Here's the diabetes study I am trying to get going.
Diabetes is a serious health problem and especially so for aboriginal people. Most efforts to improve diabetes among aboriginal people have failed. Spirituality is an important and understudied aspect of health and disease, both in terms of coping with illness, management of stress, and the possibility of direct spiritual healing. Previous research among Pima Native Americans in Arizona showed that a control group condition consisting of education in Pima culture and spirituality was actually helpful in improving diabetes control compared to the treatment condition (best American Diabetes Association diabetes disease management education and accompanying clinical services), which resulted in worse diabetes control.
We propose to investigate the effect of enhancing spirituality among primarily Aboriginal people (Native Americans in U.S. terminology) on the primary outcome of glucose control for type 2 diabetics. Secondarily, we will (1) assess the effect of enhancing spirituality on quality of life among primarily aboriginal diabetes, (2) characterize spirituality of modern day aboriginal people, both using psychometric instruments (all of which will be further validated for use with aboriginal people) and qualitative methods, including descriptions of the process of increasing spiritual fluency and practice, and characterization of any instances of spiritual transformation.
Specifically, our proposal consists of three aims: 1) A community level analysis of the effects upon diabetes control of increasing local spiritual literacy; 2) a person-based qualitative study within these communities of how increasing spiritual literacy translates into what is typically called spirituality, healing, and spiritual transformation within a primarily Aboriginal context; and 3) an individual level analysis of how increasing spirituality and spiritual literacy defined both qualitatively and quantitatively is associated with glucose control among diabetics. To accomplish this, we will match pairs of communities for culture/language group and for distance from major urban centers (the best predictor of diabetes prevalence for communities in Quebec). We will work through our Department of Family Medicine’s Northern Medical Services unit to implement community focus groups to consider implementation of the two programs to be studied – spiritual enhancement versus diabetes knowledge translation. Equal resources will be available to each community to hire community members as participatory researchers (community health liaisons), to pay spiritual leaders or diabetes health educators, to pay their assistants (singer/helpers or other educators), and to provide support for community members to participate in regular meetings (childcare, food, transportation, supplies). A participatory framework will be followed with community members enrolled as collaborative participants in collecting stories about people’s experiences, completing questionnaires, and gathering medical data. The community health liaisons will be community members who will coordinate (in collaboration with our Project Coordinator and post-doctoral fellows) story collection, questionnaire completion, and will take people to the health clinic when necessary for medical measurements. They will obtain medical data (with permission of participants) from the medical clinics. A strength of our project is the existence of a Nationalized Health Service which will pay for all necessary laboratory studies since we are followed Canadian Diabetes Association Best Practices guidelines for diabetes management in our scheduling of testing. The presence of only one health clinic in each of the communities also strengthens our capacity to obtain longitudinal data.
Programs will be randomized to communities (maintaining matched pairs). The primary outcome variable is glycohemoglobin level. Secondary outcome variables include microalbumin levels in urine, blood pressure, body mass index, LDL and HDL cholesterol levels, and triglycerides. Secondary psychosocial outcome variables include quality of life measures, anxiety, depression, and indices of spirituality and religiosity. Qualitative methods will include narrative analysis and modified grounded theory with dimensional analysis.
Quantitative data analysis will be accomplished with hierarchical linear modeling techniques using the medical outcome measures as dependent variables and treatment groups as independent variables with adjustments for potential confounding variables. Qualitative data analysis will be accomplished by local panels of experts ranking stories in order of increasing spiritual literacy in that local version of spirituality. These rank orderings will then be subjected to nonparametric statistical analysis with glycohemoglobin change as the dependent variable. More classical narrative analysis techniques will also be used.