Health Transition Fund Project NA012: Diabetes Community/Home Support Services for First Nations and Inuit

Challenges to Program Development

Every new initiative experiences barriers and challenges and the pilot teams dealt with many of the challenges by using a creative problem-solving approach. At the completion of the project, each community team was asked to look back at the challenges they encountered and describe some of the solutions they found effective. The following are challenges common to most of the pilot communities.

All communities acknowledged the importance of involving people with diabetes in decision making regarding their own care. However, community project staff observed a hesitancy to commit to the Project and to participate in program activities. The health staff acknowledged that the introduction of a new project takes time and that it is important to work at the pace of the community and the individuals with diabetes. Trust is also a variable that requires time to establish. Good communication practices with clients are important in all aspects of the planning and implementation of diabetes services.

Initially, there was a lack of knowledge about diabetes and its care and management. Not only was the initial education important for the health staff, but continuing education and support was also found to be critical. In one community, the nurses felt that, prior to the Project, clients with diabetes did not see the nurses as a source of information and support. This changed as the nurses acquired knowledge and were able to share this with their clients.

Nutrition Support

The need for increased access to health professionals with nutrition expertise was identified by three of the communities as a significant gap in their services in the needs assessments.

"Within the Labrador Inuit Health Commission we have a wonderful Internet communication system that allows for daily communication with all staff. Therefore I have been taking advantage of it and I have been providing diabetes education with the Public Health Nursing staff. I plan to continue with this type of education when I have spare time." Rigolet Diabetes Home Care Nurse

All communities recommended an increase in dedicated staff time to plan, implement, manage and monitor the new diabetes services. Combining the planning and management of the Home and Community Care Program with the new diabetes services was found to be too demanding.

Community and Leadership Involvement

At the beginning of the Project, there was a need to secure the involvement and commitment of key stakeholders. All communities acknowledged both the significance and the time required for this step. Key stakeholders included community leadership, other health agencies and personnel, community members and people with diabetes. The needs assessment and community involvement processes helped to build an awareness about diabetes and diabetesrelated care and treatment. The needs assessment also permitted the project planners to tailor the program to the community. The fit between the program and the community was viewed as a critical factor for success.

"Seeing the transformation in knowledge (of the Home Care Nurse) made me want to take the training in diabetes education." Senior Health Nurse Red Earth First Nation

"I did not know we had so many people with diabetes. I was surprised with the number. It was the same with the Council. ... We learned a lot (from the community needs assessment). Now we are able to address more what they need... It is going to be easier for me too re: my planning of programs, particularly around staff. I took the decision last week (to Council) regarding the nutritionist. Instead of having one nutritionist 3 days/week we will now have one nutritionist 5 days/week..." Health Director Wendake First Nation