FALLS AND INJURY PREVENTION
PARTICIPATORY RESEARCH PROJECT
In BC, Aboriginal peoples are three times more likely to die of a fall than members of the general population. To date, there has been little research on fall prevention in Aboriginal communities in Canada. Feedback from Fraser Health Authority Aboriginal community leaders and facilitators suggests that current fall prevention programs may not be suited to Aboriginal communities and that resources to act on recommendations are limited.
The goal of this project would be to delve into the reasons why the incidence of falls is high in Aboriginal communities and in doing so, to develop a program of fall and injury prevention that is culturally relevant, effective and sustainable. To that end, we will work together with First Nation communities located in the Fraser Canyon using a participatory research approach. First Nation leaders and older adults affected by fall related injuries will be involved as equal partners in all aspects of the research process including:
- developing relevant research questions,
- identifying how questions can be respectfully asked in the community,
- choosing appropriate research methods,
- collecting and interpreting data, and
- developing strategies to act on the information learned.
All data and results of the research will be owned by the First Nation communities involved and each community will have full control over the dissemination and action plans arising from this research. Through this research process, we hope to achieve a lasting improvement in the health and well-being of older Aboriginal adults.
This project will address fall and injury prevention in Aboriginal older adults living within the Fraser Canyon and will address some of the following data:
- Fall prevention in older adults has been identified as a key priority for the Fraser Health Older Adult and Aboriginal Health Programs, to prevent pain, disability, death and costs associated with injuries related to falls.
- Injury is one of the leading causes of death in Aboriginal peoples, and is responsible for approximately one quarter of all deaths. In BC, Aboriginal peoples are three times more likely than the general population to die of a fall.
- Administrative data from Manitoba (collected between 1987-1999) showed that Aboriginal peoples had fracture rates higher, in all types of fractures, compared to non-Aboriginals.
- Research over the last 15 years has demonstrated that interventions can be effective in preventing falls and related injuries.
- Cultural and environmental factors and perception can greatly influence the effectiveness of interventions in specific populations such as Aboriginal communities. A review of current literature revealed no fall prevention research specifically conducted in Canadian Aboriginal older adult populations.
38,105 Aboriginal peoples live in the geographic area of Fraser Health including First Nations (status/ non-status), Métis, Inuit and multiple Aboriginal identities (Census 2006). (6) The FH Mobile Falls Prevention Clinic has now hosted clinics with Katzie and Nlaka’pamux Aboriginal communities. Feedback from health providers, Aboriginal community organizers and patients have highlighted the challenges of Aboriginal communities to act on falls prevention recommendations. These challenges include a lack of community resources, social and geographic isolation, competing priorities with chronic diseases (diabetes), drug and alcohol abuse and poverty / unemployment. This project will add to literature on how best to work with Aboriginal communities to develop relevant fall prevention initiatives; leading to lasting changes in communities to keep older adults safe from fall related injuries.
In participatory action research (PAR) the “problem” originates within the community. The “research” aspects of PAR attempt to avoid the traditional research carried out by universities and governments where “experts” go to a community, study their subjects, and take away their data to write their papers, reports and theses. Research in PAR is ideally conducted by the local people and for the local people. Research is designed to address specific issues identified by local people, and the results are directly applied to the problems at hand. Local people help define the problem, questions, methods and interpretation of results with researchers.
The intended benefits of adopting this approach are to ensure that research priorities and methods are grounded within the cultural and spiritual context of the (Aboriginal) communities involved. This process gives ownership of the research to the communities and in so doing, empowering the communities to effect internal social change.
Collaborators on this Project Include:
The Nlaka’pamux Nation Tribal Council and the Fraser Thompson Indian Services Society (contact person: Anne Cochran).
Role: Participatory research will take place in the following communities: Boothroyd Band, Boston Bar First Nation, Spuzzum First Nation and Oregon Jack Creek Band (and possibly Lytton First Nation).
FH Aboriginal Health Team– (contact person: Director Leslie Schroeder).
Role: This team has been engaging Aboriginal communities across FH and will play a key role in identifying and supporting collaborators and acting on research findings.
FH Falls and Injury Prevention Team – (contact person: Dr. Fabio Feldman).
Role: To work collaboratively with First Nations communities engaged in project to develop fall and injury prevention programs that are culturally relevant, effective and sustainable.
BC Research and Injury Prevention Unit (BCRIPU) – (Contact person: Dr. Vicky Scott, Senior Advisor with the BCRIPU and the Ministry of Healthy Living and Sport).
Role: Provide a forum for provincial dissemination and exchange of information gained from this project if this is the decision of the Aboriginal communities involved in the project. In addition, Vicky Scott’s extensive experience in knowledge translation and developing fall prevention education, training and programming will be available to the research team in an advisory capacity.
Goals and Objectives of Project:
- Goal #1: Identify the lived experience of Aboriginal older adults who have fallen and the barriers to using existing fall prevention programs.
Objective #1: To develop fall and injury prevention programs with FH Aboriginal communities that are culturally relevant, effective and sustainable.
- Goal #2: Create lasting relationships with band members as research partners.
Objective #2: To develop and implement research with FH Aboriginal communities around fall and injury prevention programs
- Goal #3: To improve the health and well-being of older adults in Aboriginal communities.
Objective #3: To put research findings into meaningful actions that benefit older adults in the community.
Anticipated Long-term Outcomes:
- A reduction in falls and fall related injuries among seniors living in First Nation communities participating in this project
- First Nation communities gain valuable research expertise and skills that benefit their communities
- First Nation communities involved take ownership of programs developed and the research findings
- Better quality of life and decrease in fall related injuries for seniors
- Improved skill level in both health providers, formal researchers and community researchers in the process of participatory research
The first year of the project will focus on outreach and engagement of the Aboriginal communities who have expressed interest in working collaboratively on the project. The focus will be on the following:
- building trust
- raising cultural awareness (learning more about the communities)
- sharing of knowledge
- developing a partnership between the research team and the communities
- 3 strategic planning meetings
- establishing a Project Advisory Committee
- establishing a research partnership agreement
- hiring a community project coordinator.
The second year will focus on developing a fall and injury prevention strategy based on the community priorities identified. Outcome measures will be established along with a sustainability plan. Research workshops will be provided if the Advisory committee determines the need for research training for community research team members.
The Advisory committee will be involved in all aspects of chosing and designing research methods, selecting instrumentation and methods of data collection and analysis. By the end of the second year interventions should be underway and the research framework laid out. Assuming there may be some questionnaires or surveys used in the research, allowance has been made in the budget for supplies.
The third year will focus on the implementation of research methods to evaluate the effectiveness of the fall and injury prevention strategies. This implementation strategy may involve recruitment of study subjects, data collection, analysis and addressing sustainability issues. Interpretation of research findings will occur in the context of community values and will be reviewed at an end of project community celebration with all project stakeholders