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Beliefs, Practices and Management of Obesity and Type-2 Diabetes Mellitus among

Indigenous Population

Aryanna Kassandra Perbillo

Student Number: 201905440

St. Francis Xavier University

NURS 415: Nursing of Adults II

Professor Connie Gregory

October 30, 2021

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Introduction

Diabetes mellitus (DM) is a chronic condition wherein the pancreatic beta cells lose its

ability to produce or properly use insulin, a hormone that controls sugar levels in the blood.

There are different types of DM and in this paper, we will focus on type-2 which is associated to

multi-factorial causes. Obesity is one of the major factors leading to the development of DM.

Both obesity and type-2 diabetes mellitus (T2DM) are preventable conditions but with increasing

prevalence in the Canadian healthcare system (Harris, et al., 2017).

In the operating room where I work, there is a significant number of pediatric patients

from the Indigenous population who were either obese or were diagnosed diabetic who had

certain complications perioperatively. Some of them had surgeries brought by complications of

these conditions. Although recipients of care are more of pediatric patients, I also encounter and

communicate with their family members and relatives. The observation I made from these

encounters is the lack of awareness towards the serious impacts of these conditions towards their

health. On the other hand, concerns are raised by some of my colleagues as some of them think

that their patients don’t trust how health-related issues are being addressed in clinical settings.

Some consider themselves not culturally knowledgeable to give quality and culturally

appropriate care to this population group.

In this paper, the primary goal is to discuss a structure wherein healthcare workers can

plan a cultural-appropriate care and recommend health practices in managing conditions such as

obesity and type-2 diabetes mellitus among the Canadian Indigenous population. In aiming to be

more knowledgeable about their culture, some traditional practices and beliefs that could

influence the perception towards these medical conditions will be discussed.

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Indigenous’ Perspectives on Health and Health-Related Beliefs and Practices

For the Indigenous population, health of a person is not perceived as a personal matter as

“every person is linked to a broader physical, animal and social environment” (Ootoova, et al.,

2001, p. 1). The concept of miyupimaatissiium, “or being alive well” explains that the well-being

of an individual is a holistic concept wherein the “natural world is viewed as a source for life and

extends the view of health beyond the biomedical or social lens and recognizes connections

between ecosystems, equity, and health” (Wasekeesikaw, et al., 2019, p. 71). In this balance

includes the environment providing remedies for someone’s illness, prompting them to rely on

medicinal plants to treat various medical conditions. Use and consumption of raw and fresh

animal meat and oil is not only common for usage in the daily activities but also as remedies for

conditions such as open wounds, nausea, lice infestations and many more (Ootoova, et al., 2001).

Certain lifestyles pose serious health risks in the medical perspective while deemed as

sacred in the Indigenous culture. The concept of tobacco smoking for example is a way of

offering to establish a direct link with the spiritual world (Jetty, 2017).

Review of Related Literature

In comparison to their non-Indigenous counterparts, Indigenous individuals are diagnosed

as diabetic at a younger age, have greater severity at diagnosis, develop higher rates of

complications, and have poorer treatment outcomes (Crowshoe, et al., 2018). In a study by

Harris, et al. (2017), diabetes diagnosed before and during pregnancy plays a key contributor to

the epidemic of T2DM in the Indigenous population. In the clinical guidelines by Crowshoe, et

al. (2018), awareness should be done in the Indigenous women and girls of childbearing age as
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both maternal obesity and high blood glucose during pregnancy increases the next generation’s

risk of childhood obesity and DM.

On the other hand, obesity in the Indigenous population is mainly associated with

geographic remoteness and food insecurity (Batal & Decelles, 2019). Although many still adhere

to traditional lifestyle, most of the produces are bought for a high cost which makes “becoming

healthy” a big expense. Moreover, the diet in general is rich in fats and carbohydrates since most

of the sources of food consumption are animal meat.

