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BREATHE: “Building Respiratory Education and Awareness for First Nations, Inuit and Métis: Tools for Health Empowerment”.

The Respiratory Health Awareness Model Description

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Introduction to the Model

The model was created to provide information and awareness to First Nations, Inuit and Métis communities about the risk factors for chronic respiratory disease (e.g. asthma and associated allergies) as it relates to the social determinants of health. The main goal of the model is to increase respiratory health awareness, in particular, knowledge and understanding of chronic respiratory disease and the risk factors of its development. It was also designed to empower communities to create a self-sufficient community outreach/awareness system and to have greater access to resources on respiratory health at the community level.

Model Development

Based on the findings of projects, conducted by the project team at the Asthma Society of Canada (ASC) and its partner organizations including AllerGen NCE Inc., Assembly of First Nations (AFN), Inuit Tapiriit Kanatami (ITK), Métis Nation British Columbia (MNBC), and the National Collaborating Centre for Aboriginal Health (NCCAH), and using examples of existing community outreach and chronic disease management models (e.g. the “Chronic Care (Wagner) Model” (1998), the “Integrated Life course and Social Determinants Model of Aboriginal Health”(2009), and the “Social Ecological Model of Health” (2008)), the draft main components of the model were developed.

The Main Model Components

In general, the model components outline ways of outreaching to communities not only on a community level but also on an individual and family level. The model is designed to conduct public awareness campaigns and disseminate educational materials related to respiratory health in Aboriginal communities using a variety of means such as community workshops/public forum, health/information fairs, community programs, and social events. As well, the purpose of the model is to ensure the adequacy and cultural appropriateness of promotional/awareness programs related to chronic respiratory conditions, and their risk factors.

The central part of the model represents the idea of self-management and self-education and serves to empower community members on the individual level (child, youth and/or adult) and then expanding and reaching out to incorporate the family and the community as the whole (First Nations, Inuit and Métis). The model core is further linked to the social determinants of health showing how the individual and community involvement could lead to potential improvement in health outcomes. The five key components of the program aimed to provide awareness and education on social determinants of health as well as chronic respiratory disease:

  1. Community education
  2. Community awareness
  3. Community participation
  4. Community leadership
  5. Community health care delivery

Community Awareness

The first component aims to increase the level of awareness about respiratory health and chronic respiratory conditions targeting broader community member. This is achieved by using a combination of active (e.g., outreach through the local media or during community events and celebrations) and passive (e.g., making information available at community health centers, community centers and other community settings) (push and pull) outreach strategies. By implementing this component, the outreach is conducted on the community as a whole including both individuals directly affected and not affected by chronic respiratory disease.

Community Education

The second component encompasses respiratory health education provided to Aboriginal community members focusing on education for children and youth and their families including foster parents and family Elders. Strategies include group educational sessions using conversational cards and support groups for parents/grandparents, provision of printed educational materials that are paper based and audio/video to support self-management education. In addition, opportunities for peer-to-peer support and education are considered given that younger generation prefers to connect with one another and create awareness amongst their peers. Educational activities teach community members including children and youth about the risk factors of chronic respiratory conditions, how these factors affect someone’s health, prevention strategies, and provide information on how to manage these conditions properly, mostly for individual’s directly affected by the disease. Some activities target youth specifically given that initial project findings point to a deep concern of Aboriginal community members for the health of children and youth especially when it comes to smoking behaviour.

Community Participation

This third component includes strategies that aim to empower various community members to participate in creating a community that is concerned and well-aware of issues related to respiratory health. As existing housing conditions are strongly related to the risking rate of people with respiratory conditions, housing officials such as housing coordinators from Band Council, housing inspectors, environmental health officers, and landlords are approached and informed about the issue. Involvement of schools, workplaces, local businesses, various community facilities (e.g., community grocery stores, culture and friendship centres, libraries, major retailers, fitness centres, etc.), community organization and programs (e.g., faith-based groups, after school programs, Elder monthly sessions, youth educations programs, cultural gatherings etc.) in raising awareness of respiratory health is shown to be important for these communities.

