American Indian Alaska Native Community Partnership Guide: Supplement and Activity Plans

The American Indian and Alaska Native (AIAN) Community Partnership Guide Supplement was developed by the National Diabetes Education Program (NDEP) and the Association of American Indian Physicians to augment the comprehensive Community Partnership Guide with additional ideas and activities relevant to AIAN communities. The Community Partnership Guide is also available by calling the NDEP at (800) 438-5383.

Contents

• Letter to Diabetes Advocates
• Control Your Diabetes for Future Generations
• You Have the Power to Prevent Diabetes
• Move It!
• Diabetes affects individuals, families, and communities
• What Is the National Diabetes Education Program?
• Who Is the NDEP Trying to Reach?
• Good News About Diabetes
• Planning a Diabetes Activity for Your Community
• Sample Activity Plans
• Community Partners
• Tell Us What You Are Doing
• NDEP American Indian/Alaska Native Work Group
• NDEP American Indian/Alaska Native Staff
• Additional American Indian/Alaska Native Resources
• References

Letter to Diabetes Advocates

Dear Diabetes Advocate,

On behalf of the National Diabetes Education Program (NDEP) American Indian/Alaska Native Workgroup, I would like to thank you for helping us in our fight against diabetes in American Indian and Alaska Native (AIAN) communities. The NDEP AIAN Workgroup membership includes AIAN health professionals and community leaders who advise the NDEP on the development of culturally appropriate diabetes education materials and campaigns for AIAN communities. The NDEP American Indian campaigns have promoted a message of hope for diabetes prevention and treatment during the past 5 years, with our "Control Your Diabetes for Future Generations" campaign and our "Move It! And Reduce Your Risk of Diabetes" campaign for youth.

Recent research studies have shown that individuals with diabetes can reduce their risk of developing the complications of diabetes by lowering their blood glucose levels through healthy eating, exercise, taking their medications, and monitoring their blood glucose levels. More recently, the Diabetes Prevention Program research study showed that it is possible to prevent diabetes by healthy lifestyle changes. In addition to our "Move It!" campaign, we are releasing new materials this year to help educate AIANs of all ages that they can prevent diabetes. Making sure that every AIAN hears these messages of hope is our primary goal.

This American Indian Supplement to the NDEP Community Partnership Guide was developed to encourage you to create activities in your communities that help provide education about diabetes prevention and treatment. It is intended to provide additional ideas relevant to AIAN communities, and examples are included of specific activities that have been proposed. Since diabetes is a condition that affects individuals, families, and communities, your efforts to provide diabetes education in your community are extremely important. We hope you will find this guide to be useful, and we are grateful for your efforts in helping us all work towards a healthier future for AIAN communities.

Yvette Roubideaux, M.D., M.P.H.
Chair, NDEP American Indian and Alaska Native Workgroup

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Control Your Diabetes for Future Generations

The first wave of NDEP public awareness campaign and activities was launched in 1999 to focus on people with type 2 diabetes, because 90 to 95 percent of American Indians and Alaska Natives with diabetes have type 2. Type 2 diabetes typically develops during the adult years, with the average age of onset occurring in the middle years of life. However, type 2 diabetes is becoming increasingly common in youth.

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You Have the Power to Prevent Diabetes

NDEP's new campaign "You Have the Power to Prevent Diabetes" translates some of the encouraging findings from the Diabetes Prevention Program (DPP) study. This research trial found that lifestyle changes in diet and exercise and losing a little weight can prevent or delay the disease. To find out more about the DPP, visit the DPP website at www.bsc.gwu.edu/dpp/aboutdpp.htmlvdoc.

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Move It!

NDEP's campaign to help increase physical activity among youth.

Diabetes is one of the most serious health challenges facing American Indians and Alaska Natives in the United States today. Although diabetes is a serious problem for American Indian elders, youth need to know that they also are at risk. To address this growing issue, NDEP developed Move It! campaign packets for schools and organizations that work with youth to encourage more physical activity. These packets included posters, diabetes fact sheets, tips and ideas for youth to increase regular physical activity. Since the campaign's launch in 2002, over 2,500 schools that serve American Indian students have received these packets.

