Background
Purpose of the study
Conceptual framework
Stages/Core components | Base building and mobilization | Leadership | Vision and frames | Alliances, partnerships, networks | Advocacy agenda and action strategy |
---|---|---|---|---|---|
Stage 1 - Emergence | Participation of both paid and volunteer leaders is developed in base-building organizations; Reflection time and assessment are built into the movement activities | Movement leaders and the roles they play emerge and are recognized within the movement; Leaders are supported to develop their skills, roles and visibility | A process for creating a shared analysis of the problem is developed; Movement organizations develop strategic plans with explicit movement goals | Alliance anchors increase organizations capacity; Capacity for collaboration is developed | Needed skills and organizational capacities are identified and developed |
Stage 2 - Coalescence | New leaders are recruited; New members and constituencies are recruited and the base is expanded | Collaborative leadership philosophy is widely adopted by movement leaders; Leaders of the movement are respected for their different roles and responsibilities within the movement | Movement leaders develop shared values, motivations, and interests; Movement values and priorities begin to gain salience outside of the movement | Number, breadth, and capacity of alliances are strengthened; Joint strategic planning and identification of priorities among anchor organizations occurs; Trust is built among alliance members | Identification of collective action goals; Collaborative fundraising and sharing of resources increases |
Stage 3 - Movement’s moment | Power and leadership of the movement are recognized by the community base; Movement experiences rapid recruitment and growth | Movement leaders are recognized by public institutions and political institutions | Public support of the meta-narrative increases; Political will for movement goals significantly increases | Movement organizations share resources; Movement builds relationships with other movements | Major initiatives advance and are implemented; Collective action reaches a peak |
Stage 4 - Maintenance, integration, consolidation | N/A | New generation of leadership emerges | Norms change and the vision becomes widely shared among public and political leaders | N/A | Movement’s priorities and advocacy agenda are widely accepted and continue to drive agendas of movement organizations |
The Kahnawake Schools Diabetes Prevention Project
Methods
Research approach and design
Data collection
Data collection strategies | Data sources | Descriptions |
N
|
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1. Document review | Documents types |
n
| |
1. KSDPP annual summaries of activities and work plans | Description of school- and community-based program of activities, from year 1994 to 2016 | 12 | |
2. Scientific publications | Publications in academic journals, thesis and book chapter directly related to KSDPP (including descriptions of design and general approach of the project, implementation evaluation, outcomes assessment) or related to the antecedent stage of KSDPP (for instance, publications documenting baseline rates of diabetes in Kahnawake), from year 1988 to 2016. | 39 | |
Total documents | 51 | ||
2. Talking circles | Stakeholders groups |
n
| |
1. Intervention staff and Community Advisory Board (CAB) members | Past and current KSDPP intervention staff who develop(ed) and implement(ed) KSDPP health promotion interventions in the schools and the community. Community Advisory Board (CAB) members are past and current members of the committee supervising the administrative and financial operations of KSDPP, reviewing all intervention, research and training activities and ensuring research accountability to the community. | 7 | |
2. Research team members | Past and current community researchers from Kahnawake and researchers from various universities (including Université de Montréal and McGill University) that have contributed to a research project with KSDPP. | 7 | |
3. Community workers | Professionals working in different public sectors of the community (education, healthcare and social services) and providing direct or indirect services to or for the benefit of community members. | 5 | |
4. Community members | Residents of Kahnawake who are not involved in the previous groups and that can be conceived more as potential beneficiaries of the program (children’s relatives including parents and grand-parents). | 5 | |
Total participants | 24 |
Ethics approval and consent to participate
Data analysis
Results
Stages | /Core components | Base building and mobilization | Leadership | Vision and frames | Alliances, partnerships, networks | Advocacy agenda and action strategy |
---|---|---|---|---|---|---|
Stage 1 – KSDPP’s emergence (Early 1987 – mid-1997) |
Benchmarks
|
- Participation of both paid and volunteer leaders is beginning in base-building organizations;
