making and health for First Nations, Métis and Inuit women: a study protocol. BMC Med Inform Decis Mak 2012; 12:146. [PMID: 23249503 PMCID: PMC3541952 DOI: 10.1186/1472-6947-12-146] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 11/07/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Little is known about shared decision-making (SDM) with Métis, First Nations and Inuit women ("Aboriginal women"). SDM is a collaborative process that engages health care professional(s) and the client in making health decisions and is fundamental for informed consent and patient-centred care. The objective of this study is to explore Aboriginal women's health and social decision-making needs and to engage Aboriginal women in culturally adapting an SDM approach. METHODS Using participatory research principles and guided by a postcolonial theoretical lens, the proposed mixed methods research will involve three phases. Phase I is an international systematic review of the effectiveness of interventions for Aboriginal peoples' health decision-making. Developed following dialogue with key stakeholders, proposed methods are guided by the Cochrane handbook and include a comprehensive search, screening by two independent researchers, and synthesis of findings. Phases II and III will be conducted in collaboration with Minwaashin Lodge and engage an urban Aboriginal community of women in an interpretive descriptive qualitative study. In Phase II, 10 to 13 Aboriginal women will be interviewed to explore their health/social decision-making experiences. The interview guide is based on the Ottawa Decision Support Framework and previous decisional needs assessments, and as appropriate may be adapted to findings from the systematic review. Digitally-recorded interviews will be transcribed verbatim and analyzed inductively to identify participant decision-making approaches and needs when making health/social decisions. In Phase III, there will be cultural adaptation of an SDM facilitation tool, the Ottawa Personal Decision Guide, by two focus groups consisting of five to seven Aboriginal women. The culturally adapted guide will undergo usability testing through individual interviews with five to six women who are about to make a health/social decision. Focus groups and individual interviews will be digitally-recorded, transcribed verbatim, and analyzed inductively to identify the adaptation required and usability of the adapted decision guide. DISCUSSION Findings from this research will produce a culturally sensitive intervention to facilitate SDM within a population of urban Aboriginal women, which can subsequently be evaluated to determine impacts on narrowing health/social decision-making inequities.
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Affiliation(s)
- Janet Jull
- Institute of Population Health, Faculty of Graduate and Postdoctoral Studies, University of Ottawa, Ottawa, Canada
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Audrey Giles
- School of Human Kinetics,Faculty of Health Science, University of Ottawa, Ottawa, Canada
| | - Yvonne Boyer
- Faculty of Graduate and Postdoctoral Studies, University of Ottawa, Ottawa, Canada
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Clavier C, Sénéchal Y, Vibert S, Potvin L. A theory-based model of translation practices in public health participatory research. SOCIOLOGY OF HEALTH & ILLNESS 2012; 34:791-805. [PMID: 21929647 DOI: 10.1111/j.1467-9566.2011.01408.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This article explores the innovative practices of actors specifically mandated to support interactions between academic researchers and their partners from the community during public health participatory research. Drawing on the concept of translation as developed in actor-network theory and found in the literature on knowledge transfer and the sociology of intermediate actors, we build a theory-based model of the translation practices developed by these actors at the interface between community and university. We refine this model by using it to analyse material from two focus groups comprising participants purposively selected because they work at the nexus between research and practice. Our model of translation practices includes cognitive (dealing with the contents of the research), strategic (geared to facilitating the research process and balancing power relationships among the partners) and logistic practices (the hands-on tasks of coordination). Combined, these three types of translation practices demonstrate that actors working at the interface in participatory research contribute to multidirectional exchanges and the co-construction of knowledge among research partners. Beyond the case of participatory research, theorising translation practices helps understand how knowledge is produced at the interface between academic and experiential (or lay) knowledge.
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Affiliation(s)
- Carole Clavier
- Direction de Santé Publique de Montréal (Montreal Public Health Directorate), Canada Department of Sociology, University of Montreal, Canada.
