Holistic Diabetes Program for American Indians a Success
The Full Circle Diabetes Program in Minneapolis, Minnesota, which used a holistic approach to diabetes self-management among American Indians, proved to be an effective, culturally relevant strategy to increase knowledge of resources for managing diabetes. A community case study on the program was published in the journal Preventing Chronic Disease (www.cdc.gov/pcd/issues/2009/oct/08_0147.htm)
Between 2004 and 2007, the program engaged 255 American Indian adults with type 2 diabetes from the Minneapolis/St. Paul area in activities encompassing four dimensions—body, spirit, mind and emotion. Two-thirds of participants reported that information they learned in the program helped them manage their diabetes. Almost all (98 percent) of program enrollees participated in at least one dimension activity, and two-thirds participated in two or more activities from more than one dimension. Diabetes breakfasts and nutritional consultations were the most popular activities.
The Full Circle Diabetes Program was developed through a partnership between the Minneapolis American Indian Center (MAIC), the Native American Community Clinic (NACC) and Wilder Research. The partnership recruited community members to form a Diabetes Community Council. The Council comprised American Indian community members and elders from the Minneapolis/Saint Paul area, many of whom had type 2 diabetes. The Council represented the community and advised the partnership on program planning, development and evaluation.
Council members identified barriers to self-management by sharing personal stories. Barriers included infrequent blood sugar testing, poor eating habits, poor physical activity habits, difficulty coping with diabetes-related stress and lack of knowledge of self-management resources. The Council called their holistic approach to program development a "circle model" because of its close relationship to American Indian culture and values. Circles are ancient symbols of infinity, unity and wholeness. The circle model recognizes that all people contribute uniquely to the survival and vitality of a community.
Activities and services of the Full Circle Diabetes Program addressed four dimensions of holistic health: body, spirit, mind and emotion. Program activities were developed for each dimension with a focus on community needs.
Body dimension: Participants received routine physical exams and dietary advice. A diabetes case manager assessed patients' needs, assisted with referrals to low-cost or free health care services, and provided follow-up and support. The program offered exercise classes such as water aerobics, walking, stretching and light weight lifting; free gym memberships, physical therapy services, walking groups and consultations for home exercise programs; and nutritional consultations to develop healthier meal plans.
Spirit dimension: Clinicians supported traditional healers in providing alternative health care for participants who were interested in or already receiving treatment from healers. Diabetes Community Council meetings encouraged participants to share personal testimonies, which helped them feel less alone in their challenges and motivated them to make healthful life changes. Diabetes health fairs invited everyone in the community to participate and helped bring all generations together to learn, have fun and celebrate culture. Caregiver ceremonies acknowledged family, friends and health professionals for supporting diabetes health.
Mind dimension: Education classes focused on six topic areas—introduction to diabetes, nutrition, managing diabetes, lifetime health, physical activity and stress management. Monthly diabetes breakfasts gave participants the opportunity to share a healthy meal and benefit from ongoing diabetes education.
Emotion dimension: Talking circles provided a safe place for people to ask for and receive support from their peers and to know that others shared their challenges. Lists of mental health resources were available at each talking circle, and a mental health counselor was available. Self-esteem was nurtured by engaging participants in planned outreach activities, such as presentations at local schools. As they gained skills and had positive experiences planning and executing these activities, participants developed the confidence necessary to become advocates for self-management.
Although the program ended in 2007, many of the activities have continued. The Diabetes Community Council changed its name to Community Health Council and has expanded its reach to include all health issues. Case management and nutrition counseling at NACC continues to provide guidance and support to diabetes patients to improve their self-management.
More information, including a resource toolkit for developing a comprehensive diabetes self-management program for urban American Indians, is available from DiabetesInitiative.org.
Castro S, O'Toole M, Brownson C, et al. A diabetes self-management program designed for urban American Indians. Prev Chronic Dis 2009; 6(4): A131.
