Primary Prevention of Type 2 Diabetes: Experiences of 2 Aboriginal Communities in Canada

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 2 successful and ongoing primary diabetes prevention projects in Canada: in the Kanien'kehá:ka (Mohawk) community of Kahnawake, geographically close to Montreal, Quebec, and in the isolated Oji-Cree community of Ne gaaw saga'igan (Sandy Lake) in Northwestern Ontario. The 2 projects have recently initiated a collaboration with the goals of elucidating their successes, developing a comprehensive picture of 'best practice' sites and developing methods to measure intervention activities and incorporation of local in the development and implementation of interventions, and to evaluate the quality of activity implementation and the ongoing evolution of community mobilization and partnerships with other organizations. Particular attention will be focussed on documenting the quality of intervention activities, the incorporation of local traditions into intervention activities, communication information (audio, visual, print), skill development (personal empowerment workshops, cooking demonstrations), improvement in physical resources (recreation path, food availability) and, most importantly, community mobilization through the roles of employees, volunteers and community organizations. The goal of the collaboration is to develop a comprehensive picture of 'best practice' sites and to seek to discover if there are common key community characteristics and intervention strategies that support these long-term projects. This knowledge will then be used to identify additional Aboriginal communities and to partner with those communities to design interventions that incorporate the strengths of both KSDPP and SLHDP. This joint evaluation will contribute to both local and general knowledge by furthering the understanding of "what constitutes success." Such knowledge for the primary prevention of diabetes is essential to both improve existing health promotion initiatives and to reduce the current epidemic of type 2 diabetes in Aboriginal communities.