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Willows ND, Hanley AJG, Delormier T. A socioecological framework to understand weight-related issues in Aboriginal children in Canada. Appl Physiol Nutr Metab 2012; 37:1-13. [PMID: 22269027 DOI: 10.1139/h11-128] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Obesity prevention efforts in Aboriginal (First Nations, Métis, or Inuit) communities in Canada should focus predominantly on children given their demographic significance and the accelerated time course of occurrence of type 2 diabetes mellitus in the Aboriginal population. A socioecological model to address childhood obesity in Aboriginal populations would focus on the numerous environments at different times in childhood that influence weight status, including prenatal, sociocultural, family, and community environments. Importantly, for Aboriginal children, obesity interventions need to also be situated within the context of a history of colonization and inequities in the social determinants of health. This review therefore advocates for the inclusion of a historical perspective and a life-course approach to obesity prevention in Aboriginal children in addition to developing interventions around the socioecological framework. We emphasize that childhood obesity prevention efforts should focus on promoting maternal health behaviours before and during pregnancy, and on breastfeeding and good infant and child nutrition in the postpartum and early childhood development periods. Ameliorating food insecurity by focusing on improving the sociodemographic risk factors for it, such as increasing income and educational attainment, are essential. More research is required to understand and measure obesogenic Aboriginal environments, to examine how altering specific environments modifies the foods that children eat and the activities that they do, and to examine how restoring and rebuilding cultural continuity in Aboriginal communities modifies the many determinants of obesity. This research needs to be done with the full participation of Aboriginal communities as partners in the research.
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Affiliation(s)
- Noreen D Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5, Canada.
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Cargo MD, Delormier T, Lévesque L, McComber AM, Macaulay AC. Community Capacity as an “Inside Job”: Evolution of Perceived Ownership within a University-Aboriginal Community Partnership. Am J Health Promot 2011; 26:96-100. [DOI: 10.4278/ajhp.091229-arb-403] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To assess the evolution of perceived ownership of a university-Aboriginal community partnership across three project stages. Design. Survey administration to project partners during project formalization (1996—T1), mobilization (1999—T2), and maintenance (2004—T3). Setting. Aboriginal community of Kahnawake, outside Montreal, Quebec, Canada. Participants. Partners involved in influencing decision making in the Kahnawake Schools Diabetes Prevention Project (KSDPP). Measure and Analysis. A measure of perceived primary ownership subjected to linear trend analysis. Results. KSDPP staff were perceived as primary owner at T1 and shared ownership with Community Advisory Board (CAB) members at T2 and T3. Trend tests indicated greater perceived ownership between T1 and T3 for CAB (χ21 = 12.3, p < .0001) and declining KSDPP staff (χ21 = 10.5, p < .001) ownership over time. Academic partners were never perceived as primary owners. Conclusion. This project was community driven from the beginning. It was not dependent on an external academic change agent to activate the community and develop the community's capacity to plan and implement a solution. It still took several years for the grassroots CAB to take responsibility from KSDPP staff, thus indicating the need for sustained funding to build grassroots community capacity.
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Affiliation(s)
- Margaret D. Cargo
- Margaret D. Cargo, PhD, is with the School of Health Sciences, University of South Australia, Adelaide, South Australia. Margaret D. Cargo, PhD, is also with the Douglas Hospital Research Centre, McGill University, Verdun, Quebec, Canada. Ann C. Macaulay, CM, MD, FCFP, is with Participatory Research at McGill, Department of Family Medicine, McGill University, Verdun, Québec, Canada. Treena Delormier, PDt, and Alex M. McComber, MEd, are with the Kahnawake Schools Diabetes Prevention Project, Kahnawake
| | - Treena Delormier
- Margaret D. Cargo, PhD, is with the School of Health Sciences, University of South Australia, Adelaide, South Australia. Margaret D. Cargo, PhD, is also with the Douglas Hospital Research Centre, McGill University, Verdun, Quebec, Canada. Ann C. Macaulay, CM, MD, FCFP, is with Participatory Research at McGill, Department of Family Medicine, McGill University, Verdun, Québec, Canada. Treena Delormier, PDt, and Alex M. McComber, MEd, are with the Kahnawake Schools Diabetes Prevention Project, Kahnawake
| | - Lucie Lévesque
- Margaret D. Cargo, PhD, is with the School of Health Sciences, University of South Australia, Adelaide, South Australia. Margaret D. Cargo, PhD, is also with the Douglas Hospital Research Centre, McGill University, Verdun, Quebec, Canada. Ann C. Macaulay, CM, MD, FCFP, is with Participatory Research at McGill, Department of Family Medicine, McGill University, Verdun, Québec, Canada. Treena Delormier, PDt, and Alex M. McComber, MEd, are with the Kahnawake Schools Diabetes Prevention Project, Kahnawake
| | - Alex M. McComber
