Case 8: The use of a holistic wellness framework & knowledge networks in Métis health planning

Citizen Engagement in Health Casebook

Manitoba Metis Federation Health & Wellness Department
Judith G. Bartlett; Sheila Carter; Julianne Sanguins; Brenda Garner


Métis are a distinct People, descended from 17th century strategic economic, social, and political relationships between North American Indians and Europeans.1 The Manitoba Métis Federation (MMF) was founded in 1967 to represent Métis citizens in Manitoba. The organization has 200 employees governed by an elected Board (consisting of a president and 21 board members) that is accountable for programs delivered from the MMF Winnipeg Home Office and seven MMF Regions.2 MMF Regions include approximately 150 MMF Locals spread across the province, each of which has three representatives that provide direction to Regions and the MMF Annual General Assembly. The MMF — Health & Wellness Department was created in July 2005 to enable MMF Regions, affiliated Regional Health Authorities, and Local Métis citizens to engage for health planning.

Initially, the Health & Wellness Department set out to develop a process for ongoing health planning engagement but found little information with which to proceed. In February 2006, the Health & Wellness Department approached the University of Manitoba to partner in publishing the Profile of Métis Health Status and Health Care Utilization in Manitoba: a Population-Based Study, also called the Métis Atlas.3 From 2008-2010, the Health & Wellness Department had sole use of preliminary Métis Atlas data, which was interpreted at Knowledge Network discussion tables using a specific Knowledge Translation model. The Knowledge Network discussion tables, the Knowledge Translation model and a holistic framework approach were essential for using "what we know" from research to influence "what gets done" in health services.

In this case, the holistic "Life Promotion Framework" methodology was adapted for use with the Métis population.4 Its use was to ensure the MMF-Regions and their affiliated Regional Health Authority had a basis for jointly developing a positive and holistic vision of the future, which makes it much easier to discuss more difficult current issues. Importantly, the "Life Promotion Framework" is a holistic tool that is not culturally-specific to the Métis population; it may be adapted for use by any group or organization.


Knowledge translation

This Knowledge Translation model (Table 1) ensures that Métis research is used to maximize benefit for the Métis population. The model, based on the five levels of public participation articulated by the International Association of Public Participation, functions as a participatory method for "understanding and negotiating influence and action."5 It facilitates negotiation between partners where they might inform, consult, involve, collaborate and empower one another during health planning.

Table 1: Understanding and Negotiating Influence & Action
Influence Inform Consult Involve Collaborate Empower
We promise to: Keep one another informed Obtain feedback and acknowledge concerns Reflect concerns and provide feedback Incorporate advice as much as possible Make joint decisions
Manitoba Métis Federation Informs Regional Health Authority on… Consults Regional Health Authority on… Involves Regional Health Authority in… Collaborates with Regional Health Authority on… is empowered to…
Regional Health Authority Informs MMF on… Consults MMF on… Involves MMF in… Collaborates with MMF on… is empowered to…

Clear understanding of each partner and what they can or cannot commit to at the beginning of discussion avoids frustrations and misunderstandings. Having been extensively evaluated in the "Métis Need to Know Too" Knowledge Translation research project in two MMF-Region Knowledge Networks, the Knowledge Translation model is highly supported and has already been implemented in a number of additional MMF-Region Knowledge Networks.

Knowledge networks

A Knowledge Network is a discussion table of six to ten individuals drawn from the MMF-Region offices and their affiliated Regional Health Authorities. To establish a Knowledge Network, the MMF-Region Vice-President requests participation from the Regional Health Authority Chief Executive Officer (CEO). To date, most Regional Health Authority participants are either the CEO and/or Senior Health Planners.

The MMF-Region participants are the Vice-President (or designate) and two or three program staff, plus an HWD-Knowledge Network Coordinator. Selection of Métis citizen participants is determined by the MMF-Region staff that has regular contact with citizens at the Métis Local level. Knowledge Networks receive all activities mapped out in the meeting schematic (Table 2) and described below, with focus on their own geographic area.

Table 2: Knowledge Network Activities to Interpret Métis Health Research
Two-Day Session (1) Two-Day Session (2) One-Day Session for Each Chronic Disease Final Two-Day Session
  • study overview & informed consent
  • orientation to holistic lens and approach
  • develop 10-year vision for Métis health
  • produce high level scan of Métis health perceptions
  • train on reading graphs/ understanding chronic diseases
  • overview of Métis Atlas content
  • examine prevalence of Chronic Diseases
  • select three priority Chronic Diseases for interpretation
  • orient to adaptation initiative
  • review Knowledge Network expectations
  • orient to Knowledge Translation model
  • negotiate Knowledge Network relationship
  • review additional Chronic Disease priority-related graphs from Métis Atlas
  • add Métis citizen stories/ experience with Chronic Diseases & health system
  • add Chronic Disease protective & risk factors (based on literature & Métis citizen stories /experience)
  • review additional Métis Atlas graphs
  • add MMF Region social/economic program/services & Regional Health Authority health programs/services
  • add general Métis health consumer experience as known by MMF or Regional Health Authority
  • all information transferred to 3x5 cards; mapped on wall around holistic framework
  • walls photographed for later use
  • holistic view shows health information & policy gaps
  • identify new research needs
  • process cards in thematic analysis workshop
  • use themes to develop a Knowledge Network plan to adapt Regional Health Authority programs/services
  • produce evaluation plan for adaptation activities
  • MMF Regions also use Knowledge Network outcomes for planning

Research needs are sent back to Health & Wellness Department

An initial two–day Knowledge Network session orients and trains participants on the holistic approach. The holistic methodology is then used to develop a ten–year vision for Métis health and wellness, followed by a high level scan of current perceptions of Métis health. Training modules on reading graphs and understanding chronic diseases are provided. An overview of the Métis Atlas is provided to prepare the Knowledge Network for receiving a first full set of health graphs. A graph with seven major chronic diseases is shown and the Knowledge Network selects three priority chronic diseases to examine in greater detail. Priority selection may be based on a high rate or severe consequences of a particular chronic disease, but it may also be based on other reasons, such as selecting a chronic disease where there is a program in place.

