American Indians' Family Health Concern on a Northern Plains Reservation: "Diabetes Runs Rampant Here"

The Medicine Wheel as a public health approach to lifestyle management interventions for indigenous populations in North America

This analytic essay intends to elevate Medicine Wheel, or generally "four directions" teachings, to encourage a more comprehensive alignment of lifestyle intervention components with traditional ecological knowledge systems of Indigenous cultures in North America. North American Medicine Wheels provided people with a way to orient themselves both within their traditional belief systems and to the seasonal changes in their areas, improving survivability. The wheel or circle is a sacred symbol, indicating the continuity and perpetuity of all of life. The four directions are iconized in many Indigenous cultures across North America with different directions representing different aspects of our world and of ourselves, different seasons of the year and of our lives, different beings of the earth and tribes of humans with a balance among those necessary for health and wellbeing. In the context of public health, teachings of the four directions warn that a lack of balance limits our ability to achieve optimal health. While there is much public health success in lifestyle interventions, existing practice is limited by a siloed and one size fits all approach. Medicine Wheel teachings lay out a path toward more holistic and Indigenous-based lifestyle intervention that is modifiable depending on tribal teachings and needs, may appeal to a variety of Indigenous communities and is in alignment with health behavior change theory. It is a public health imperative that lifestyle management interventions are fully optimized to rigorously determine what can be achieved when interventions are implemented in a holistic and Indigenous-based manner, and in alignment with an Indigenous model of health. This more complete alignment would allow for a stronger foundation to further explore and develop social determinants (i.e., housing, employment, etc.) and structural intervention enhancements to inform public health practice and promote health equity.

Centering the Strengths of American Indian Culture, Families and Communities to Overcome Type 2 Diabetes

Type 2 diabetes (T2D) is a critical Indigenous health inequity rooted in experiences of colonization and marginalization including disproportionate exposure to stressors, disruption of traditional family and food systems, and attacks on cultural practices that have led to more sedentary lifestyles. Thus, an important step in redressing inequities is building awareness of and interventions attuned to unique Indigenous contexts influencing T2D and Indigenous culture as a pathway to community wellbeing. Using a dynamic, stage-based model of intervention development and evaluation, we detail the creation and evolution of a family-based, culturally centered T2D preventive intervention: Together on Diabetes (later Together Overcoming Diabetes) (TOD). The TOD program was built by and for Indigenous communities via community-based participatory research and has been implemented across diverse cultural contexts. The TOD curriculum approaches health through a holistic lens of spiritual, mental, physical and emotional wellness. Preliminary evidence suggests TOD is effective in reducing diabetes risk factors including lowering BMI and depressive symptoms, and the program is viewed favorably by participants and community members. We discuss lessons learned regarding collaborative intervention development and adaptation across Indigenous cultures, as well as future directions for TOD.

Reconciling with Minoaywin: First Nations Elders’ Advice to Promote Healing from Forced Displacement

En 2011, dans la région d’Interlake, au Manitoba, une inondation provoquée par l’homme a déplacé 17 communautés des Premières nations ayant de profonds liens ancestraux avec leurs terres. L’inondation et les déplacements forcés ont eu des effets dévastateurs dans ces communautés, incluant des morts prématurées, l’aggravation de maladies chroniques, la dépression et la solitude. En 2015, une réunion des aînés des Premières nations a rassemblé 200 personnes à Winnipeg pour discuter des moyens de se remettre des inondations provoquées. Une approche qualitative et un cadre participatif ont été utilisés pour documenter les perspectives des aînés. Vingt-trois aînés ont participé à des entrevues semi-dirigées en ojibwé et en anglais, enregistrées sur vidéo. Les discussions en petits groupes ont été documentées et transcrites en verbatim. Les recommandations des aînés sur la réconciliation avec le minoayawin (bien-être) ont été partagées par le biais d’un livret de guérison et d’un site Web. Les aînés ont partagé leurs réflexions sur le besoin de guérison de leurs peuples et de leurs communautés et ont proposé les stratégies suivantes pour aller de l’avant : pardonner, rester unis, promouvoir l’autodétermination, retrouver leur identité culturelle, et se rapprocher de la terre.

Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support

American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals' connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.