- Margaret D. Cargo, PhD, is with the School of Health Sciences, University of South Australia, Adelaide, South Australia. Margaret D. Cargo, PhD, is also with the Douglas Hospital Research Centre, McGill University, Verdun, Quebec, Canada. Ann C. Macaulay, CM, MD, FCFP, is with Participatory Research at McGill, Department of Family Medicine, McGill University, Verdun, Québec, Canada. Treena Delormier, PDt, and Alex M. McComber, MEd, are with the Kahnawake Schools Diabetes Prevention Project, Kahnawake
| | - Ann C. Macaulay
- Margaret D. Cargo, PhD, is with the School of Health Sciences, University of South Australia, Adelaide, South Australia. Margaret D. Cargo, PhD, is also with the Douglas Hospital Research Centre, McGill University, Verdun, Quebec, Canada. Ann C. Macaulay, CM, MD, FCFP, is with Participatory Research at McGill, Department of Family Medicine, McGill University, Verdun, Québec, Canada. Treena Delormier, PDt, and Alex M. McComber, MEd, are with the Kahnawake Schools Diabetes Prevention Project, Kahnawake
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13
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Eriksson A, Axelsson R, Bihari Axelsson S. Development of health promoting leadership – experiences of a training programme. HEALTH EDUCATION 2010. [DOI: 10.1108/09654281011022441] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Jacobs B, Roffenbender J, Collmann J, Cherry K, Bitsói LL, Bassett K, Evans CH. Bridging the divide between genomic science and indigenous peoples. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2010; 38:684-696. [PMID: 20880250 DOI: 10.1111/j.1748-720x.2010.00521.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The new science of genomics endeavors to chart the genomes of individuals around the world, with the dual goals of understanding the role genetic factors play in human health and solving problems of disease and disability. From the perspective of indigenous peoples and developing countries, the promises and perils of genomic science appear against a backdrop of global health disparity and political vulnerability. These conditions pose a dilemma for many communities when attempting to decide about participating in genomic research or any other biomedical research. Genomic research offers the possibility of improved technologies for managing the acute and chronic diseases that plague their members. Yet, the history of particularly biomedical research among people in indigenous and developing nations offers salient examples of unethical practice, misuse of data, and failed promises. This dilemma creates risks for communities who decide either to participate or not to participate in genomic science research. Some argue that the history of poor scientific practice justifies refusal to join genomic research projects. Others argue that disease poses such great threats to the well-being of people in indigenous communities and developing nations that not participating in genomic research risks irrevocable harm. Thus, some communities particularly among indigenous peoples have declined to participate as subjects in genomic research. At the same time, some communities have begun developing new guidelines, procedures, and practices for engaging with the scientific community that offer opportunities to bridge the gap between genomic science and indigenous and/or developing communities. Four new approaches warrant special attention and further support: consulting with local communities; negotiating the complexities of consent; training members of local communities in science and health care; and training scientists to work with indigenous communities. Implicit is a new definition of "rigorous scientific research," one that includes both community development and scientific progress as legitimate objectives of genomic research. Innovative translational research is needed to develop practical, mutually acceptable methods for crossing the divide between genomic researchers and indigenous communities. This may mean the difference between success and failure in genomic science, and in improving health for all peoples.
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Affiliation(s)
- Bette Jacobs
- O'Neill Health Law Institute, Georgetown University
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15
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Abstract
Promoting cultural competency in health care was examined from the Canadian perspective, and explored practice environments and educational programs for future health professionals that foster cultural awareness and support culturally sensitive care. Many of the issues raised are generic and likely to occur whenever patients' health practices and beliefs differ from conventional Western care. The main theme that emerged with respect to the practice environment was the use of a participatory action approach to foster collaboration with patients, traditional healers and the community. Successful collaboration is likely to result in a blend of ideas and perspectives from traditional health practices and conventional Western health care. With respect to education, programs need to focus on providing opportunities both in the classroom and in the clinical arena for students to work in interprofessional teams. These teams should not only comprise partners from medicine, nursing, physical therapy and other health professions but also include aboriginal paraprofessionals. Pedagogical initiatives also need to incorporate case-based formats and interactive sessions with patients and families. The principles underlying this approach: openness, mutual respect, inclusiveness, responsiveness and understanding one's roles should be fundamental to the delivery of culturally competent health care to all ethnic communities.