- Reflection time and assessment are built into the movement activities
|
- Movement leaders and the roles they play emerge and are recognized within the movement;
- Leaders are supported to develop their skills, roles and visibility
|
- A process for creating a shared analysis of the problem is developed;
- Movement organizations develop strategic plans with explicit movement goals;
|
- Alliance anchors increase organizations capacity;
- Capacity for collaboration is developed
|
- Needed skills and organizational capacities are identified and developed
|
Evidence of achievement | - Kahnawake community leaders and elders start to mobilize and seek the collaboration of academic partners. - The Community Advisory Board (CAB) is formed with more than 40 volunteering people, representing a wide spectrum of local organisations, services, and the community at large. - All the partners take the time to collectively develop the project’s vision and the terms and conditions of the partnership. | - Community leaders, including elders and family physicians that raised the alarm about diabetes, invite academic researchers to join the partnership for their expertise in community research. - The intervention team is staffed by two full-time community members, chosen for their leadership in the community. These staff members can acquire new skills and enhance their competencies through formal training. | - In the early beginnings, a community awareness process allows to shift the perception of diabetes from a matter of fact to a community issue that can be acted on. - After acquiring funding, the partnership defines a shared vision that proposed an ideal for Kahnawake and lays the ground for strategic goals. - The terms and conditions of the participatory research process are collaboratively developed through a Code of Ethics. | - KSDPP developed from the alliance of community-based professionals coming from the Kahnawake Education Centre and the Kateri Memorial Hospital Centre, as well as researchers from McGill University and Université de Montréal. - The newly formed CAB included volunteers from multiple sectors of the community, that increased capacity for collaboration with local health, education, recreation, and community service organisations. | - Formal training in various areas for community and staff members develop new skills and increased capacities. - KSDPP provided opportunities for community collaborators to acquire new skills (e.g. new health curriculum delivered by the teachers). | |
Stage 2 – KSDPP’s coalescence (mid-1997 - 2000) |
Benchmarks
|
- New leaders are recruited;
- New members and constituencies are recruited and the base expand
|
- Collaborative leadership philosophy is widely adopted by movement leaders;
- Leaders of the movement are respected for their different roles and responsibilities within the movement
|
- Movement leaders develop shared values, motivations, and interests;
- Movement values and priorities begin to gain salience outside of the movement
|
- Number, breadth, and capacity of alliances are strengthened;
- Joint strategic planning and identification of priorities among anchor organizations occurs;
- Trust is built among alliance members
|
- Identification of collective action goals;
- Collaborative fundraising and sharing of resources increase
|
Evidence of achievement | - Important community leaders (the Mohawk Council of Kahnawake, Kahnawake Shakotiia’takehnhas Community Services, and the Kahnawake Education Center) commit to KSDPP and provide funds to enable KSDDP’s action. - Teachers began to be more comfortable with the new curriculum and are committed to the cause of KSDPP. | - KSDPP implements a participatory /collaborative and non-hierarchical style of governance. - Respectful relationships of collaboration are established between partners. | - KSDPP translates its vision into a full and workable action strategy that build and integrate traditional and cultural values. - The fact that community partners provide funds to KSDPP is a good indicator of KSDPP’s values and priorities being accepted and prioritized by community actors. | - At that time, half of activities are conducted by KSDPP independently whereas half result from collaborative partnerships between KSDPP and partners. - Community members and organisations bring in their knowledge of the community, and contribute ideas on how best to carry out the activities in which they are involved. - Trust and respect characterize the relationships with the education system. | - The intervention team establishes core of intervention activities and develops a good experience in implementing these within the community. - Collaboration allows partners to optimize community resources, share responsibilities and support each other’s efforts. | |
Stage 3 – KSDPP’s moment (2001–2006) |
Benchmarks
|
- Power and leadership of the movement are recognized by the community base;
- Movement experiences rapid recruitment and growth
|
- Movement leaders are recognized by public institutions and political institutions
