Developing, implementing and evaluating falls prevention programs with Aboriginal Communities using participatory research methods. Dr.

Transcription

1 Developing, implementing and evaluating falls prevention programs with Aboriginal Communities using participatory research methods Dr. Sonia Singh

2 Long History 2007 Improving follow-up after low trauma fracture Community Based Clinical Investigator salary award, UBC 2011 Recent participatory research award

3 Overview What is participatory research? How did the idea come about? How did we develop the grant? Update on research in progress Challenges and rewards

4 What is participatory research? 7 Principles (B. Hall): Problem originates in community Goal to improve lives of those involved Community members control the entire research process Focus on marginalized populations

5 What is participatory research? 7 Principles (B. Hall): Process enables action by empowering people People themselves are researchers in equal partnership with academic researchers Academic researchers are committed learners in a process leading to change Not detached observers.

6 How did the idea come about? Key components Mobile Improves access to falls risk assessment Partners with local community services Links with family physicians Low cost ($60 per patient)

7 Nurse Review Review of of health health record record Postural BP Height /Weight Weight Vision Falls / fracture history Pharmacist Medication, Calcium, Vitamin D Bone Health Clinic Flow Falls risk assessment PPA Lower Limb Strength Reaction time Explain results List of targeted recommendations Contrast Sensitivity Postural Sway PT / OT Review of home safety check Prescribe exercise programs Review of mobility aids and hip protectors Proprioception

8 April Boston Bar Nlaka pamax First Nations Spuzzum Boothroyd Boston Bar Coordinated by Anne Cochrane longstanding community consultant

9 Geographic location within FH

10 Not suited to Aboriginal communities Challenges to act on falls prevention recommendations: Social and Geographic isolation Lack of community resources Competing priorities of chronic diseases Drug and alcohol abuse Poverty and unemployment

11 Summer of 2010 How could we modify the mobile clinic? Culturally relevant Recommendations fit with existing resources Identify gaps in community resources Engage community in falls prevention

12 Summer of 2010 Vancouver Foundation announced Health and Medical Education / Research Grant Application On holidays in Britain

13 Letter of intent (LOI) 2 day extension Connected with FH Aboriginal health, falls prevention manager, Anne Cochrane our community liason LOI submitted

14 Key to success Keep ideas on the ready Never know when an opportunity may arise Ask for extensions

15 How did we develop the grant? Overall goal: Develop a program of fall and injury prevention with 3 bands from the Nlaka pamux First Nations using participatory research methods 3 key goals and objectives

16 Goal #1 Identify the lived experience of older First Nation adults who have fallen and the barriers to using existing fall prevention programs. Objective #1: To develop fall and injury prevention programs that are culturally relevant, effective and sustainable.

17 Goal #2 To create enduring relationships with First Nation community members as research partners. Objective #2: To develop and implement research with participating First Nation communities around fall and injury prevention programs

18 Goal #3 To improve the health and well-being of older First Nation adults within their communities. Objective #3: To translate research findings into meaningful actions that will benefit older adults in First Nation communities

19 Anticipated long term outcomes Reduction in falls and fall related injuries among seniors living in communities Communities gain valuable research expertise/skills Aboriginal communities involved take ownership of programs developed and the research findings

20 Anticipated long term outcomes Better quality of life and decrease in fall related injuries for seniors Improved skill level in health providers, formal researchers and community researchers in the process of participatory research

21 Timeline of 3 year proposal Year One-Community Engagement Focus on building trust, cultural awareness, sharing of knowledge, developing partnerships Ethics approval FH Development of Project Advisory committee Hiring of Community Engagement coordinator and Research assistant Development of Research Partnership agreement Research workshops Strategy to identify community priorities around older adult mobility, falls and injury prevention

22 Timeline of 3 year proposal Year 2 Implement strategy to identify community priorities around older adult mobility, falls and injury prevention Focus groups, interviews, questionnaires Town hall meetings Educational events Develop programs based on identified priorities Develop research questions related to programs / priorities

23 Timeline of 3 year proposal Year 3 Implement research methods to evaluate effectiveness of falls and injury prevention programs Address sustainability plans Dissemination of findings to community Generation of future research ideas

24 Keys to success Engagement of communities Letter of support and intention to partner 3 bands-spuzzum, Boston Bar and Boothroyd Support of community consultant Anne Cochrane to act as a bridge between First Nations communities and the formal research team

25 Keys to success Strong core research team Fabio Feldman, PhD FH Manager for fall, injury prevention seniors Leslie Schroeder Director FH Aboriginal Health Joannie Sims-Gould, PhD Centre for Hip Health and Mobility, experienced qualitative and participatory researcher

26 Keys to success Strong external advisory committee Vicky Scott, PhD: Senior Advisor on Fall and Injury with the BC Injury Research and Prevention Unit expertise in the content area of fall and injury prevention and knowledge translation

27 Keys to success Strong external advisory committee Mary Louise Kelley, PhD: Professor of Social Work, Lakehead University, past Director of the Centre for Education and Research on Aging and Health.

28 Keys to success Strong external advisory committee Marion Crook. PhD: Past Research Ethics Board Chair at Kwantlen Polytechnic University. Dr. Crook s doctorate research centered on Aboriginal education.

29 Keys to success PI with past research experience Vancouver Foundation Grant CIHR Smaller pilot study funding Kwantlen, Peace Arch Hospital Foundation

30 Keys to success Pilot study work Student lead project Qualitative Barriers and facilitators to falls prevention programs in Aboriginal communities Health providers Kwantlen Elders

31 Keys to success Strong collaborations between key organizations Nlaka pamux Nation Tribal Council and the Fraser Thompson Indian Services Society FH Aboriginal Health /Falls Prevention BC Research and Injury Prevention Unit Centre for Hip Health and Mobility, UBC

32 Update on research in progress Notification of Success! Dec Preliminary steps Meetings with formal research team First meeting with community leaders-april 2010 Questions about research process Take back to each band for in-depth review and approval Project start August 2011 Ethics application approved Funds transferred Cultural competency course

33 Update on research in progress Committee structures /Terms of reference External advisory committee Working committee Community advisory committee Job descriptions Community engagement coordinator Research assistant

34 Update on research in progress 2 other bands have joined the project! Lytton First Nations & Oregon Jack Creek Band Each of the 5 bands signed a MOU

35 Update on research in progress First full research team meeting April 11 at Wilfred Campbell Health Centre in Boothroyd Getting to know each other New Goal of project: Develop a research ethics review process for communities New partners: Interior health Director Aboriginal Health Manager for falls and injury prevention

36 Update on research in progress Willing to be part of community advisory committee Meet 4 times / year Advise and guide on all aspects of project Develop a communication strategy

37 Update on research in progress Action items Research tools for ethical review in Aboriginal communities Further develop TOR for committees Hiring of community engagement coordinator Invitation to meet with Lytton Band council June Next meeting date June 22

38 Challenges and Rewards Challenges No experience with research method No experience working with Aboriginal peoples Rewards New research skills Expand my understanding of Aboriginal culture, ways of thinking about health

39 Challenges and Rewards Challenges Slow pace of participatory research Lack of control on the unfolding of research plan Reaching consensus with each stage of the process Rewards Patience is a virtue, process is important Research is truly informed by the community and benefits the community Learning valuable negotiating / facilitating skills

40 Summary Participatory research is: Hard work At times frustratingly slow Requires patience and respect of all partners Breaks down barriers between researchers and study subjects

41 Summary Powerful research method that can lead to joint action for improved health of a community Research responsive to community needs Research findings will be relevant to community Direct application of research findings

42 Questions?