Conformity with traditional interventions in resolving their health problems is a factor

towards not adhering to the approaches of modern medicine (Wasekeesikaw, et al., 2019).

Nowadays, there are different community health services offered to the Indigenous population,

but hesitancy towards these resources is common. This is explained by residential schools and

“Indian” hospital brought by previous government laws and policies of colonization. According

to the World Health Organization (2009, cited in Crowshoe, et al., 2018), colonization is the

most significant social determinant of health affecting Indigenous peoples worldwide. As it

greatly disrupted the Indigenous values, culture and spiritual practices, the experienced trauma

puts significant repercussions on the relationship between them and the healthcare team

(Wasekeesikaw, et al., 2019; Hayward, et al., 2016).

As mentioned earlier, some healthcare workers feel uneasy to bring care to the

Indigenous people due to the feeling of lacking knowledge about their culture. They perceive this

as giving inadequate care to them (Harris, et al., 2017). Knowing every information about the

different cultures of the Canadian Indigenous people doesn’t justify one’s cultural competence.

However, it is cultural humility that develops a nurse’s cultural competence. It is when an

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individual broadens his/her mind to new ideas and other cultures, while still being true to one’s

identity (El Hussein & Osuji, 2020).

Establishment of Culturally Sensitive Practices: The E4E Care Framework

To address the issue regarding care towards the Indigenous population’s plan of care for

DM, a framework is being encouraged to be used wherein healthcare workers can base their

cultural-appropriate plan of care. E4E Care Framework is an ongoing global framework aiming

for healthcare workers to improve Indigenous patients' capacity for change in a way that

acknowledges the social factors that affect the increasing diabetes rates, while using a cultural

lens to facilitate improved outcomes (Crowshoe, et al., 2018).

The E4E Care Framework viewed colonization as an important barrier to improved

outcomes in relation especially to DM (Crowshoe, et al., 2018). Structural competency in

balance with cultural safety should be central to the clinical process when negotiating diabetes

management with Indigenous patients.

This framework also provides knowledge and recommendations for use as a motivational

interviewing. This is shown through engagement of therapeutic means of communication such as

reflective listening, open-ended questions and letting oneself enhance their autonomy. This is

believed to overcome ambivalence and avoidance on the disease management and aids in

opening the minds of Indigenous people towards health promotion behavioural changes

(Crowshoe, et al., 2018).

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Stakeholders

The main stakeholders that would be affected of the change are the patients of Indigenous

population and their families and relatives, the healthcare team under their care and the staff of

care services in the communities of the Indigenous population. As certain changes in the health

practices of the Indigenous people might affect their traditional lifestyle, this could be

overwhelming for them. Establishing a culturally sensitive plan will lessen their mistrust towards

the healthcare system and would be more cooperative towards the healthcare team. On the other

hand, it will have an impact on the healthcare workers, as this would cause dilemma in certain

situations. However, this will encourage them to be more culturally sensitive to their care of plan

and be motivated to know more of their cultural practices especially health-related traditions and

beliefs. Moreover, the Canadian healthcare system will benefit also in the long run. If more

Indigenous people are convinced of the seriousness of having either DM or obesity, preventive

strategies can be done by themselves and in the community settings, which could result to

possible decrease in need for hospitalizations (Hayward, et al., 2016).

Tasks and Resources

Building rapport is the vital task in here before pursuing for the change. The entire

process includes active participation of both the patients and relatives of Indigenous background

towards the discussion of healthcare teams. In return, the healthcare team plans out health

promoting behaviours that they can integrate in their daily live, and addresses the concerns of the

patients, especially the social and cultural factors.

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A key strategy for improving Indigenous health is community development

(Wasekeesikaw, et al., 2019). Connecting with respective community resources is vital in

ensuring continuity of care as well as health promotion in a community level. As Indigenous

people are open to others who either share their culture or immerse with them in their community

(Hayward, et al, 2016), Information materials such as posters and leaflets in their native language

can be distributed also by these community resources to strengthen more the advocacy of health

promotion. Hospital can play a major role in communicating with external resources, as the

means of implementation protocols are under their supervision.

