Community Health

Informing and educating

Kahnawake is a Kanien’kehaka (Mohawk) community of approximately 7000 people, located 10 km south of Montreal, on the banks of the St. Lawrence River (Figure 1) (http://www.kahnawake.com). In 1985, 12% of adults aged between 45 and 64 years had documented type 2 diabetes. Moreover, the average age of onset for type 2 diabetes has decreased in this population of people from 59 years in 1985 to 49 years in 1995 (Macaulay et al. 1997).
Type 2 diabetes is a complex disease of multifactorial etiology where genetic and lifestyle factors are major contributors (Macaulay et al. 1997). Moreover, obesity is the most important risk factor associated with the development of type 2 diabetes. 
In this context, concerns about the high incidence of diabetes and the perceived increase in obesity among children, encouraged the community to seek expertise from academic researchers to aid in the development of a diabetes prevention program. In response, the development of the Kahnawake Schools Diabetes Prevention Project (KSDPP) was initiated. The long-term purpose of KSDPP was to reduce the incidence of type 2 diabetes through short-term objectives of increasing physical activity and nutritional strategies (Potvin et al. 2003). Similarly, important objectives were to encourage community capacity building, empowerment, and program ownership, while respecting Mohawk tradition and culture.

The increase in obesity (a precursor for the development of type 2 diabetes) among the native children of Kahnawake may diminish their future quality of life. Moreover, the need for primary prevention among Native populations is especially vital given their predisposition to the development of type 2 diabetes.

The KSDPP’s achievements in this study were based on four key implementation principles/strategies that supported KSDPP’s objectives of promoting community capacity building and ownership of the project. 
Principle 1: Integration of community members as equal partners. [Link Principle 3, Participation] [Link Principle 5, Joint ownership] [Link Principle 8, Empowerment]. Community members had major influences throughout the project in terms of the design, intervention strategy and dissemination of information within the schooling system and the community as a whole.
Principle 2: Integration of intervention and evaluation. [Link Principle 10, Proactive learning]. In the community, the research component (intervention and evaluation) of the KSDPP was identified as being part of the community project. Aboriginal communities recognised that Kahnawake was creating innovative approaches to diabetes prevention. This created a source of pride among the community and was instrumental in the preservation of participatory responses throughout the project.
Principle 3: Organisational and programmatic flexibility. [Link Principle 6, Flexibility]. Flexibility and adaptation were crucial conditions for the survival of the program.
Principle 4: Making the project a learning opportunity for all. [Link Principle 8, Empowerment] [Link Principle 10, Proactive learning]. The development of partnerships between the KSDPP and other organisations during the early stages of the project allowed for the integration of several levels of expertise. Community members and organisations were not considered as passive agents of someone else’s vision. They contributed to the dissemination of knowledge to the community and contributed to ideas on the strategies of the program.

The success of this project was facilitated by a number of essential strategies that brought together the community’s vision of creating a healthier life for its people and building capacity among the population through empowerment, equality, and leadership. Moreover, KSDPP demonstrates how a dynamic process of health promotion can be successfully implemented through the establishment of equal partnership between community groups and academic researchers [Link Principle 1, Inclusiveness] [Link Principle 3, Participation] [Link Principle 5, Joint ownership].  Furthermore, the involvement of staff and community members as equal players in the project was essential for the diffusion and dissemination of information and helped facilitate the integration of all the program components.