Research Profile - A Community Effort

A participatory research project improves awareness and prevention of type 2 diabetes in Kahnawake, Quebec.

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L-R: Judi Jacobs, Eva Johnson, Elaine Delaronde, Kaiatitakhe Jacobs, Alex McComber, Cindy Diabo Mike Diabo, Kakaiostha Deer, Rhonda Kirby, Treena Delormier, Beverly Delormier, Chris Bush, Edward J Cross.

Dr. Treena Delormier received a life-changing invitation shortly after graduating as a nutritionist. She was asked to be part of a new project to address the high rate of diabetes in Kahnawake, a Mohawk community southwest of Montreal. "They were inviting anyone in the community who had expertise and was willing to contribute to making the project a success," says Dr. Delormier.

Seventeen years later, the Kahnawake Schools Diabetes Prevention Project (KSDPP) was the recipient of the 2010 CIHR Partnership Award and has evolved into an internationally recognized research program. And Dr. Delormier has watched it transform her community's approach to diabetes prevention and treatment.

In the early 90s, community hospital and baseline work by the late Dr. Louis T. Montour and Dr. Ann C. Macaulay revealed that the people of Kahnawake, like many First Nations, had a high rate of type 2 diabetes. There were calls from community members to make a change for the health of the Seventh Generation, or the generation yet to be born.

Drawing on the Mohawk philosophy of community participation, researchers and community members partnered to develop a school-based program that would raise awareness. KSDPP engaged elementary school students in hands-on activities, from exploring healthier food choices to incorporating physical activity into daily lessons.

"The curriculum was developed by people who were either from the community or had worked in the community in the schools, so they understood the context," says Dr. Delormier. "So it was developed in a way that was community-based and reflected the experience of the people, and community-wide interventions supported the messages being delivered in the schools."

To assess the impact of the curriculum, the community research team brought in researchers from several universities, including McGill, Queen's and the University of Montreal. As the project went on, the participants incorporated feedback from the community and the researchers to adapt KSDPP. For example, a school nutrition policy is now being revised to focus on positive, rather than negative messages. And the community is looking at introducing a similar physical activity policy.

According to Dr. Delormier, the most dramatic and lasting effect of KSDPP has been the awareness it has brought to the community.

"Everyone knew that diabetes was an issue," says Dr. Delormier. "But it wasn't a collective understanding. The initial studies actually showed the proportion of people that had diabetes and stimulated this notion of prevention rather than treatment or management."

In addition to raising awareness about type 2 diabetes, the project has helped build significant research capacity in Kahnawake, with community members attaining master's and doctoral degrees. More capacity building occurs through the KSDPP Training Program in Diabetes Prevention led by Alex McComber, who is sharing the message with other Aboriginal communities across Canada.

"I think that's what is really special about KSDPP," says Dr. Delormier. "It is, in itself, a rich learning environment because you can see how research questions come up and get answered in a participatory way. Personally, that led to my decision to pursue my PhD, which I probably wouldn't have done if I'd stayed strictly in a university."

But the community's work isn't finished. They are constantly looking for ways to keep the KSDPP message alive and keep the community on the path to health. This will mean expanding the project beyond elementary schools and looking for collaborators who can help on a broader level.

"We really need to look at ways of creating an entire community that makes healthy choices the easier, natural choice."