Kica-Wasimisinanahk Miyo-ayawin ~ Our Children's Health. Promoting Physical Activity and Nutrition Through a Health Promoting School-Based Intervention in a Metis Community.

摘要

First Nations and Metis children living in Canada continue to experience disproportionately high levels of obesity and type 2 diabetes (T2D) compared to the general Canadian child population (Young 2003; Oster and Toth 2009). Evidence supports the need to develop and implement culture-based physical activity and nutrition health programming in order to support the adoption of healthy lifestyles among First Nations and Metis school-aged children (Macaulay, Paradis et al. 1997; Potvin, Cargo et al. 2003; Ng, Young et al. 2010). Culturally relevant health promoting interventions have been created in collaboration with First Nations communities; however, given that Metis populations have unique cultural characteristics that differ from First Nations groups, there is strong rationale for developing, implementing and evaluating culture-based health programs in collaboration with Metis communities that take a preventative approach with school-aged children. Therefore, the purpose of this research was to evaluate the impact of a Metis culture-based comprehensive school health program on the physical activity and nutrition knowledge, attitudes, beliefs and behaviours of Metis children, using participatory action research (PAR).;Physical activity and nutrition knowledge, attitudes, beliefs and behaviours among the Metis children were measured prior to and following the implementation of the health program. A group of 21 age-matched students attending separate Grade 3 and 4 classes acted as a comparison standard care group and did not receive health promotion programming. A variety of qualitative and quantitative methods were used including interviews (focus groups; individual with children and teachers), questionnaires (food frequency; knowledge, attitude and beliefs; physical activity questionnaire (PAQ-C)), accelerometry (using Actical accelerometers), and photovoice (using digital cameras).;Physical activity data showed that participating students were more physically active than students who did not receive the intervention. Participating students spent significantly fewer minutes in sedentary activities compared to a comparison group post-intervention, 495 min/day compared to 527 min/day respectively. Moderate-to-vigorous physical activity (MVPA) levels did not significantly decrease in students participating in the intervention, while a comparison group experienced significant decreases in MVPA levels. This suggests that the intervention was successful in preventing a decline in MVPA levels that may normally be observed.;Nutrition data revealed no statistically significant differences between the two groups. However, greater improvements were measured in the reported consumption of low nutrient dense foods such as cakes, cookies, pie, doughnuts and pop beverages. Fifty percent and 46% of intervention participants improved their consumption of "pop drinking" and "cakes, cookies, pie and doughnuts", respectively. Student perceptions and awareness of healthy foods were positively impacted following the health programming.;Initially, relationships were built and nurtured with the participating community and collaborations commenced to develop and implement a Metis culture-based school health program. Metis community members' input was sought to develop a series of 17 culturally relevant physical activity and nutrition health promoting lessons. The participating teacher delivered these lessons to one split class of Grade 3 and 4 Metis students (age 8 and 9 years; n=16) attending the local elementary school once per week over a 4-month timeframe. Overall, children were taught about healthy eating and physical activity and how a healthy lifestyle can prevent obesity and diabetes.;Although the primary purpose of the project was to evaluate the effectiveness of a school health program on physical activity and nutrition knowledge, attitudes, beliefs and behaviours, an important component of the research was also to evaluate the process of using PAR methods in collaboration with a Metis community. My reflections on using PAR methods integrated my personal observations, experiences, interactions and feedback received from the participating teacher and community research team members throughout the project. The successes and challenges of using PAR methods included the importance of (1) building rapport with the community; (2) maintaining flexibility regarding research timelines; (3) respecting reciprocity of exchanging knowledge and action between the community and myself; and (4) finding balance to ensure that the community was actively participating.;The overall results of this study indicate that a comprehensive school health program can improve physical activity levels and can influence awareness of healthy foods among Metis children. The active engagement of the community ensured the integration of Metis culture, enhanced the sustainability of the program in the community, and largely influenced my learning of engaging in collaborative, Metis community-based research that will be lasting for me as a researcher in the future.