The next two–day Knowledge Network session begins with relevant training on the MMF Adaptation Initiative that is intended to adapt health services to meet Métis needs, Knowledge Network expectations, and the Knowledge Translation negotiation model. At this point, the Knowledge Network negotiates its relationship by completing and documenting the statements in the Knowledge Translation model (found in Table1). This model focuses on both understanding and negotiating influence and action by mapping how partners in the process inform, consult, involve, collaborate and empower the various stakeholders.

The Knowledge Network then views additional Métis Atlas graphs related to each of the three selected chronic diseases priorities. Outside of the Knowledge Network meeting times, the HWD Knowledge Network Coordinator, supported by MMF Region staff, implements multiple focus groups with Métis citizens from MMF Locals in their Knowledge Network geographic area. This ensures that the voices of Métis citizens are included in the Knowledge Network health planning process.

Next, three one–day Knowledge Network sessions build on health information by adding:

The final two–day Knowledge Network session reviews all information (which at that point has been transferred to 3x5 inch cards) mapped on a wall around the holistic framework. This view is photographed so that the layout of the holistically articulated ideas can be recalled at a later date. More importantly, the holistic view clearly identifies information gaps that require new research and provincial policy issues that require resolution. Finally, the cards are removed from the wall and processed through a group–based thematic analysis workshop.6 Resulting themes are used to inform a plan that advises the Regional Health Authority on potential service adaptations and an evaluation plan for adaptation activities.

Outcomes and impact

Since 2008, nine of 11 Regional Health Authorities (six of seven MMF Regions) have engaged in MMF Region Knowledge Networks and are at various stages of completion in their first Knowledge Network cycle. Several have completed their first cycle of chronic diseases interpretation and now are moving to the next cycle to examine Métis Atlas child health and education results. Knowledge Network-determined research is underway or completed for five quantitative age and sex-specific studies and two community-based qualitative projects (involving eight Métis communities).

Ongoing provincial funding for the MMF-Health & Wellness Department central management of Knowledge Networks has been achieved, and a five-year Chronic Diseases surveillance program has been funded by the Public Health Agency of Canada. A Provincial Métis Health Policy-Knowledge Network, which will use the same process, is planned to start early next year. Although not yet fully evaluated, the "Métis Need to Know Too" Knowledge Translation model has shown significant promise as a method of creating strong and sustainable health planning engagement between MMF Regions and their affiliated Regional Health Authorities.

Although Knowledge Networks were developed to influence Regional Health Authority services, MMF Regions are finding outcomes useful in their own social and economic program planning. Both MMF Regions and Regional Health Authorities are committed to continuing the process.

Lessons learned

Knowledge Networks are geared toward the needs of Regional Health Authorities. Some of these are straightforward, while others are very complex. For example, the Winnipeg Regional Health Authority plans services centrally but organizes its work into 13 Winnipeg Community Areas, each with a Community Area Coordinator. The MMF Winnipeg Region-Knowledge Network logically began its activity in a Community Area with poorer Métis health. After getting to the point of needing to create an adaptation plan, it became apparent that there was no mechanism to transfer the Métis-specific knowledge to central planners. The solution is a two-pronged approach: first is the creation of a Winnipeg-wide MMF Winnipeg Region's "Community Area Coordinators" Knowledge Network, followed by Community Area-based Knowledge Networks. While the Community Area Coordinators Knowledge Network is able to influence central planners, the Community Area Knowledge Networks allows Métis citizens belonging to Winnipeg-Region Métis Locals and local community area health service providers to engage in planning to adapt existing service.


Footnote 1

Sprague D.N., Frye R.P., The Genealogy of the First Métis Nation: The Development and Dispersal of the Red River Settlement (Winnipeg, MB: Pemmican Publications, 1983).


Footnote 2

For more information on the Manitoba Métis Federation.


Footnote 3

Martens, P., Bartlett, J.G., Burland, E., Prior, H., Burchill, C., Huq, S., Romphf, L., Sanguins, J., Carter, S., Bailly, A., Profile of Métis Health Status and Healthcare Utilization In Manitoba: A Population-Based Study (Published by the Manitoba Centre for Health Policy in collaboration with the Manitoba Métis Federation, 2010).


Footnote 4

Bartlett, J.G., Theory, Reality, Hope: Proceedings, Proceedings of the Third International Conference on Diabetes and Indigenous Peoples (Winnipeg, MB, 1995), pp. 44–48. Copyright for Métis Life Promotion Framework©, associated tools, and methods, is retained by Dr. Judith G. Bartlett for protection of Indigenous knowledge.


Footnote 5

International Association of Public Participation (IAP2) (2003 and 2007) (retrieved Dec 9, 2011).


Footnote 6

Bartlett J.G., Iwasaki Y., Gotlieb B., Mannell, R., Forcythe, S., Hall, D., "Framework for Aboriginal-Guided Decolonizing Research involving Métis and First Nations Persons with Diabetes," Social Science & Medicine 65 (2007): 2371–2382.


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