Teach Our Children: Stroke Education for Indigenous Children, First Nations, Ontario, Canada, 2009–2012

Abstract

BackgroundBecause of the heightened risk for stroke among indigenous people, we conducted this multiyear community case study from 2009 through 2012 to address stroke education needs among children aged 11 to 13 years residing in northern urban, rural, and remote First Nations in Ontario, Canada. The goal was to determine what young people understand about stroke and to develop an age-appropriate and culturally appropriate educational product.Community ContextThis project responded to First Nations requests that we educate their young people about the signs and symptoms of stroke and the need for early response. Ten First Nations and 4 indigenous health organizations took part; 7 contributed to the educational product.MethodsThis study was developed under the guidance of the Northwestern Ontario Regional Stroke Network Aboriginal Advisory Committee. It employed indigenous researchers and facilitators to ensure that methods used (questions assessing children’s knowledge of stroke and their ideas on how best to deliver messages) reflected the cultural values of participating study sites.OutcomeIndigenous children had limited knowledge about stroke and its signs, symptoms, and consequences; children in remote communities were better informed than those in other locations. Educators agreed that a DVD was the most effective way to deliver stroke information to children in this age group. The principal outcome from this 3-year community engagement was an 11.5-minute DVD titled Act F-A-S-T 1-2-3!. Follow-up indicated that the educational tool continued to be used to educate indigenous children and adults about stroke signs and symptoms, the need for early response, and risk reduction.InterpretationAlthough indigenous communities are each unique in their culture and traditions, all have a strong commitment to improving health and are generous in their support for research that addresses their needs. Our study provides examples of the engagement and participatory research strategies that were effective, the practical supports required, limitations to the study, and how barriers to stroke education can be overcome.

A case study of using the He Pikinga Waiora Implementation Framework: challenges and successes in implementing a twelve-week lifestyle intervention to reduce weight in Māori men at risk of diabetes, cardiovascular disease and obesity

“…The use of tuakana and kaiarahi is consistent with the literature on community health workers (CHW) [51,52]. CHW are frequently employed with Indigenous communities in order to connect culturally with participants and systematic reviews demonstrate positive health gains from interventions delivered by CHW [31,32]. The current findings are also supportive of the benefits of using participatory research approaches to develop and adapt lifestyle interventions for risk factors associated with diabetes, cardiovascular disease, and obesity [20][21][22][23].…”

“…Both interventions used components from various lifestyle interventions (physical activity and nutrition) primarily the Diabetes Prevention Program [29,30]. Other elements of the intervention were developed through the co-design process although one key element (use of a peer or community health worker for support) has grounding in the extant literature [31,32]. These elements identified during the co-design process came from the participants as being motivating factors for their participation; differences between the two cohorts reflect this process.…”

Baseline Stroke Literacy of Young Children Based on “FAST 112 Heroes” Program

“…The majority of children in this work could not identify the appropriate course of action in case of a stroke and no child completed the test with a perfect score. Recent studies have shown that educational programs can have a positive impact, not only on children's stroke knowledge, but also on their extended families, since children can be leveraged as conduits and transfer stroke literacy to the family members (19)(20)(21)(22). We show that young children are not aware enough of the stroke symptomatology and thus suggest more school-based interventions that will deliver stroke knowledge to children.…”

Preschool children deliver stroke knowledge to their families with the FAST 112 Heroes educational programme

“…It is well known that older adults are at greater risk of stroke than those in younger age groups (Gorelick, 2019; Teh et al, 2018; Tsivgoulis et al, 2018). In multigenerational families, older adults spend a substantial amount of time with their children or grandchildren, with grandparents often acting as secondary caregivers (Hill et al, 2017; Pulgaron et al, 2016). Women who do not give birth before the age of 30 are a typical example of older parents living in the family household.…”

“…Importantly, a programme suited for the extended family is effective in promoting community health if it addresses both child and parental learning (Graybill et al, 2010; Ishigami et al, 2017; Kato et al, 2017; Morgenstern et al, 2007). Since previous studies have shown that intervention effects often cease when a health promotion programme is over (Morgenstern et al, 2007; Sakamoto et al, 2014), this programme aimed to deliver sustainable information by requiring children to disseminate stroke information to their extended family members, using posters, refrigerator magnets, stickers and other teaching aids (Hill et al, 2017). These aids act as positive reinforcers of programme participation and are integral to the programme’s effectiveness and sustainability.…”