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16
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Conference on "Multidisciplinary approaches to nutritional problems". Symposium on "Diabetes and health". Nutrition interventions for the prevention of type 2 diabetes. Proc Nutr Soc 2008; 68:55-70. [PMID: 19068148 DOI: 10.1017/s0029665108008823] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diabetes mellitus is escalating globally and it is predicted that 200 million individuals worldwide will have diabetes by 2010 and 300 million by 2025. However, there is compelling evidence from many studies that for subjects with impaired fasting glucose or impaired glucose tolerance the presentation of type 2 diabetes can be delayed by lifestyle modification. The aim of the present review is to present a summary of lifestyle modification interventions that have included a dietary component in their overall diabetes prevention programme. Medline, allied health literature and diabetes journals were searched for peer-reviewed literature using the terms 'diet*' and 'diabetes' and 'intervention'. Inclusion criteria were: peer-reviewed studies from 1975 to 2008; a sample of at least fifty subjects; a healthy eating and/or physical activity component; prevention of diabetes as a primary goal. Generally, the participants were in a high-risk category for the development of diabetes. Outcomes were evaluated at two points in time (pre- and post-intervention) in terms of knowledge, behaviour change and clinical improvement, which included weight, blood pressure, BMI, body fat, waist circumference, waist:hip ratio and physiological and/or biochemical measures. Findings indicate that the most successful interventions combine individual dietary counselling with an activity component. Further factors predicting success are weight loss achieved, duration and intensity of the intervention and dietary compliance.
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Cargo M, Delormier T, Lévesque L, Horn-Miller K, McComber A, Macaulay AC. Can the democratic ideal of participatory research be achieved? An inside look at an academic-indigenous community partnership. HEALTH EDUCATION RESEARCH 2008; 23:904-914. [PMID: 18187491 DOI: 10.1093/her/cym077] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Democratic or equal participation in decision making is an ideal that community and academic stakeholders engaged in participatory research strive to achieve. This ideal, however, may compete with indigenous peoples' right to self-determination. Study objectives were to assess the perceived influence of multiple community (indigenous) and academic stakeholders engaged in the Kahnawake Schools Diabetes Prevention Project (KSDPP) across six domains of project decision making and to test the hypothesis that KSDPP would be directed by community stakeholders. Self-report surveys were completed by 51 stakeholders comprising the KSDPP Community Advisory Board (CAB), KSDPP staff, academic researchers and supervisory board members. KSDPP staff were perceived to share similar levels of influence with (i) CAB on maintaining partnership ethics and CAB activities and (ii) academic researchers on research and dissemination activities. KSDPP staff were perceived to carry significantly more influence than other stakeholders on decisions related to annual activities, program operations and intervention activities. CAB and staff were the perceived owners of KSDPP. The strong community leadership aligns KSDPP with a model of community-directed research and suggests that equitable participation-distinct from democratic or equal participation-is reflected by indigenous community partners exerting greater influence than academic partners in decision making.
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Affiliation(s)
- Margaret Cargo
- Psychosocial Research Division, Douglas Hospital Research Centre-McGill University, Verdun, Québec, Canada H4H 1R3.
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18
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Cargo M, Mercer SL. The Value and Challenges of Participatory Research: Strengthening Its Practice. Annu Rev Public Health 2008; 29:325-50. [PMID: 18173388 DOI: 10.1146/annurev.publhealth.29.091307.083824] [Citation(s) in RCA: 515] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Margaret Cargo
- Department of Psychiatry and Douglas Mental Health University Institute, McGill University, Verdun, Quebec H4H 1R3, Canada
- Current address: School of Health Sciences, University of South Australia, City East Campus, Adelaide, South Australia 5001;
| | - Shawna L. Mercer
- The Guide to Community Preventive Services, Division of Health Communications, National Center for Health Marketing, Centers for Disease Control and Prevention, Atlanta, Georgia 30333;
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19
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Abstract
Although Hawaii boasts relatively low rates of death from heart disease and stroke, past data suggest that Native Hawaiians bear a disproportionate burden of mortality from cardiovascular disease (CVD). This study examined 2005-2006 data on CVD mortality and risk factors to see if disparities experienced historically by Native Hawaiians have continued, increased, or been reduced. Existing data were reviewed related to CVD and risk factors for Native Hawaiians in Hawaii and compared with statewide and US rates. These data show that Native Hawaiians are experiencing continuing and perhaps growing disparities in CVD mortality rates and risk factor prevalence. Nevertheless, increased support for enlightened social policy and community-directed problem solving can help reduce CVD health disparities experienced by Native Hawaiians. Future research should be directed at better delineation of the various components of cardiometabolic risk and culturally sensitive, and educationally appropriate approaches to CVD risk reduction.
