Developing community-driven quality improvement initiatives to enhance chronic disease care in Indigenous communities in Canada: The FORGE AHEAD program protocol

Mariam Naqshbandi Hayward, Jann Paquette-Warren, Stewart B. Harris, Marie Tyler, Alexandra Chirila, Stewart Harris, Sonja Reichert, Amardeep Thind, Lloy Wylie, Merrick Zwarenstein, Mariam Naqshbandi Hayward, Selam Mequanint, Jordan Tompkins, Susan Webster-Bogaert, Braden Te Hiwi, Harsh Zaran, Jim Esler, Meghan Fournie, Jackie McLellan, Marnie OrcuttEd Barre, Audrey Walsh, Onil Bhattacharyya, David Dannenbaum, Keith Dawson, Jay Wortman, Roland Dyck, Jo Ann Episkenew, Michael Green, Anthony Hanley, Monica Parry, Barry Lavallee, Ann Macaulay, Jon Salsberg, Alex McComber, Sheldon Tobe, Ellen Toth, Ross Bailie, Kayla Collins, Claire de Oliveira, Michael Hindmarsh, Valeria Rac, Linda Stanley, Joanne Lewis, Marlene Nosé, Brigitte Parent, Stephen Sundquist, Lillian Houle, Amber Houle, Dawn Montour-Lazare, Joelle Emond, Jessica Jacobs, Randy Littlechild, Bonny Graham, Tina Littlechild, Devon Guy, Chalsea Onespot, Ivan Kimble McComb, Emilie Dufour, Verna Jolly, Charlene Diamond, Jennifer Jones, Danna Hadden, April DeYaeger, Theresa O'Keefe, Ada Roberts, Maggie Organ, Patricia Keesickquayash, Darlene Panacheese, Shelley Kirkness, Marie Jebb, Carla Constant, Allen Deleary, Rennie Nawash, Lori Sinclair, Heather McDonald, Bonnie Nickel, FORGE AHEAD Program Team

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Background: Given the dramatic rise and impact of chronic diseases and gaps in care in Indigenous peoples in Canada, a shift from the dominant episodic and responsive healthcare model most common in First Nations communities to one that places emphasis on proactive prevention and chronic disease management is urgently needed.

Methods: The Transformation of Indigenous Primary Healthcare Delivery (FORGE AHEAD) Program partners with 11 First Nations communities across six provinces in Canada to develop and evaluate community-driven quality improvement (QI) initiatives to enhance chronic disease care. FORGE AHEAD is a 5-year research program (2013–2017) that utilizes a pre-post mixed-methods observational design rooted in participatory research principles to work with communities in developing culturally relevant innovations and improved access to available services. This intensive program incorporates a series of 10 inter-related and progressive program activities designed to foster community-driven initiatives with type 2 diabetes mellitus as the action disease. Preparatory activities include a national community profile survey, best practice and policy literature review, and readiness tool development. Community-level intervention activities include community and clinical readiness consultations, development of a diabetes registry and surveillance system, and QI activities. With a focus on capacity building, all community-level activities are driven by trained community members who champion QI initiatives in their community. Program wrap-up activities include readiness tool validation, cost-analysis and process evaluation. In collaboration with Health Canada and the Aboriginal Diabetes Initiative, scale-up toolkits will be developed in order to build on lessons-learned, tools and methods, and to fuel sustainability and spread of successful innovations.

Discussion: The outcomes of this research program, its related cost and the subsequent policy recommendations, will have the potential to significantly affect future policy decisions pertaining to chronic disease care in First Nations communities in Canada.
Original languageEnglish
Article number55
Pages (from-to)1-12
Number of pages12
JournalHealth Research Policy and Systems
Issue number1
Publication statusPublished - 26 Jul 2016


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