Expected Outcomes

Foremost, trust towards the healthcare system is aimed for a better patient-healthcare-

provider interaction and relationship. The goals in the plan of care could be met if there is a

mutual effort between the two parties. After establishing this framework for a cultural-sensitive

care of plan, active participation from the Indigenous patients can be somehow ensured. On the

perspective of health care workers, they would develop their cultural competence as they

understand better various cultural beliefs and practices which are different from his/her own.

Creating Awareness of Change

A thorough review of the E4E Care Framework is advised. It would be possible to have a

committee focused on extracting information and then integrating culturally sensitive plan of

care to the framework. As for the regular staff, emphasis of cultural humility should be

promoted. Self-reflection could be done by an individual.

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Prevention is the best strategy to minimize, if not avoid, having chronic conditions (El

Hussein & Osuji, 2020). This is important for the Indigenous people to understand, that

modifications are directed towards preventing the prevalence of both obesity and DM and not

towards cultural adaptation.

Conclusion

In medical conditions as diabetes mellitus and obesity wherein traditional lifestyle and

beliefs have great impact, focus on social and cultural elements is fundamental to effective care

among Indigenous patients. As much as the health system tries to follow-up on these patients, the

plan of care cannot succeed without the active participation of the patient and their family

members in the case of younger patients. The best management towards these conditions starts

with a culturally sensitive health education towards the Aboriginal youth and the parents or

relatives of the Aboriginal children.

Furthermore, involvement of different resources is important. Communication between

hospitals, healthcare practitioners and the community-driven resources in the remote areas is

critically important in ensuring not only health promotion behaviours but also the continuity of

care for previously hospitalized patients.

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References

Batal, M. & Decelles, S. (June 2019). A Scoping Review of Obesity among Indigenous Peoples

in Canada. Journal of Obesity, 9741090. https://doi.org/10.1155/2019/9741090

Crowshoe, L., Dannenbaum, D., Green, M., Henderson, R., Hayward, M. N, & Toth, E. (2018).

2018 Clinical Practice Guidelines: Type 2 Diabetes and Indigenous Peoples. Canadian

Journal of Diabetes, 42, S296-S306. https://doi.org/10.1016/j.jcjd.2017.10.022

El Hussein, M.T & Osuji, J. (2020). Brunner & Suddarth’s Canadian textbook of medical-

surgical nursing (4th ed.). Philadelphia, PA: Wolters Kluwer

Harris, S. B., Tompkins, J. W. & TeHiwi, B. (2017). Call to action: A new path for improving

diabetes care for Indigenous peoples, a global review. Diabetes Research and Clinical

Practice, 123, 120-133. http://doi.org/10.1016/j.diabres.2016.11.022

Hayward, M., N., Paquette-Warren, J. & Harris, S. B. (2016). Developing community-driven

quality improvement initiatives to enhance chronic disease care in Indigenous communities

in Canada: the FORGE AHEAD program protocol. BioMed Central health Research

Policy and Systems, 14(55), 1-12. http://doi.org/10.1186/s12961-016-0127-y

Jeety, R. (October 2017). Tobacco use and misuse among Indigenous children and youth in

Canada. https://cps.ca/documents/position/tobacco-aboriginal-people

Ootoova, I., Qaapik Atagutsiak, T., Ijjangiaq, T., Pitseolak, J., Joamie, A., Joamie, A. &

Papatsie, M. (2001). Interviewing Inuit Elders: Perspectives on Traditional Health (Volume

5). Iqaluit, NU: Nunavut Arctic College

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Wasekeesikaw, F. H., Bourque Bearskin, R. L. & McDonald, C. (2019). Chapter 5 – The legacy

of colonization for the health and well-being of indigenous people. In McIntyre, M. &

McDonald, C. Realities of Canadian nursing: Professional, practice and power issues (5th

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