Abstract
Background: The purpose of our work is to improve diabetes prevention and treatment in our communities by strengthening the capacity at a local level to help achieve our team’s vision of “community-empowered diabetes care that is wholistic and sustainable”. Diabetes is highly prevalent among Indigenous people in Canada, particularly in Northwestern Ontario, where intergenerational trauma from colonization and structural racism contribute to this health crisis. In response to the impact of diabetes on First Nations communities, the Sioux Lookout First Nations Health Authority (SLFNHA) passed a chiefs’ resolution to develop and implement a Regional Diabetes Strategy. This strategy focuses on integrating diabetes prevention and care programs & services among providers in the Sioux Lookout area. Our approach emphasizes collaboration with community members, community leaders, local health authorities, healthcare managers & providers, and government & academic partners.
Approach: To gain insight into the model of care for diabetes from the perspectives of communities—particularly those living with diabetes and their families—we collaborated with our partners to co-develop an ecosystem map for diabetes services. The goal of this service mapping was to assess how the model of care was implemented from an integrated care perspective. We aimed to determine whether services were working together at the community level, identify gaps or areas for improvement, and highlight exemplar innovations and successes. Our methodology included a desk review of program reports, documents, and websites to catalogue the available services. We then consulted with key stakeholders, including community members with lived experiences of diabetes, service providers, managers, and health system policymakers, to co-create and validate the diabetes ecosystem map for the region.
Results: Through our work, we created a visual representation of the complex and multi-layered model of diabetes care at the community level using these ecosystem maps. Three key lessons emerged from our self-reflection and community discussions: 1) the necessity of participation from all sectors, including community members, service providers, and health system decision-makers; 2) the importance of prioritizing the perspectives of the community served over the needs of service providers or the health system; and 3) the need to understand and assess the capacity and readiness of different service providers to consider the collective impact of their services. A notable example of successful integration was the Diabetes Community Health Worker (CHW) program, which engages CHWs residing locally within the communities they serve. This program has demonstrated potential to provide culturally relevant care, support continuity of care, and ensure timely access to services.
Implications: Service mapping, particularly from an ecosystem perspective, is a recognized strategy often used as an initial step toward developing or enhancing integrated services. It provides a comprehensive overview of available programs and the interconnections between them, while identifying community-level gaps that require attention. Moving forward, our next steps involve validating and creating individual diabetes ecosystem maps for each community in the Sioux Lookout area. This process aims to bolster community-led advocacy for an integrated diabetes care approach, ultimately reorienting diabetes care in our region toward greater community empowerment, autonomy, and ownership.