Here are a few examples that show how schools have used these materials:

• Used the posters as a talking point to begin discussion of diabetes in the community
• Displayed posters in hallways, near the entrance to the building or the cafeteria, in health, science or Physical Education classrooms, in the school infirmary, or in counselors' offices.
• Used the materials to promote health-related events such as a school health fair, a Diabetes Awareness Day, or even a school-wide fitness activity, such as a basketball tournament.
• Copied materials and distribute to parents.
• Began a walking club with staff and students after school.
• Began a staff weight loss program.
• Sponsored a wellness committee with students and teachers to organize campus-wide diabetes prevention or physical fitness activities.
• Provided diabetes screening to students and counseling for individuals who test at high risk for diabetes.
• Had community or tribal health educators come into the school and talk with students about diabetes and diabetes prevention.

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Diabetes affects individuals, families, and communities

Facts

• 110,814 or 14.9% of American Indians and Alaska Natives aged 20 years or older and receiving care from IHS have diabetes. (CDC)
• At the regional level, diabetes is least common among Alaska Natives (8.2%) and most common among American Indians in the southeastern United States (27.8%) and southern Arizona (27.8%). (CDC)
• On average, American Indians and Alaska Natives are 2.3 times more likely to have diabetes as non-Hispanic whites of similar age. (CDC)
• American Indians with impaired glucose tolerance have a higher incidence of diabetes than those whose glucose tolerance test results are in the normal range (Knowler WC, Saad MF, et. al 1993)
• About 20% of AI/AN adults have high blood pressure and over a quarter of AI/ANs living in 3 geographic regions have high blood cholesterol, both health problems lead to diabetes complications. (AHA)
• Diabetes among American Indian youth (ages 15-19) has increased 106% between 1990 and 2001. (IHS)

A series of focus groups was conducted by the Association of American Indian Physicians (AAIP), in which tribal leaders, Indian health professionals, and American Indian community members expressed a strong preference for diabetes education materials relevant to their specific tribe or culture.¹ In response, the Community Partnership Supplement was developed to provide examples of activities, ideas, and tips to help your community take action toward controlling diabetes.

1 Roubideaux Y, Moore K, Avery C, Muneta B, Knight M, Buchwald P. Diabetes Education Materials: Recommendations of Tribal Leaders,Indian Health Professionals, and American Indian Community Members. The Diabetes Educator 2000;26:2

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What is the National Diabetes Education Program?

The National Diabetes Education Program (NDEP) is a partnership between the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), and the Centers for Disease Control and Prevention (CDC) and more than 200 organizations across the country, encompassing African American, American Indian/Alaska Native, Asian American/Pacific Islander, and Hispanic/Latino populations. The goal of the National Diabetes Education Program (NDEP) is to reduce illness and deaths associated with diabetes and its complications.

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Who is the NDEP trying to reach?

NDEP is trying to reach all ethnic minority populations including American Indians and Alaska Natives with type 2 diabetes and those at risk for developing this disease.

More than 500 distinct American Indian and Alaska Native communities reside in the United States. Diabetes and prediabetes is common in many tribes, and the associated health consequences can be severe. American Indians and Alaska Natives with uncontrolled diabetes are at far greater risk of developing complications such as heart disease, kidney disease, blindness, dental disease, and nerve damage. Unfortunately, many AIANs may not know that controlling their blood glucose levels can help prevent such complications.

How is the NDEP reaching American Indian and Alaska Native communities?

NDEP reaches communities by creating culturally appropriate print and radio PSAs, posters, and school and tribal-based interventions and activities.

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Good News about Diabetes

Even though over half of the elder American Indian population has diabetes and the risk of developing diabetes increases as you get older, the GOOD NEWS is that diabetes is controllable. Better control of blood glucose can reduce the risk of complications.

Diabetes can be controlled with:

• Healthy eating
• Regular physical activity
• Blood glucose monitoring
• Medication
• Regular feet, eyes, and dental exams (at least once a year, twice a year for teeth)

If you don't have diabetes but are at risk for it, you can PREVENT DIABETES by taking small steps toward a healthier lifestyle.

What can you do to prevent diabetes?

• Exercise regularly
• Eat less fat and calories
• Lose weight

The Diabetes Prevention Program research study, which included 177 American Indians and Alaska Natives, found that small lifestyle changes in eating and physical activity, along with a modest weight loss can decrease a person's risk for diabetes by 58%!

