Transforming Rhetoric into Action: CoCreating Participatory Action Research Mary Ann Morris, MScN, BSN, RN; Braden MacLeod, 4 in Rural Guatemala Year BSN Student th
University of Victoria at Selkirk College
Background
“Health is a human right. This is our new collective struggle.”
Number of diabetesrelated deaths globally is expected to double in the next 20 years; 80% of people living with diabetes live in low and middleincome countries, especially China, India, and Latin America 2/3 of Guatemalan population lives in poverty; 73% of Indigenous population lives in poverty, 23% in extreme poverty. 36 year civil war in Guatemala from 19601996 Cooperative of Nuevo Horizonte founded in 1998 by excombatants of the URNG following signing of Peace Accords Gains include: housing, potable water, schools, daycare, economic projects, selfgovernance, greenspace Renewed community focus on health; diabetes identified by membership as a growing concern with request for assistance extended
What is the prevalence of type 2 diabetes and cardiovascular risk in Nuevo Horizonte? What interventions will support living well with diabetes in Nuevo Horizonte? How will active participation of BSN students in PAR contribute to their professional development?
Photo 2: Health mural on women’s coop store
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BSN curriculum aims to foster critically reflective practitioners who support global health and human rights by attending to economic, political, and social forces Nine year practice partner relationship between Nuevo Horizonte and UVic/Selkirk College BSN program
Research Questions
Shifting roles to share power, knowledge, and experiences Viewing diabetes as personal and collective, biological and social Action to address multiple dimensions of diabetes Facilitating space with youth to explore facets of diabetes and opportunities for engagement •Creating bridges between local, national, and int’l partners
Participatory Action Research – Diabetes in Nuevo Horizonte R e r se ar ch er
Nursing Instructor
Nuevo Horizonte Coop
Forces of… Vulnerability • Novice researcher • Contested views of nursing • Responsible for students • Insider/outsider tensions • Concern for unchecked T2D • Competing roles and demands
Resilience • Active support system • PHC experience & commitment • Long tern solidarity with Guatemala • Experience with this practice course • Spanish fluency
BSN Student
Forces of… • • •
Forces of… • • • • • • • •
Fig. 1: Conceptual framework
tic ip an t
Le a
Pa r
rn er
e h ac e T
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Vulnerability Limited education Poverty Limited dietary options Food preferences “West = best” Aggressive corporate marketing Dominance of biomedicine T2D previously unknown Historical trauma
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Resilience Healthy skepticism Marked critical analyses “For my children’s children” Autonomy Collective identity born of struggle Holistic view of health Organizational capacity Values youth as the future
Photo 1: Display used to illustrate sugar content of locally available beverages at community breakfast.
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Vulnerability Unfamiliar environment Group process stressors Course requirements Health status Power differentials Novice nursing Language limitations
Resilience • “Fresh eyes” • Selfregulated engagement • Integrated curriculum • Built on and contributing to partnerships • Commitment to PHC
Photo 4: BSN student reflecting upon mural of the disappeared in Guatemala City
Activities
Conceptual Approach
Meetings: Guatemalan NGO Patronata del Diabetico & Nuevo Horizonte health committee Threehour diabetes education with highschool youth Three consecutive diabetes and cardiovascular risk screenings Integration of youth into screening process Breaking fast with community breakfasts and diabetes information table Laboratory followup for people with abnormal diagnostic results Development of follow up management plan at individual and community levels Mural: “Health is a Human Right: It Is our Collective Struggle today” Hulahooping with children and youth
As per Israel et al (1998), we strove to integrate the following principles of PAR: Recognize community as unit of identity Build on strengths and resources within the community Facilitate collaborative partnerships in all phases of research Integrate knowledge and action for mutual benefit of all partners Promote colearning and empowering process that attends to social inequalities Involve a cyclical and iterative process Disseminate findings and knowledge gained to all partners Photo 3: Local students and BSN students facilitating type 2 diabetes and cardiovascular risk screening
References Collaboration for Academic Education in Nursing. (2013). Foundational perspectives. Retrieved from http://www.caen.ca/aboutus/foundationalperspectives Coop Nuevo Horizonte. (2012). History. Retrieved from http://coopnuevohorizonte.org/en/thecoop/history/ Israel, B., Schultz, A., Parker, E., & Becker, A. (1998). Review of communitybased research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19(1), 173202. doi:10.1146/annurev.publhealth.19.1.173 World Health Organization. (2014). Country cooperation strategy at a glance: Guatemala. Retrieved from http://www.who.int/countryfocus/cooperation_strategy/ccsbrief_gtm_en.pdf