COMMUNITY MOBILIZATION TRAINING (CMT) FOR DIABETES PREVENTION: READINESS & ENGAGEMENT 2018 NATIONAL INDIGENOUS DIABETES CONFERENCE HALIFAX, NOVA SCOTIA

Lucie Lévesque, Brittany McBeath, Colin Baillie & Alex M. McComber CMT PATHWAYS & INDIGENOUS WELLNESS PROJECTS

• About the projects • Community readiness • Strategies to ensure community determination • Ethical framework The CMT Pathways Team

PARTICIPATING COMMUNITIES • Manawan First Nation, Qc • Centre D'Amitié Autochtone De Lanaudière, Qc • Fort Erie Native Friendship Centre, On • Niagara Regional Native Centre, On • Little Grand Rapids First Nation, Mb • Black River First Nation Mb • Tyendinaga Mohawk Territory, On

• Kahnawake Schools Diabetes Prevention Project • Queen’s University, McGill University FORMER COMMUNITIES • Université Laval, Limerick University • First • First Nations Health & Social Secretariat of Manitoba Nation, On • First Nations of Quebec & Labrador Health & Social Services Commission • Nanaandawewigamig Wikwemikong • Indigenous Diabetes Health Circle, On Unceded First Nation, On • National Aboriginal Diabetes Association • Minowaywin Mishkikii Qwe, On • National Association of Friendship Centres • Timmins Native Friendship Centre • Regroupement des centres d’amitié autochones du Québec • Southeast Resource Development Council Corp, Mb The Kahnawá:ke Schools Diabetes Prevention Project, 1994- KSDPP RESEARCH PARTNERSHIP

KAHNÁ:WAKE McGILL UNIVERSITY

QUEEN’S UNIVERSITÉ DE UNIVERSITY MONTRÉAL COMMUNITY ADVISORY BOARD

Education

Health & Social Service Recreation

Political

Social

Economic

Spiritual

Cultural KSDPP INTERVENTION FRAMEWORK

Parental Support Healthy Eating Eating Self-efficacy Healthy School Food Eating Obesity Environment Diabetes School Program Knowledge Physical Community Activity Physical Activity Program Physical Activity Self-efficacy

Parental Support Physical Activity OUTCOMES AND BENEFITS FOR KAHNAWÁ:KE

 Continued diabetes prevention activities  Training opportunities (academic and community researcher training)  Job creation/capacity building  New funding sources  Community empowerment  Role modeling and Leadership for Indigenous research ethics in Canada KSDPP COMMUNITY MOBILIZATION TRAINING, 2001-

• 5-DAY TRAINING • COMMUNITY-DRIVEN, CULTURALLY RELEVANT PLANNING & PROGRAMMING • INDIGENOUS WAYS OF KNOWING, LOCAL CULTURE WITH EVIDENCED-BASED PRACTICE • COMMUNITY VALUES & VISION OF WELLNESS • TEAM & COALITION-BUILDING • HEALTHY LIFESTYLE PLANNING & EFFECTIVE PROMOTION RESEARCH GOALS

 To assess implementation & impact of the KSDPP CMT

 To examine the factors, conditions, & type of social system needed to implement & scale-up the CMT

 To identify Indigenous wellness indicators that capture the impact of CMT in communities RESEARCH APPROACH

 Community-based Participatory Research • Project Advisory Circle • Local CRA • Local Ethics • OCAP

 Two-Eyed Seeing • Indigenous ways of knowing + Western/mainstream ways of knowing RESEARCH QUESTIONS

1. What are the characteristics, features, & nature of the social system of the successful KSDPP model & in previously trained communities? 2. What are the barriers & facilitators to implementing the KSDPP model? 3. What are the necessary dose, fidelity, quality, & costs related to training community stakeholders to implement the KSDPP model? 4. How does the social system in the community receiving CMT change in response to KSDPP model adoption?

5. How does the availability of diabetes prevention opportunities in the community receiving CMT change in response to KSDPP model adoption?

6. What is the uptake of e-health technology to support & sustain the implementation of the KSDPP model post CMT?

7. What Indigenous wellness indicators best capture the impact of the CMT in communities? COMMUNITIES AND REGION/NATIONAL INDIGENOUS ORGANISATIONS

Little Grand Rapid FN

Black River

NADA Minowaywin Mishkikii Qwe SERDC Biigtigong Nishnaabeg

Wiikwemkoon g

IDH C COMMUNITY READINESS

“Community readiness is the degree to which a community is ready to take action on an issue.” ~Community Tool Box, Chapter 2, Section 9 IMPORTANT CHARACTERISTICS OF COMMUNITY READINESS

 It is issue-specific

 It can vary across dimensions

 It can vary across different segments of the community

 It is essential for addressing an issue CREATION STORY OF OUR MEASURE CREATION STORY OF OUR MEASURE CREATION STORY OF OUR MEASURE GATHERING INFORMATION

 Literature search  Community Readiness Model by the Tri-Ethnic Center for Prevention Research at Colorado State University  Assessing Community Readiness & Implementation Risk Reduction Strategies Manual by the Canadian Aboriginal AIDS Network (CAAN)  Peer reviewed journal articles  KSDPP publications & consultation  Consulting with partnered organizations  Going straight to the source – “What would you expect a community to be like if they were ready for community mobilization to tackle Type 2 Diabetes”? KEY CONSTRUCTS IDENTIFIED

Cultural Grounding Stability

Cooperation Dynamics Access to Resources Infrastructure Knowledge & Interest COMMUNITY READINESS ASSESSMENT COMMUNITY READINESS EVALUATION

 Measures – Questionnaire  Open Ended Questions  Provided more space for the respondent to elaborate more on the community’s strengths  Was placed at the beginning to avoid influence of key constructs  Cultural Grounding  Rate & Describe Key Constructs  5 two-part questions  Rate on a scale of 1 to 5, where 1 is very poor, and 5 is very good  Describe your reasons for giving that rating COMMUNITY READINESS ASSESSMENT PARTICIPANTS – WHO SHOULD BE SURVEYED?

Indigenous Diabetes Health Circle (1DHC)

Southeast Resource Development Council Corporation (SERDC)

First Nations of Quebec and Laborador Health and Social Services Commission (FNQLHSS)

Regroupement des centres d'amitié autochtones du Québec (RCAAQ)

National Aboriginal Diabetes Association (NADA) RESULTS

 All regional partner’s rated ready communities at medium-high levels in each key construct  Only funding and access to resources had a lower average score compared to the other key constructs  Cultural grounding was a key strength in each of the ready communities – common themes that emerged included:  Working toward or currently maintaining their respective traditional language and teachings  The importance of Elders/knowledge keepers in the community ENGAGING WITH “READY” COMMUNITIES COMMUNITY-BASED INITIATIVES CHOOSING A RESEARCH PARTNER COMMUNITY RESEARCHERS SETTING UP A COMMUNITY ADVISORY BOARD SHARED VALUES

Article 9.11- Creating Mutually Agreed Upon Expectations SHARED VALUES

Rigour

(Brydon-Miller et al., 2015) SHARED VALUES

Values Partnership Recruitment Data Collection Going Public

Humility

Rigour

Compassion

• Community co-researchers, researchers, and other stakeholders select defined values

(Brydon-Miller et al., 2015) USING & RESPECTING OCAP ®

(FNIGC, 2015) SHARING KNOWLEDGE

Aaniin ezhi- wiinzod awedi ikwe nemadabid.

Language Knowledge “Products” Living Stories KSDPP - CODE OF RESEARCH ETHICS

A living document A living document

http://ksdpp.org/elder/code_ethics.php