Phase III: Advocacy and Tool Kit Development
Phase III consists of compiling all the information gained in the previous phases and, through community participation, designing actions that translate the acquired knowledge into practical tools for the prevention and management of type 2 diabetes.
This requires the participation of the whole community, from health authorities to neighbourhood associations. Together we want to design useful initiatives for the community. We call this process “contextualising the evidence”, which involves the design of relevant and feasible actions for the community, while accompanying them with advocacy actions to make the process visible to local authorities, empowering citizens to claim their right to health.
In this phase, our target is to identify recommendations for type 2 diabetes management adapted to the reality of the inhabitants of Quito and the Esmeraldas region. In other words, we want to bring knowledge into the real lives of people and communities. We aim to design effective and transversal prevention measures for the adequate management of type 2 diabetes based in the community and involving citizens and institutions.
- 1. What do we intend to do?
- 2. How are we going to do it?
- 3. Community-based participatory research
- 4. Prioritisation and selection of appropriate tools
- 5. Tool kit dissemination
Contextualising evidence involves translating theory and knowledge to the reality of people and communities. A community consists of a system of people, associations, companies, and institutions living together in a particular environment at a given time. Therefore, contextualising means adapting. We want the recommendations for the management and prevention of type 2 diabetes to be realistic. For this purpose, the community must collaborate in the design of these recommendations.
To achieve effective participation and prioritisation, we will use methodologies that ensure the participation of each community member. On the one hand, we will carry out community asset mappings along with a series of community-based research activities, such as storytelling. On the other hand, we will undertake a Delphi study and semi-structured interviews in order to discuss the prioritisation and selection of appropriate actions for the development of a tool kit.
Community-based research is a research methodology that puts the community at the centre of the decision-making process. In other words, participants are no longer the object of study but become an active part of the research process. Generally, research is divided into four phases: ideation, design, implementation and evaluation. Participatory research seeks to involve participants in all these stages. Our research will include an asset mapping accompanied by a report to the authorities, a co-creation action and a storytelling.
About Health Asset Mapping
Health assets, according to Morgan and Ziglio (2006), are defined as those factors or resources that contribute to maintaining, and in many cases improving, the health and wellbeing of a community, and which in turn help to reduce existing inequalities between the people and groups that make up the community. Asset mapping consists of identifying and locating on a physical map each of these resources, commenting on what does or does not make it an asset for the community.
Mapping requires the active participation of the people who use the resources first-hand. There may be occasions when resources that are thought to be assets are not in practice. From parks to neighbourhood associations, all environments have resources that can be turned into health assets. The important thing is that the resources are used, thus becoming assets.
In our mapping, the community was invited to participate in locating and describing each resource perceived as an asset and was asked to rate each resource positively and negatively.
Mapping allows us to focus attention on what benefits or harms communities, so after the mapping was done, a report was prepared including the positive and negative aspects identified by the participants for presentation to the authorities involved and interested parties. Each parish has different characteristics that must be dealt with individually so that the authorities are aware of the reality of their communities. This report synthesises, informs and highlights the aspects that must be addressed and those that should receive special attention.
Participants included people linked to: Neighbourhood organisations and groups; groups of diabetic and hypertensive patients; groups of elderly people; groups of people using health services; groups managing urban gardens; traditional medicine centres; cultural groups; the Ministry of Public Health; and the Municipality of Quito.
Some assets described in groups could not be fully mapped. Some examples are:
- Pets / Dogs
- Public Transport Lines
- Community Police Units
- Integrated Child Development Centres, Schools, High Schools
- Streets and pavements
- Green areas
- Communal / Neighbourhood Houses
Co-creation is the joint realisation of actions. It is a term and practice built up in the private sector that originally consisted of developing products tailored to end consumers. When we talk about co-creation in the field of public health, we adapt the original practice to the interests of the public sector, i.e. to generate well-being and maintain the health of the population. In other words, co-creation in public health is about providing a service that is tailored and individualised to the needs of a specific population.
In our first community-based research activity, we want to share the results of the population-based survey on risk factors related to diabetes and other non-communicable diseases and promote healthy behaviours directly connected to their prevention. To do this, participants, through consultative processes, will decide what actions can be taken in their communities to promote health, how to take them and how to evaluate them.
Telling a story has always been a simple and effective way of transmitting information, and Storytelling methodology benefits from this reality. This participatory methodology consists mainly of approaching a topic from the narrative in which it is found, using characters, images or simply an audio, telling what you want to convey. Storytelling in health serves to reflect feelings, share emotions and, in some way, accompany those who thought they were alone.
We want a diabetic association to tell its story, for its participants to tell their experience as chronic patients, what it was like to participate in a diabetic group and how it affected the disappearance of the group after the pandemic.
We want to personify the enormous benefits of support groups, both in disease management and social life. We want our stories to have a face, we want to show through people and their stories their reality so that their strength translates into greater support from institutions and authorities.
One of the main objectives of this phase, as discussed above, is to ensure the participation of each of the groups that make up the community. This participation must be accompanied by advocacy actions that connect the interests of citizens with the authorities. We are aware that this is not a simple task and that each group requires a specific process of participation. For this reason, we decided to carry out a series of interventions aimed at including people of recognised experience and prestige combined with the experience gained in participatory research. These actions include a Delphi study and structured interviews, the objective of which will be to prioritise and identify effective tools for the management and prevention of type 2 diabetes in the capital and region of Esmeraldas.
About the Delphi Study
The name of this research technique is taken from the oracle of Delphi, which according to Greek mythology was able to predict the fate of mortals. In the 21st century we do not have these supernatural resources of Classical Greece, but fortunately we do have science. A Delphi is about obtaining prospective knowledge, i.e. about what will happen in the future by analysing present knowledge. This knowledge must be based on the opinions of people of recognised prestige and experience.
Our Delphi will involve members of the CEAD research team, representatives of the ministry responsible for public health in Ecuador and an interdisciplinary committee composed of experts. Up to three rounds are planned, culminating in the priority elements to be included in the toolkit.
About structured interviews
An interview is a research technique that allows us to gather information through questions, so when we talk about semi-structured interviews we mean interviews that combine prepared questions with other questions that arise as the interview progresses. We will conduct semi-structured interviews with representatives of local and national health authorities in order to learn from the information gathered above what can be done to strengthen health systems and how to implement specific policies on type 2 diabetes.
Once the advocacy campaigns have been carried out and the tools that allow us to cross the bridge between the world of scientific evidence and people’s real lives have been defined, our final task will be to build a ‘tool kit’ and disseminate its effectiveness. This means making it freely available to the interested public on the project website. It will also be disseminated among the communities participating in the project and, of course, among the scientific community, by publishing articles and papers in specialised international scientific journals.