Author: admin

Review by Jennifer W. Purcell
Kennesaw State University

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Review by Sarah Stanlick
Lehigh University

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Turkle, S. (2012). Alone together: Why we expect more from technology and less from each other. New York: Basic Books.

Review by Paul H. Matthews
University of Georgia

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Is social entrepreneurship education just a kind of service-learning found in business schools? Or is it grounded in such different history, assumptions, and practice that its commonalities with community-based pedagogy are only superficial at best? The field of social entrepreneurship—an “innovative, social value-creating activity” (Wei-Skillern, Austin, Leonard, & Stevenson, 2007, p. 4)—is sometimes construed as analogous to service-learning, but on many campuses the two fields seem to occupy disparate and non-overlapping spaces. Sandra Enos’s brief volume (84 pages in four chapters, plus prefix, one appendix, and references), published in 2015 as part of the Community Engagement in Higher Education series (Palgrave Macmillan), seeks to change that, and to illustrate some of the ways in which these pedagogies of service-learning and social entrepreneurship can, do, and do not intersect on college campuses.

In the first chapter (“The Landscape of Social Change Education”), Enos—a sociology professor with experience in both service-learning and social entrepreneurship—sets the context with a sketch of some recent discussions of university engagement’s place in higher education, and contends that both fields focused on in this volume should be considered a subset of “social change education.” She provides evidence for the growing institutionalization of each, for instance through journals and professional associations, and draws parallels specifically between the existence of overarching organizations that encourage campus involvement in both movements (e.g., between Campus Compact and Ashoka U). Next, she summarizes prior work presenting these two fields’ commonalities (e.g., these are social-change oriented movements seeking greater campus reach; entail community-based partnerships; and provide opportunities for real-world applications of knowledge) as well as differences (e.g., a stronger focus on student learning in service-learning, versus on community/societal change in social entrepreneurship; a stronger orientation toward “disruption” of existing structures and practices in the latter; and differing language as well as desired learning outcomes). While Enos also contends that “[S]ocial entrepreneurship prizes the founding of new organizations” (p. 18), other researchers have noted the growth and value of social “intrepreneurship”—i.e., working to implement change within existing structures and organizations (Bornstein, 2007; Bornstein & Davis, 2010)—a construct not included in Enos’s overview.

Her second chapter (“Organizing for Engagement”) comprises the bulk of the book’s research contribution, an attempt to determine how these two pedagogies are organized and interrelate on campuses that offer both. Enos reports on website analyses and interviews she conducted with staff at the 10 campuses currently recognized with both Carnegie’s community engagement classification and the “Changemaker Campus” designation by Ashoka U. She contends that these “exemplars of service-learning and of social entrepreneurship education” (p. 23) should offer a view into the current status of institutionalization and potential relationships between these subfields of community engagement on U.S. campuses. As such, she investigates whether there are “patterns in the organization of these programs, whether there are typical disciplinary homes for service-learning and social entrepreneurship courses, …and how programs that offer [them] are related to each other” (p. 27). However, Enos reports that little consistency was found; instead, “what we see are individual profiles, tied to institutional size, history, culture and leadership” (pp. 32–33). While she summarizes information about each campus in a table, its content reads more like field notes than an analysis. As might be expected from a range of institutional sizes, types, and locations, she found that the colleges and universities studied had varying amounts of coursework, centralization, and support structures, and used different terminology in talking about their initiatives.

In chapter three, “Challenges for Service-Learning and Social Entrepreneurship,” Enos iterates several of the criticisms that have been extended toward these two sets of practice, including (for service-learning) a lack of “deliberate and intentional incorporation of civic skills” (p. 45), as well as issues of privilege, social justice, and the problematization of “service” (pp. 47–48). For social entrepreneurship, Enos notes that this field sometimes uses different terms (e.g. “social enterprise”) implying different foci; that innovations may struggle in being implemented at scale; and that the “celebratory nature of innovations in the social entrepreneurship space makes it difficult to mount a critical review of these practices” (p. 55). She also summarizes concerns that social entrepreneurship may tend to “paint the state, unions, public employees and other existing nonprofits as the enemy” (pp. 56–57), undermining rather than enhancing existing efforts, which may contrast with service-learning’s focus. In terms of social entrepreneurship education, Enos notes that existing courses have been criticized for a lack of emphasis on complex problem-solving, and for mismatches between desired competencies identified in course syllabi and those recommended by practitioners in the field. While interesting, and a good overview of some of the critiques offered for each field, this chapter does not contribute much new to the discussion beyond summarizing.

