Willows Noreen, Dyck Fehderau David, Raine Kim D
Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Health Soc Care Community. 2016 Sep;24(5):567-75. doi: 10.1111/hsc.12229. Epub 2015 Mar 31.
Indigenous First Nations people in Canada have high chronic disease morbidity resulting in part from enduring social inequities and colonialism. Obesity prevention strategies developed by and for First Nations people are crucial to improving the health status of this group. The research objective was to develop community-relevant strategies to address childhood obesity in a First Nations community. Strategies were derived from an action-based workshop based on the Analysis Grid for Environments Linked to Obesity (ANGELO) framework. Thirteen community members with wide-ranging community representation took part in the workshop. They combined personal knowledge and experience with community-specific and national research to dissect the broad array of environmental factors that influenced childhood obesity in their community. They then developed community-specific action plans focusing on healthy eating and physical activity for children and their families. Actions included increasing awareness of children's health issues among the local population and community leadership, promoting nutrition and physical activity at school, and improving recreation opportunities. Strengthening children's connection to their culture was considered paramount to improving their well-being; thus, workshop participants developed programmes that included elders as teachers and reinforced families' acquaintance with First Nations foods and activities. The research demonstrated that the ANGELO framework is a participatory way to develop community-driven health programmes. It also demonstrated that First Nations people involved in the creation of solutions to health issues in their communities may focus on decolonising approaches such as strengthening their connection to indigenous culture and traditions. External funds were not available to implement programmes and there was no formal follow-up to determine if community members implemented programmes. Future research needs to examine the extent to which community members can implement programmes on their own and whether community action plans, when implemented, lead to short- and long-term benefits in health outcomes.
加拿大的原住民第一民族人群慢性病发病率很高，部分原因是长期存在的社会不平等和殖民主义。由第一民族人群制定并为其服务的肥胖预防策略对于改善该群体的健康状况至关重要。本研究的目的是制定与社区相关的策略，以解决一个第一民族社区的儿童肥胖问题。这些策略源自一个基于与肥胖相关环境分析网格（ANGELO）框架的行动研讨会。13名具有广泛社区代表性的社区成员参加了该研讨会。他们将个人知识和经验与社区特定及全国性研究相结合，剖析了影响其社区儿童肥胖的一系列广泛环境因素。然后，他们制定了针对儿童及其家庭的健康饮食和体育活动的社区特定行动计划。行动包括提高当地居民和社区领导层对儿童健康问题的认识，在学校推广营养和体育活动，以及改善娱乐机会。加强儿童与自身文化的联系被认为是改善其福祉的关键；因此，研讨会参与者制定了相关计划，其中包括让长者担任教师，并强化家庭对第一民族食物和活动的了解。该研究表明，ANGELO框架是一种制定社区驱动型健康计划的参与式方法。它还表明，参与为其社区健康问题制定解决方案的第一民族人群可能会专注于去殖民化方法，比如加强他们与本土文化和传统的联系。没有外部资金来实施这些计划，也没有进行正式的后续跟进以确定社区成员是否实施了这些计划。未来的研究需要考察社区成员能够自行实施计划的程度，以及社区行动计划实施后是否会在短期和长期内带来健康效益。
