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Kholghi, Maedeh Khayyat. (2013). The Barriers and Facilitators of the Kateri Memorial Hospital Center health Education Curriculum. McGill Family Medicine Studies Online, 08: e05.


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Introduction: In years 1994 to 1997, the Kateri Memorial Hospital Center in conjunction with the Kahnawake Education Center, and the Kahnawake Schools Diabetes Prevention Project developed an elementary school diabetes prevention curriculum. The curriculum aimed to increase knowledge of type 2 diabetes, healthy eating and active lifestyles of the children with the long term goal of preventing obesity and diabetes among the Kanien’keha ́:ka (Mohawk) population of Kahnawake, Quebec. The curriculum consisted of three units: nutrition, fitness, and lifestyles and diabetes, divided into 10, 45-minute lessons for grades 1 through 6. The Kahnawake Diabetes Prevention Project has been involved with one of the longest diabetes prevention school based curricula; it has been implemented in Kahnawake elementary schools for 15 years.


Objectives: To evaluate the implementation of the Kateri Memorial Hospital Center health education curriculum in the years 2010/2011 and 2011/2012, and to further explore the barriers and the facilitators of the health education curriculum from the perspectives of teachers, parents, curriculum authors and school administrators.


Subject and Method: This study adopted a community-based participatory approach. The participants of this study were selected from four groups of people including teachers, parents, curriculum authors and school administrators. The design of this study was qualitative descriptive combined with a cross-sectional survey. Questionnaires were distributed to classroom teachers in the Kahnawake elementary schools. The qualitative portion was undertaken using talking circles with parents, curriculum authors and teachers. Semi-structured interviews were conducted with school principals to understand current issues with the curriculum and to develop recommendations for future changes and implementation. Descriptive statistics were applied to analyze the questionnaire results such as the number of curriculum lessons taught, the number of teachers who implemented the curriculum and the number of students who received the curriculum. The talking circles, and the semi-structured interviews were audio-recorded, and transcribed verbatim. Thematic textual analysis was performed to identify emerging themes.


Results: The findings showed that participants perceived the health education curriculum as important to the children to increase knowledge regarding health behaviours to prevent Type 2 diabetes. The strengths of the curriculum included factors involving a positive school environment and certain aspects of delivery and curriculum content. Weaknesses included lack of administrative support, instructional time and time management issues, a lack of Mohawk cultural representation, and outdated or missing resource materials. Recommendations addressed curriculum content, cultural integration, methodology development and administrative support to revitalize the curriculum and its delivery.


Conclusion: To our knowledge, this project was the first study exploring the barriers and facilitators of this 15-year-old diabetes prevention curriculum. The results obtained from this project provide knowledge on the challenges and the strengths faced with a health education curriculum from different perspectives. The findings will be used to make recommendations for revision, development and implementation of a new health education curriculum.


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