Dear Tribal Leaders, Native Community Members and Native Health Providers,
It has been a long road to get to this point; we are on the cusp of reauthorizing the Indian Health Care Improvement Act for the first time since 1992. The IHCIA is part of the health care reform bill, which has seen its own roller-coaster ride through Congress. We are so close to realizing passage of the bill, the House is expected to vote in the coming days on the Senate passed bill, then both chambers will consider a "reconciliation bill." If the House passes the Senate health care bill, it will be ready to be signed into law. The Indian Health Care Improvement Act would be a realization for Indian Country at that signing. Not only does the health care reform bill include the IHCIA, it includes many provisions that will protect the Indian Health Care system from the reforms instituted by the broader bill. These provisions will ensure the treaty obligations and trust responsibility is not diminished, but rather affirmed, through the passage of health care reform. The current pending Senate version of IHCIA includes permanent reauthorization. The vote in the House is the major obstacle, if it does not pass, the effort will fall short. Now more than ever, your members of Congress need to hear from YOU. The stories and passion only you can provide about the need for this bill in your communities is what will help members see the need to pass the bill. I know everyone is busy with the day-to-day activities of their work, but just a few minutes to call members of Congress can mean the difference whether Indian Country can see its health care system brought into the 21st century. We cannot count on the same members who voted for the bill the first time around to be an automatic "yes" for this bill; they need to hear from constituents, they need to be held accountable for their votes. Let them know Indian Country wants them to vote YES for health care reform, because it is health care for all Americans. I urge each of you to call our staff at the National Indian Health Board and let them assist you in contacting your members of congress immediately. National Indian Health Board Staff
Stacy A. Bohlen - Sault Ste. Marie Chippewa
Executive Director, Media Contact, NIHB Board Liaison
Phone: 202-507-4070 Jessica L. Burger, RN - Little River Band of Ottawa Indians
Director of Government Relations
Phone: 202-507-4079 Rick Haverkate, MPH - Saulte Ste. Marie Chippewa Indians
Director of Public Health
Phone: 202-507-4074 Jennifer Cooper, JD, MPA - Seneca Nation of Indians
Phone: 202-507-4076 Thank you for your attention, thank you for reaching out, I look forward to speaking with you all soon, when the IHCIA is law! Yours in health, Mr. Reno Keoni Franklin
Elected Tribal Health Delegate, Kashia Pomo Tribe
Chairman, California Rural Indian Health Board
Chairman, National Indian Health Board
4400 Auburn Blvd, 2nd Floor
Sacramento, CA 95841
(707) 291-2737 cell
Finding more ways to work with Native Americans to improve their health is the goal of a University of Nebraska Medical Center conference later this month.
Native American health disparities are a major problem, said Shireen Rajaram, director of the Center for Reducing Health Disparities at the UNMC College of Public Health.
Native Americans have higher rates of diabetes, heart disease and other health problems than whites, she said.
A key focus of the conference will be finding more ways to create partnerships with tribal groups on research aimed at reducing health disparities. The conference is a collaboration between UNMC and the Aberdeen Area Tribal Chairman's Health Board, which serves 17 tribes in the region.
Rajaram said it's important to work closely with Native American groups to better understand the culture and what they believe are the biggest health problems, along with causes and solutions.
High rates of diabetes, for example, can stem from a number of causes such as limited availability of fresh fruits and vegetables and limited access to health care.
The conference is scheduled for March 18 at the Scott Center at the University of Nebraska at Omaha. For more information, call 559-2095.
Within the coming weeks Nike will be releasing another sneaker part of their American Indian N7 line, this time a Nike Huarache 09. The Huarache 09 sports a white leather upper with grey paneling that includes the use of a few blue pinstripes. Accents of blue, orange (red?) and black appear throughout the upper with what looks to be an N7 hit on the tongue tag. full story at: http://www.sneakerobsession.com/17972/nike-huarache-09-n7/