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Planning a Diabetes Activity for Your Community

The NDEP developed the Community Partnership Guide* to provide individuals, organizations, diabetes health educators and other health professionals with ideas, tools, and tips to help communities take action toward controlling diabetes. The Guide provides specific instructions on how to plan, promote, and evaluate diabetes activities.

How do you go about starting a successful diabetes education activity?

The Guide can help you:

• Select and work with partners to help with the activity (pages 17-20)
• Outline the planning meeting (page 21)
• See what your diabetes activity plan might look like (page 22)
• Ask questions about the problems and possible solutions for diabetes control from the community's perspective (page 25)
• Choose an activity, and complete an event planner's checklist, and sample timeline (pages 26-30)
• Publicize your event (pages 32-33)
• Use NDEP campaign PSAs (page 103, print ads in back of guide)
• Identify calendar opportunities to tie your event to national dates with a health focus or cultural significance, e.g., October is Family Health Month, November is American Indian/Alaska Native Heritage Month and National Diabetes Month (page 37)
• Customize camera-ready campaign ads (back of partnership guide), Visit the NDEP Web sites: ndep.nih.gov, and www.cdc.gov/diabetes/ndep
• Evaluate your efforts (page 92)

The Guide also provides lists of resources:

• State Diabetes Prevention and Control Programs, www.cdc.gov/diabetes/states/index.htm (page 125)
• Local diabetes experts (page 15)
• American Indian organizations (page 136)
• the Community Partnership Guide is available from NDEP by calling 1-800-438-5383 or by downloading an order form from the NDEP website, ndep.nih.gov/publications/index.aspx?Category=Control1.

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Sample Activity Plans

Healthy Eating and Cardiovascular Sample Activity Plan

Community:
Southeast Alaska

Audience:
Alaska Native families

Profile:
Alaskan village with a population of 700, majority native, located on a large island in Southeast Alaska, transportation by boat or plane. Diabetes and heart disease are prevalent and Alaska Native youth are at high risk for diabetes.

Goal:
To improve diabetes management through healthy lifestyle changes, such as "Getting Physical."

Objective:
To assist families with meal planning, and encourage a healthier diet to control diabetes. To increase participants' knowledge about diabetes and its effect on the cardiovascular system.

Objective:
To encourage participants to exercise regularly to strengthen the heart muscle and control blood sugar. They will choose foods that meet dietary guidelines by eating a balanced diet.

Activity:

1. Schedule home visits with families to demonstrate meal planning using guidelines provided by the ADA. Assist family members in developing weight management plans.
2. Collaborate with the community center to develop low-impact aerobics and chair aerobics, geared to physical ability.
3. Expand community center activities to include meal planning/cooking demonstrations and various physical activities throughout the year.
4. Resources and materials will be available through AAIP-NDEP, State Diabetes Prevention and Control Program, CDC, ADA, and so forth.

Organizer:
Health Clinic and Community Health Practitioner

Delivery:
Community center, home visits, airplane drops, mail service, PSAs

Partners:
Media sources, local planning committee, AAIP-NDEP, Diabetes Prevention and Control Program

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Physical Activity Sample Activity Plan

Community:
Reservation in Washington State

Audience:
Pregnant women

Profile:
Young adult females at high risk for diabetes.

Goal:
To raise awareness about diabetes.

Objective:
To increase knowledge about diabetes and its risk factors.

Objective:
To encourage physical activity through a regular walking program.

Activity:
Develop a weekly physical activity workshop at the community center that will provide stretching, floor exercise, and walking. The workshop will be comprised of two parts:

• weekly educational seminar
• physical activity

Organizer:
Tribal community health educator

Delivery:
Local community center

Partners:
Community health nurse, dietitian, and volunteer certified exercise specialist, local tribal health clinic, tribal office personnel, local grocer, laundromat, church

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Physical Activity Sample Activity Plan

Community:
Community College-Central California

Audience:
American Indian college students

Profile:
College community and surrounding area that includes a population of diverse American Indian tribes. Participants include young families and/or students.

Goal:
To raise awareness among young adults in the college community about diabetes as a serious and common disease.

Objective:
To encourage the college community to participate in a physical fitness activity.

Objective:
To introduce appetizing prepared dishes which will encourage participants to eat healthy foods low in calories and fat.

Activity:
Plan a Fitness Week Program that will include a basketball tournament, other sport/fitness activities and nutritious food demonstrations. Air NDEP public service announcements on local college TV/radio station.