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20
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Abstract
Participation enjoys a very special status in health promotion discourse. Conceptualised both as a process and a valued outcome, it is often viewed as a defining feature and a key principle of health promotion (Robertson & Minkler, 1994; Rootman, Goodstadt, Potvin & Springett, 2001). Taking advantage of an undisputable position as a cardinal value, the role of participation has rarely been critically examined in relation to health promotion practice and its contribution to public health. The questions regarding the role of participation and how, in practice, practitioners can facilitate and support its emergence, have not been given satisfactory answers. Answers to these crucial questions can only result from a theoretical understanding of what participation entails in terms of action in the social situations of health promotion interventions. Theorizing on the role of participation in health promotion and on the social processes at play when it occurs is a prerequisite to reframing participation as a professional practice rather than as an ideology (see Pelikan, Chapter 6), and to develop appropriate procedures that can foster the conditions for effective participation.
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21
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Quantz D, Thurston WE. Representation strategies in public participation in health policy: The Aboriginal Community Health Council. Health Policy 2006; 75:243-50. [PMID: 16399168 DOI: 10.1016/j.healthpol.2005.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
Abstract
Within Canada's Aboriginal population, an ongoing health promotion strategy has been the facilitation of community participation in the development and application of health policy. The Calgary Health Region's Aboriginal Community Health Council has provided a setting for involving the local Aboriginal population in health policy and program development for over a decade. This paper represents the results of a case study to identify the Council's strategies for this work. Data sources included documents, such as meeting minutes and other reports; key informant interviews with past and present Council members and health region representatives; and participant observation of Council functions. Although direct membership in the Council provided a core approach for representing the community, other strategies were actively utilized to involve the public. These included building links and partnerships with community organizations, networking, consultation activities and the identification of special needs groups.
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Affiliation(s)
- Darryl Quantz
- Vancouver Coastal Health, 301-555 West 8th Avenue, Vancouver, BC, Canada V5Z 1C6.
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Macaulay AC, Nutting PA. Moving the frontiers forward: incorporating community-based participatory research into practice-based research networks. Ann Fam Med 2006; 4:4-7. [PMID: 16449390 PMCID: PMC1466984 DOI: 10.1370/afm.509] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 12/14/2005] [Indexed: 11/09/2022] Open
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Abstract
Prevention research aims to address health and social problems via systematic strategies for affecting and documenting change. To produce meaningful and lasting results at the level of the community, prevention research frequently requires investigators to reevaluate the boundaries that have traditionally separated them from the subjects of their investigations. New tools and techniques are required to facilitate collaboration between researchers and communities while maintaining scientific rigor. This article describes the tribal participatory research approach, which was developed to facilitate culturally centered prevention research in American Indian and Alaska Native communities. This approach is discussed within the broader context of community-based participatory research, an increasingly prevalent paradigm in the prevention field. Strengths and limitations of the approach used in the study are presented.
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Paradis G, Lévesque L, Macaulay AC, Cargo M, McComber A, Kirby R, Receveur O, Kishchuk N, Potvin L. Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien'keha:ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project. Pediatrics 2005; 115:333-9. [PMID: 15687441 DOI: 10.1542/peds.2004-0745] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Report the 8-year impact on body size, physical activity, and diet of a community-based diabetes prevention program for elementary-school children in a Kanien'keha:ka (Mohawk) community in Canada. METHODS Follow-up (1994-1996) of subjects in the intervention and comparison community and repeat cross-sectional measurements in the intervention community alone from 1994 to 2002. Measures included triceps and subscapular skinfold thicknesses, body mass index (BMI), weekly number of 15-minute episodes of physical activity, run/walk test times, television watching, and consumption of sugared foods, fatty foods, and fruits and vegetables. RESULTS The longitudinal data of 1994-1996 showed some early positive effects of the program on skinfold thickness but not on BMI, physical activity, fitness, or diet. Repeat cross-sectional measures from 1994 to 2002 showed increases in skinfold thickness and BMI. Physical activity, fitness, and television watching showed favorable trends from 1994 to 1999 that were not sustained in 2002. Key high-fat and high-sugar foods consumption decreased, as did consumption of fruits and vegetables. CONCLUSIONS Although early results showed some successes in reducing risk factors for type 2 diabetes, these benefits were not maintained over 8 years.
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Affiliation(s)
- Gilles Paradis
- Direction de Santé Publique de Montréal and Division of Preventive Medicine, McGill University Health Center, Montreal, Quebec, Canada.
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25
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MacQueen KM, Buehler JW. MACQUEEN AND BUEHLER RESPOND. Am J Public Health 2004. [DOI: 10.2105/ajph.94.11.1841-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Kathleen M. MacQueen
- Kathleen M. MacQueen is with Family Health International, Durham, NC. James W. Buehler is with the Center for Public Health Preparedness and Research, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - James W. Buehler
- Kathleen M. MacQueen is with Family Health International, Durham, NC. James W. Buehler is with the Center for Public Health Preparedness and Research, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
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