|
- Public support of the meta-narrative increases;
- Political will for movement goals significantly increases;
- Proposed benchmark: Increasing dissemination of the program vision and goals
|
- Movement organizations share resources;
- Movement builds relationships with other movements;
- Proposed benchmark: Movement enlarges its scope
|
- Major initiatives advance and are implemented;
- Proposed benchmark: Collective action reaches a peak
|
Evidence of achievement | - During this stage, KSDPP benefits from deep community roots and recognition. - Kahnawake is recognized as a diabetes prevention leader among First Nations communities across Canada and internationally. | - KSDPP secures funding to develop the KSDPP Center for Research and Training in Diabetes Prevention, this acknowledging KSDPP experience, expertise and leadership in this field. - KSDPP staff and research team members are elected at important positions in national diabetes and international research networks. | - KSDPP becomes more active and extensively spread its vision locally and nationally through participation in national forums addressing diabetes and health issues for Indigenous people. - The newly created Onkwatakaritatshera health research council acknowledges KSDPP’s CAB as a valid and autonomous ethics authority for diabetes research prevention and adds KSDPP’s code of research ethics to their toolkit. | - KSDPP’s program of activities, already collaborative in nature, continues to build on partners’ strengths, allowing to increase both the reach and intensity of the program. - KSDPP’s program expands to include preschool children and engages adolescents in youth empowerment projects. - Partnerships with local organizations broaden to include local businesses. | - KSDPP’s collective action strategy reaches a peak, building on a core program of activities that has achieved maturity and the addition of other activity components. - More than 100 different interventions target individuals of all ages, families, organizations and political groups. | |
Stage 4 – KSDPP’s maintenance and integration (2007 - now) |
Benchmarks
|
- Proposed benchmark: Mobilization slows down and the movement appears less visible
|
- New generation of leadership emerges and builds capacities
|
- Norms change and the vision becomes widely shared among public and political leaders
|
-
Proposed benchmark
:
Capacity-building of the partners allows for transfer of responsibilities
|
- Movement’s priorities and advocacy agenda are more widely accepted and continue to drive agendas of movement organizations and partners
|
Evidence of achievement | - Decrease in resources, coupled with a lack of novelty, rendered KSDPP less visible. - Community mobilization slowly decreases. - Some administrative environments in the community become less sensitive to KSDPP’s action. | - A new generation of leaders in different components of the partnership, including KSDPP staff and research team, is slowly emerging. | - The vision promoted by KSDPP (a healthy community free of diabetes) and the norm underlying this vision (diabetes is a preventable disease) are adopted by many community members. | - Community partners are now taking over some of the responsibilities initially held by KSDPP (e.g. school physical activity policy, active school transportation project). | - KSDPP’s agenda is integrated into those of some partnering organisations, such as schools. |
The emergence of KSDPP: from early 1987 to mid-1997
“It took a year, a year and a half to prepare things once we had the grant. I remember saying things like ‘We need to do things, it takes time that we are out there. If we want to have an effect, we need to do things’. So we did such things as developing a code [of research ethics], a vision, developing all those kinds of things that take a lot of time, take a lot of discussion of participatory nature (…). I think that the way we did things put a very solid foundation; that what is sustained there, this kind of vision, this kind of relationship, the code of research ethics, and those kinds of things are traceable through those times.” (group 2)
Coalescence of KSDPP: from mid-1997 to 2000
“(KSDPP) went up there, spoke and invited people to come and sit on the Community [Advisory] Board… [this] was a place where your ideas were acceptable. Like you had to be the ones to write the terms of reference, you had to be the one for this mission, (...) it was always like a corporate thing.”
KSDPP’s moment: from 2001 to 2006
KSDPP’s maintenance, integration and consolidation: from 2007 to present
New proposed benchmarks
KSDPP’s areas of potential improvement
“Something that we talked about (...) is working with the economic sector of the community on health promotion. (...) Because if we look at the people that are selling food, are providing food services, we know that they are supplying demand; the community is demanding salt, fat, sugar, carbs, etcetera. We want them to shift to something else but we always backed off from them.”