Health Transition Fund Project NA012: Diabetes Community/Home
Support Services for First Nations and Inuit
Overview of the Pilot Project
(How the project was designed)
In 1998, Health Canada partnered with First Nations and Inuit
on a proposal to the Health Transition Fund (HTF) for a Pilot Project
on "Diabetes Community/Home Support Services for First Nations
and Inuit". The HTF provided short-term funding
for projects designed to identify innovative and effective means
of improving the health and the health care of Canadians in four
priority areas: home care, ntegrated service delivery, pharmacare
and primary care.
The goal of the Project was to identify ways to provide expanded
diabetes support through home care services. The objectives for
the Project, as outlined in the Project Charter [ The Project Charter guided the common undertaking of the Project by outlining the Project's purpose, objectives, how the Project would be carried out, and the role/responsibilities of key Project stakeholders. ] were:
- to identify the home/community care and support needs of people
with diabetes and their families;
- to develop home care models of effective community based diabetes
care, support and education;
- to develop approaches towards integration and coordination
of services at the community, regional, provincial and federal
levels;
- to identify the training and education needs of people with
diabetes and their families and of health care staff; and
- to validate the First Nations and Inuit Home Care Framework
and the elements of the Aboriginal Diabetes Initiative.
Four pilot communities participated and were selected for their
diversity in terms of culture, geography, governance structure
and degree of isolation. The pilot communities were:
- Sliammon First Nation - a non-isolated Coast
Salish community with 643 on-reserve members located on the west
cost of the British Columbia mainland. It is 12 kilometres way
from the city of Powell River. The community has a health centre
and community health services. At the beginning of the Project,
there were 26 persons or 4% of the community who had been diagnosed
with diabetes.
- Red Earth First Nation - a semi-remote Swampy
Cree community with 844 on-reserve members located in the marshlands
in the north east of Saskatchewan. At the beginning of the Project,
there were 91 persons or 10.8% of the total on-reserve population
were diagnosed with diabetes.
There is a community health centre on reserve that has biweekly
physician visits. The nearest hospital is a one hour drive away.
Travel to medical specialists takes 2.5 hours.
- Wendake First Nation - a non-isolated Huron-Wendat
Community located near Quebec City with an on-reserve population
of 1,188 persons. At the beginning of the Project, 4.4% of the
on-reserve population was diagnosed with diabetes. Within the
community there are several health services available including
community health services, an Elders lodge and a private medical
clinic.
- Rigolet - a remote isolated Inuit community
with a population of 313 people. At the beginning of the Project,
16 people or 5.1% of the population had been diagnosed with diabetes.
The community has a provincially funded nursing station. Community
health services are provided through the Labrador Inuit Health
Commission. The nearest physician and medical facility is a forty-five
minute plane trip. A physician visits the community every four
to six weeks.
Project Description
Each community first received orientation to the Project objectives
and requirements, including receiving a copy of the Project Charter.
Meetings were held with community staff periodically throughout
the Project and monthly conference calls were held to maintain
support and communication. Expert support was provided in the areas
of program evaluation, diabetes education and home care.
The pilot communities were required to conduct several activities
to meet the objectives of the Project. These included:
- carrying out a community needs assessment to identify the home
and community care needs of the people with diabetes and their
families;
- assessing the diabetes training needs of care providers;
- developing a home care and diabetes service delivery plan,
including an implementation plan;
- developing a comprehensive program evaluation plan -- a program
logic model and performance indicators for future evaluations;
- implementing the services; and
- participating in the Project evaluation.
The short time lines of the Project required a design that included
specific ways to facilitate the completion of the Project activities.
A number of tools were developed to assist the pilot communities
though each phase of the Project.
Tools for Planning
- A Community Diabetes Needs Assessment Kit which included: a
data collection tool to gather information about the heath status
of the community; a chart audit form to collect baseline information
on the health care status of persons with diabetes; a Learning
Needs Self Assessment for health workers to determine their level
of diabetes knowledge; and a key informants' consultation tool.
The data collected by the pilot community staff was analysed
and compiled by a project consultant.
Tools for Planning and Delivering Services
- A Diabetes Home Care Plan service delivery template was provided
to assist the communities with the development plan for services.
- Monthly report forms were developed for the summary report
as well as a report form for client services statistics.
- A client Diabetes Assessment Tool to facilitate client identified
goal planning.
Tools for Program Evaluation
- A Self-Assessment Tool for evaluation was developed for the
pilot team to describe both progress to date and plans for the
future.
- A Client Survey tool was provided to capture clients' perception
of and satisfaction with services provided by the project.
- A sample logic model and a sample logic model book were developed
to assist the communities to develop their individualized models.
Project Evaluation
(How the Information was Gathered)
The focus of the evaluation was to describe the planning and development
of the program initiatives in the four pilot communities which
may be helpful to other First Nations and Inuit communities who
are designing diabetes services. This Report describes the results
of the Project to date. A further evaluation in one to two years
will permit determination of indicators for long term client outcomes.
Evaluation information was gathered in several ways. Throughout
the Project, monthly summary and statistical reports were submitted.
The project teams completed a comprehensive self-assessment describing
the services developed to date and plans for the future. A client
satisfaction survey was also conducted. Each community prepared
an evaluation model (logic model) to be used for future evaluations.
Lastly, the community-based pilot team, clients and leadership
were interviewed by conference calls.
Limitations
The data reported from the communities should be considered preliminary
and reflective of early changes that have the potential to lead
to longer term positive outcomes. Several variables had influenced
progress in each of the communities:
the short project time lines and the extensive requirements; the
complexity of diabetes; the varied learning needs of both health
staff and community members and the length of time needed for change
to happen. The data in this Report is qualitative in nature. The
common themes have been validated by representatives from each
of the pilot communities.
"As recommended, we established an
evaluation committee composed of the members of the multidisciplinary
team, the project coordinator, the psycho-social support worker,
and a person with diabetes. We held three meetings to discuss
and validate a background document on project self-assessment
prepared by the project coordinator. This exercise was fruitful
in a number of ways, proving to be: a helpful feedback exercise
with respect to planned activities; a helpful exercise for reviewing
the implementation of planned activities; a means of guiding
future stages more effectively; a crucial part of the evaluation
process."
Project Coordinator - Wendake First Nation
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