Organizer:
American Indian Students' Association, student(s) recently diagnosed with diabetes, college students, young adults and their families.

Delivery:
Local recreation center

Partners:
Nutrition educator, recreation coordinator, TV/radio stations, newspapers editors, local grocery store or farmer's market, AAIP, NDEP, State Diabetes Control Program, CDC.

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Nutrition Fair and After School Sample Activity Plan

Community:
American Indian community-Northern Arizona

Audience:
American Indian students, ages 12-14

Profile:
Students from communities with many persons with diabetes.

Goal:
Early prevention of diabetes.

Objective:
To improve the participants' knowledge of diabetes as a serious but controllable disease.

Objective:
To increase physical activity and encourage healthy eating choices through planned youth activities.

Activity:

1. Organize an after-school sports program (basketball, softball, race walking). Include guest athletes, a tournament, prizes, and a special ceremony.
2. Conduct a month-long nutrition fair. Students will develop a slogan that emphasizes healthy eating. Incorporate nutrition and fitness into classroom lesson plans (science, art, biology, physical education, drama, etc.), role playing, displays, posters, and a special assembly program. Older youth (ages 12-14) will mentor younger children (ages 6-8) who may enjoy creating a play and dressing up as different vegetables to dramatize the classroom lesson, or engage in another creative activity.

Organizer:
School Board Member, Tribal Council Leader, and Community Health Representative, School Staff.

Delivery:
School assembly programs, classrooms, church, parks and recreation.

Partners:
Radio and television stations, church members, tribal leaders, grocery store, and school staff, AAIP, NDEP, Arizona Diabetes Prevention and Control Program.

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Garden Project Sample Activity Plan

Community:
A rural community in Oklahoma

Audience:
Elders and youth

Profile:
Close family units, moderate income, and high incidence of diabetes.

Goal:
To promote traditional lifestyle and intergenerational activities while raising awareness about diabetes control.

Objective:
To enhance cultural awareness and physical activity through elders' teaching of traditional songs and dances.

Objective:
To increase knowledge and improve glucose control through intergenerational support.

Activity:
Garden Project. Activities to include weeding a neighborhood lot, preparing the soil, planting seeds, maintaining the garden, harvesting, and planning a harvest celebration. In addition, weekly gourd dances will be organized at the community center.

Organizer:
Community-based work group with Tribal council support and State Rural Development Councils.

Delivery:
Tribal community lot/community center

Partners:
Local radio station, Tribal council, Land Manager, local high school, elders program, bingo enterprise, local university (agriculture department or extension service), and local health center, AAIP-NDEP, CDC, NIH.

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Diabetes Education Exhibit Sample Activity Plan

Community:
Reservation-South Dakota

Audience:
Tribal members and their families attending pow-wow and rodeo.

Profile:
Tribal members with high rates of diabetes, high blood pressure, and obesity.

Goal:
To demonstrate the benefits of exercise/nutrition and early intervention.

Objective:
Introduce the benefits of healthy eating, with food portions demonstrated. To offer a variety of exercise plans that will fit each person's ability level for physical activity. To provide special attention to helping each person become more physically fit.

Activity:
Develop an exhibit. Have a display table at a pow-wow showing children engaged in physical fitness activities and nutrition education activities. Health screening (testing) will be available for participants to check blood sugar*, cholesterol, and blood pressure. (Include a special booth for screening and speaking to the healthcare person.) The screening will be available to all attending pow-wow and rodeo. NDEP brochures and educational materials will be distributed. Fresh fruit/vegetables, water, and juice will be available throughout the pow-wow.

Organizer:
IHS Diabetes Educator, School Athletic Program Coordinator, Community Health Representatives, and tribal employees.

Delivery:
Weekend Tribal Fair and Pow-wow.

Partners:
Tribal Fair and Pow-wow Committee, IHS Health Department, Tribal Newsletter, School, Tribal Diabetes Project, Rodeo Committee, AAIP-NDEP.

* Currently, community-based testing is not usually recommended by the National Diabetes Education Program. However, blood glucose testing/screening as described in these examples is appropriate in many American Indian and Alaska Native settings because of the high prevalence of diabetes in this population and the availability and involvement of Indian health programs that may provide follow up care for test results.

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Community Sample Activity Plan

Community:
Urban American Indian Community-Northeastern United States.

Audience:
American Indian Community, all ages.

