Indigenous communities across the country discovered unique ways to improve care for people living with diabetes as part of the FORGE AHEAD project.

Based at the Schulich School of Medicine & Dentistry, the FORGE AHEAD project – a partnership between Western University and Indigenous community leaders – sought to empower Indigenous communities to design and implement their own health-care initiatives for patients with Type 2 diabetes.

“When you work with Indigenous communities, it’s really important to recognize the need for empowerment and self-empowerment,” said Dr. Stewart Harris, Principal Investigator. “You can think of FORGE AHEAD as a community-centred, and therefore patient-centred approach.”

For Dr. Harris, a Professor in the Department of Family Medicine, the road to compassionate, patient-centred care starts with recognizing that not all solutions are uniform. He attributes the success of the FORGE AHEAD project to the local expertise provided by Indigenous leaders and health care practitioners, as the needs of each community vary by location, isolation level and population.

The project used Quality Improvement (QI) methods and the integrated population health principles of the Expanded Chronic Care Model to drive forward unique initiatives for diabetes prevention and clinical management.

• “At the core of our program is what’s called participatory research. We worked in partnership with Indigenous communities to have shared ownership of the strategies that are implemented, the outcomes, and the whole process.”

  Dr. Stewart Harris, Professor, Department of Family Medicine

“During the project, the team provided a QI framework to local community leaders, including readiness consolations, ongoing coaching and support, an online diabetes registry and a clinical tracking system. A series of QI training workshops, where communities could collaborate, share ideas and best practices with each other, were also held.

“It was totally up to each community how they wanted to implement the QI framework,” explained Harsh Zaran, Project Coordinator. “FORGE AHEAD really is a community-based, community-driven project.”

Nine Indigenous comminutes from coast to coast completed the program, each with individual sets of goals and interventions.

“It’s really exciting to see that there was tremendous uptake in interest. The Indigenous communities we worked with loved the concept of QI, and the principles of participatory research really helped enshrine this as their own program,” said Dr. Harris.

Rates of Type 2 diabetes are significantly higher among Canada’s Indigenous populations, and individuals living in Indigenous communities are less likely to receive adequate care.

The impact of FORGE AHEAD – which stands for TransFORmation of IndiGEnous PrimAry HEAlthcare Delivery – on those communities, and patients with Type 2 diabetes, was remarkable.

At the program level, researchers saw significant improvements in clinical indicators for diabetes, including blood glucose control, blood pressure and LDL cholesterol for high-risk patients. Individuals who participated in the program were also more likely to participate in kidney disease screening.

As a result of FORGE AHEAD, Type 2 diabetes patients in the communities were 51 per cent more likely to have had at least three-quarters of the recommended services for diabetes care as outlined by Diabetes Canada’s Clinical Practice Guidelines.

“We’re very excited because FORGE AHEAD demonstrated relevant, meaningful clinical outcomes that we believe will ultimately lead to improvements in diabetes care and outcomes in Canada’s highest-risk population,” said Dr. Harris.

Reflecting on the project, it’s the connections that were made in the pursuit of improved care that stand out for Zaran.

“The most memorable moments from the project for me were having that human-to-human connection with health care leaders and really seeing the transformation that happened with individuals and teams in these communities,” said Zaran.

On Miawpukek First Nation in Newfoundland & Labrador, the FORGE AHEAD model was used to implement programs like lunch-and-learn sports programs for youth to improve physical activity, a data collection system to monitor diabetes patients; and a series of inactive aimed at pre- and post-natal diabetes management for pregnant women.

“There is no cookie-cutter approach that works for all communities,” said Cynthia Benoit, a Miawpukek social worker. “FORGE AHEAD empowered the community to develop a plan to increase health outcomes for persons with diabetes and was instrumental in making sure our plan was reflective in supporting what was best for the communities and the health centres.”

As the FORGE AHEAD team continues to build on their success, they look toward building a toolkit that can be scaled up for use across the country with more Indigenous partners. The new QI program, called REACH, aims to help even more communities and diabetes patients throughout Canada.

“Ultimately, what FORGE AHEAD translates into at the clinical practice level is an improved approach, and you could call it a patient-centred one,” said Dr. Harris. “It’s one that is more culturally appropriate and culturally sensitive, and better organized in terms of recognizing the realities of delivery of care on reserves and in Indigenous communities.”