Reducing Health Disparities Related to Diabetes: Lessons Learned Through the Canadian Diabetes Strategy Community-Based Program

Case Study 3: LiveWell™ with Chronic Conditions for Aboriginal People: Adapting and Promoting Self-Management Approach Through Storytelling

Lead Organization

• Saskatoon Health Region

Key Partners

• Saskatoon Health Clinic
• Sunrise Health Region
• Yorkton Friendship Centre
• Yorkton Tribal Council
• Community Diabetes Outreach Program

Funder

• Public Health Agency of Canada

Target Group

• Aboriginal adults at high risk of or living with chronic diseases

Communities

• Saskatoon and Yorkton area communities, Saskatchewan

Background

Learning to live fully despite the drawbacks of a chronic illness is a major life challenge. Aboriginal people in Saskatchewan are more likely than the general population to develop a chronic condition, and many elderly have more than one chronic illness. Diabetes rates there are at least three times the national average. In addition, Aboriginal persons deal with many other social, economic and health challenges. Despite these challenges, Aboriginal persons are under-represented in prevention and management programs.

The Stanford Chronic Disease Self-Management Program uses pairs of trained volunteers who have personal or professional experience with chronic disease. These volunteers facilitate small groups that meet weekly, following a scripted manual that promotes self-care.

This program does not replace, but is complementary to traditional health care interactions. This intervention has been evaluated and has been shown to be effective in promoting self-management and a sense of well-being and in reducing health care use.

In Saskatchewan, the Stanford model had been piloted under the name "LiveWell™ With Chronic Conditions" (LWCC). This project looked at whether this model would work well with Aboriginal populations.

Implementation

The project started in early 2007 with an assessment of the LWCC manual by elders to see whether content adaptations were needed for Aboriginal participants. As a result, an introduction using the Medicine Wheel was developed, approved by the Stanford licensing body, and was added to the manual. Since then, it has been added to all LiveWell™ manuals used in Saskatchewan.

Lay Aboriginal peer leaders were trained through a four-day training workshop. The LWCC groups were promoted through and linked with existing diabetes prevention and management programs used by the target populations. The groups met once a week for six weeks in familiar venues in two health regions.

During the study period, 19 Aboriginal leaders were trained and 37 participants attended the self-care groups.

Trained Aboriginal leaders participated in a photography session that resulted in 13 promotional posters, each featuring a sentence about how the LWCC program has affected that person. These posters form part of an ongoing dissemination strategy, as they are displayed in Aboriginal facilities throughout the province.

The LWCC program has now spread into all areas of the province, using the modified LWCC manual (with the Medicine Wheel introduction). Many of the activities initiated by this project have continued with funding from other sources.

"[The digital stories] are without a doubt the most powerful way to advocate for the LWCC program."

Project Coordinator

Evaluation

The Stanford model has been extensively evaluated. However, additional evaluation funding allowed for a qualitative evaluation using digital storytelling to capture the Aboriginal leaders' perceived impact of the LWCC program, including how they saw this program contributing to their community.

The method and approach to storytelling were adapted from those developed by the California-based Center for Digital Storytelling. Consultants were hired and led a workshop with the trained Aboriginal peer leaders. Ten short (2- to 4-minute) stories were created that reveal aspects of the storyteller's life and how the LWCC program is helping them. The stories themselves serve as the evaluation, but the stories also form a stand-alone product that has had a synergistic effect on the project as a whole.

Reaching the Population

• The LWCC worked well for the Aboriginal population, many of whom are struggling with diabetes, as well as other chronic conditions.
• Linking this program with other programs that connect with Aboriginal people ensured success in reaching this population, as well as in providing venues and structured opportunities for LWCC actions to take place.
• There was a need to culturally adapt the approach to delivering the LWCC program in different Aboriginal communities.
• In some places, the Aboriginal leaders used informal opportunities to introduce the material, scheduling formal groups later on.
• The digital storytelling technique is a perfect fit for this population, as it respects the oral tradition of Aboriginal culture.

Lessons Learned

• Originally intended as an evaluation tool, digital storytelling was found to be important for evaluation, dissemination and promotion. It is being used as a powerful vehicle to reach the target group in a culturally meaningful way. However, it is an expensive approach and may present some technological challenges.
• In some places, Aboriginal leaders delayed the scheduling of formal groups, choosing to introduce materials on an informal basis first. With this approach, it took a while to build momentum. This will need to be considered in future programs.
• The LWCC program is still challenged to be accepted by health care professionals who are slow to refer patients or are not aware that their patients are participating in the program.

"I am diabetic and learning to live well with my chronic condition. All of my elders and my parents and even some younger people have died of chronic conditions. It is hard; some people turn to drugs and alcohol—they can't cope. The LWCC helped me to cope."

Participant/Aboriginal Leader

Resources

• A Medicine Wheel introduction was developed for the LWCC manual.
• A series of promotional posters was produced.
• A digital storytelling DVD was created and the stories were also posted to the Internet (www.patient-voices.org.uk/sask.htm ).

For additional information:
Suzanne Sheppard
E-mail: suzanne.sheppard@saskatoonhealthregion.ca