Community Leadership

The fourth component is a vital element in the development of a self-reliant and well-aware community. As community leaders play a cornerstone role in any community functions and practices and often are community knowledge keepers, they are involved in the delivery of respiratory health messages and in creating community awareness of the issues related to chronic respiratory disease and the risk factors for its development. Community leaders are being properly trained to become community champions/advocates with an online training module on respiratory health issues and lead the community in implementing the main model components. For example, the Chief, the Band Council, the community Elders can use their knowledge, significance and authority to make changes in the awareness of respiratory health in discussion at community workshops and other events with established group presentations on respiratory health risks and prevention strategies. These individuals also have the authority to implement appropriate by-laws (e.g., anti-idling and smoke-free environment) and policies aimed to mitigate the risk of developing chronic respiratory disease.

Community Health Care Delivery

This last component plays a slightly different role in the model and its implementation. The main goal of this model component is to establish a connection between community-based initiatives and healthcare delivery. According to the project results and findings from other reports prepared by the ASC (e.g., “A Shared Voice”, 2009; “Shared Voice”, 2010), many communities have very limited access to healthcare professionals for a variety of reasons and the existing healthcare resources are rather scarce. Therefore, the model requires active participation of healthcare providers working in the communities (e.g., physicians, nurses, etc.) to disseminate information and education in that can also be made available through tele-health or web-based methods (e.g., webinars). For example, materials for model implementation are readily available in all healthcare facilities within and outside the community. Information includes not only educational resources on respiratory health and chronic respiratory conditions, but also advice on how to navigate the healthcare system and where to access resources on respiratory health.

Additional Model Elements

Other components of the model such as Community Coordination, and Community Empowerment and Capacity Building are connected to the five components presented above and aim to empower communities in model implementation by enabling them to modify the model based on their unique needs and circumstances; participate actively in creating materials and resources, and establishing community policies; and sustain model activities beyond the initial implementation.

Proper Community Coordination is essential in implementing any community-based initiatives. To make the model implementation successful, many activities and initiatives are well-coordinated at the community level and involve main community stakeholders by, for example, a community advisory group. Communities also choose a hub to coordinate all the activities and serve as a resource centre. In some communities, this role could be fulfilled by a health centre or the Department of Health and Social Development that could be a point of primary access to educational materials and other resources. Having the resource centre will help ensure that all community members are aware of how and where to find the needed information about respiratory health. Community Coordination is also crucial to establishing a community that can carry on the model activities and be able to coordinate further awareness initiatives on its own.

Community Empowerment and Capacity Building represents the ultimate outcome of the implementation of the main model components and outlines additional strategies that are applied to build a community that can independently sustain the model and related activities. Community capacity serves as a measure of how well the community can create and maintain proper respiratory health awareness with available resources. With the limited resources that some Aboriginal communities have, communities can apply a step-by-step approach to the model implementation and build slowly the community capacity while ensuring proper engagement of all community members. For example, community profiles and scans and ongoing community surveillance are conducted prior and/or during the model implementation. Ongoing evaluation of outcomes are performed to help community leaders to create different sustainable methods and approaches and understand which areas need special attention. The community must wok slowly and steadily on building this capacity by using a step-by-step approach and identifying priorities for action. As communities gain more knowledge and resources, their capacity will grow empowering community leaders to implement more strategies and activities towards better awareness of respiratory health and improved knowledge on chronic respiratory conditions including self-management approaches and prevention strategies. This component also speaks about the use of cultural practices (e.g. traditions, languages, images, etc.) in delivering respiratory health messages. The degree of cultural relevance and how culture should be incorporated in awareness activities is largely determined by the actual community and based on the existing traditions and practices.

The final model component is BREATHE, Building Respiratory Education and Awareness for First Nations, Inuit and Métis: Tools for Health Empowerment, which acts as a clearing house for educational resources on asthma and other chronic respiratory diseases as well as the risk factor of their development for First Nations, Inuit and Métis communities from across Canada. This clearinghouse is established to serve as a central point in Canada to access and distribute educational materials and resources on respiratory health. This clearinghouse can also coordinate the model implementation on a national level and serve as the support resources for participating communities. Further, the clearinghouse aims to not only provide a database of existing materials and resources, but it will also establish a “community of practice”. Discussion forums, e-newsletters, success stories, and ongoing feedback and suggestions for improvement obtained from Aboriginal communities are potential ways to keep communities engaged and share experience and lessons learned from the model implementation.

In summary, each model component focuses on various strategies and activities to enable First Nations, Inuit and Métis communities to create better awareness of lung health, to improve their knowledge about chronic respiratory conditions and their management, and to be able to establish more resources on respiratory health. The ultimate goal of the model is to improve decision making towards better policies and programs for First Nations, Inuit and Métis communities. In addition, the model implementation could potentially lead to advocacy initiatives in those communities.