Profile:
Diverse tribal population of various ages in the urban American Indian community at high risk for diabetes.

Goal:
Promote the NDEP campaign, "Control Your Diabetes. For Life." Raise awareness about diabetes and encourage healthy eating habits as a way of controlling the disease.

Objective:
To promote community awareness of diabetes and its effects.

Objective:
To start a community garden and encourage participants to eat a variety of healthy fresh fruits and vegetables.

Activity:

1. Youth will organize a Hand Game and invite community members and elders to explain the community goal for controlling diabetes. Incorporate their ideas and suggestions in plans for future activities.
2. Form a community garden group that will plant, take care of, and harvest produce.
3. Celebrate with a harvest activity where some of the harvest is cooked and eaten and part of the bounty is given to the elders.

Organizer:
Students and local companies (the companies would donate seeds to the community), Urban Indian Center.

Delivery:
An empty lot located near the urban center.

Partners:
Radio stations, local companies, hardware stores, and the community members, church, 4-H Club, Urban Indian Center, AAIP-NDEP.

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Health workshops and Screening Sample Activity Plan

Community:
Five reservations across the Florida peninsula, including rural and urban areas

Audience:
Tribal members and American Indians with diabetes.

Profile:
Tribal members, many diagnosed with diabetes for five or more years.

Goal:
Promote diabetes prevention awareness initiatives through education and access to healthcare.

Objective:
To increase knowledge of diabetes and its risk factors.

Objective:
To provide blood sugar*, blood pressure, and foot screening.

Activity:
Plan and deliver workshops and health screenings at special areas within the communities. Workshop includes: foot screening, diabetes education and risk factors, and the importance of foot care and screening. A healthy lunch will be provided.

Organizer:
Diabetes Educators from Indian Health Service, Public Health Nurses, Health Service Providers from local clinics.

Delivery:
Tribal library system branches.

Partners:
Tribal leaders, librarians, tribal casinos' food service, Native Broadcasting Department and sister stations, Florida DPCP, NDEP, American Diabetes Association.

* Currently, community-based testing is not usually recommended by the National Diabetes Education Program. However, blood glucose testing/screening as described in these examples is appropriate in many American Indian and Alaska Native settings because of the high prevalence of diabetes in this population and the availability and involvement of Indian health programs that may provide follow up care for test results.

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Community Partners

Seek out other organizations and community leaders to enhance your program with more resources, knowledge and support.

Who are some of these partners?

What can partners provide?

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Tell us what you are doing!

The National Diabetes Education Program wants to hear from you. Tell us how you helped increase the awareness of diabetes in your specific tribe or culture. We can share your experiences and successes with our partners and communities throughout the country. Your words of wisdom will provide a wealth of ideas on which other communities can build their diabetes awareness efforts.

What was your activity?

How did you do it?

Who helped?

What were the results?

Did local media cover the event?

Any next steps planned?

What else would you like to see from the NDEP?

Name

Organization

Address

City

State

Zip

Phone

Fax

E-mail

Can we refer other groups to you for additional information? Yes No

Can we post information about your program on the NDEP partner website? Yes No

Fax or mail your submission to:

National Diabetes Education Program, Division of Diabetes Translation
4770 Buford Highway, NE (MS K-10), Atlanta, GA30341-3717
Fax: (770) 488-5195, Phone: (770) 488-5196

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NDEP American Indian/Alaska Native Work Group

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NDEP American Indian/Alaska Native Staff

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Additional American Indian/Alaska Native Resources

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References

American Heart Association. Statistical Fact Sheet - Populations. American Indians/Alaska Natives and Cardiovascular Disease, pps. 2-3. www.heart.org/downloadable/heart/1046238734663FS02AM03.pdf Accessed November 18, 2003.

Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2003. www.cdc.gov/diabetes/pubs/factsheet.htm Accessed November 18, 2003.

Charles MA, Pettitt DJ, Saad MF, Nelson RG, Bennett PH, Knowler WC. Development of impaired glucose tolerance with or without weight gain. Diabetes Care. 1993 Apr;16(4):593-6.

Department of Health and Human Services. Office of the Secretary. Office of Public Health and Science. HHS Announces Funds for Diabetes Prevention Among American Indian and Alaska Native Youth. [Press release.] December 10, 2002. minorityhealth.hhs.gov/templates/content.aspx?ID=3024 Accessed July 23, 2004.

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Revised 2004