In the book’s final chapter, “Educating for Engagement: A Turning Point,” Enos renews her recommendations that, as two subsets of campus/community engagement, service-learning and social entrepreneurship should become better integrated institutionally. She provides examples from her own and other universities as demonstrations of how these two fields may fit into a broader conceptualization of civic engagement, as well as how particular disciplines might implement both. After repeating her calls for more cross-fertilization, Enos suggests the need “to challenge each other on what works—in teaching and research—and certainly on what strategies get us closer to working with community partners in problem-solving reciprocal ways” (p. 83). Finally, the book’s appendix provides a list of campus representatives for Chapter 3’s interviews.

Several aspects of this book raise issues worthy of contemplation for those in the community engagement field. The explicit comparison and contrasting between the two sets of philosophies and practices illuminates several interesting points. For instance, Enos contends:

Among the most important differences between service-learning and social entrepreneurship include the former’s focus on groups and collaboration vs. the latter’s on individualism, and vocabulary borrowed from the nonprofit sector vs. vocabulary taken from the business world. Other points that differentiate these fields are skepticism about market-based approaches to social problems on part of the service-learning community compared to an embrace of market-based solutions in the social entrepreneurship field. The service-learning field aims to educate students for civic engagement and democracy while some versions of social entrepreneurship work at solving problems outside of or independent of politics (pp. 16–17).

Likewise, a careful consideration of what each field might offer the other is a valuable exercise. Could some of the tools and concepts used in social entrepreneurship—e.g., the double/triple bottom line for determining return on investment—be helpful for assessing service-learning programs’ impacts? Could service-learning’s established expertise in reflection and in highlighting the importance of reciprocity with community partner organizations bolster the success of social entrepreneurship education and application?

In several areas, the book could be stronger. For instance, while couched at times in the language of research, this volume’s findings from campus interviews do not seem to follow many standards of qualitative methodology (e.g., thick description, coding, etc.), and as such fall somewhat short. Likewise, while the author includes a solid listing of prior articles that relate to this work’s guiding questions, Enos’s style of reviewing literature often seems more focused on enumerating a list of each author’s points, rather than synthesizing them as a whole. While in two separate chapters Enos offers other authors’ definitions for “social entrepreneurship,” she does not ever clarify how, specifically, she is using the term; and, while she notes that “the practice of social entrepreneurship is distinct from social entrepreneurship education” (p. 11), that distinction is not consistently apparent in the volume.

Several chapters enumerate details about certain journals, organizations and initiatives, yet omit others of similar potential interest and merit without explanation. For instance, for service-learning and community engagement, she lists several journals (JCES; the Michigan Journal of Community Service Learning) and conferences and organizations (IARSLCE; Campus Compact), while other equally relevant resources (e.g., the Journal of Higher Education Outreach and Engagement; the Engagement Scholarship Consortium) are omitted. On the social entrepreneurship side, Enos provides a strong focus on both the Skoll Foundation and Ashoka, but does not acknowledge other important resources and players such as the Acumen Fund, the Schwab Foundation for Social Entrepreneurship, or Echoing Green (Bornstein & Davis, 2010). Likewise, her “short history of social entrepreneurship” seems to lay the founding of this field at the feet of Jeffrey Skoll and Bill Drayton, with no mention of key international “pioneers” (Bornstein & Davis, 2010, p. 13) such as Muhammad Yunus (Grameen Bank) and Fazle Abed (Bangladesh Rural Advancement Committee). Finally, frequent typos and minor errors (e.g., in names of national organizations, journals, and funders, or in referring to the “2012 [sic] Carnegie round of applications” [p. 29]) also distract somewhat from the book’s content.

In the end, Enos defends and extends her thesis statement: “Some may believe that service-learning and social entrepreneurship models of educating students for community engagement are incompatible but I am going to argue that they are not” (p. 70); however, as her own research shows, even on campuses considered exemplary in each area, at present these two fields tend not to converge in practice. For readers interested in how these two branches of engaged pedagogy might interweave more productively, Service-Learning and Social Entrepreneurship in Higher Education may be a good starting point, from either side of the equation.

Acknowledgment

The JCES editorial team would like to acknowledge and thank Palgrave Macmillan for providing an electronic copy of the book for this review.

References

About the Reviewer

Paul H. Matthews is associate director of the University of Georgia Office of Service-Learning.

Eric Conrad, Meghan Shewmake, Courtney Shows, and Jen Nickelson

Ahmed, S.M., & Palermo, A.S. (2010). Community engagement in research: Frameworks for education and peer review. American Journal of Public Health, 100(8), 1,380–1,387.

Blouin, D.D., & Perry, E.M. (2009). Whom does service learning really serve? Community-based organizations’ perspectives on service learning. Teaching Sociology, 37(2), 120–135.

Green, L.W., & Kreuter, M.W. (2005). Health program planning: An educational and ecological approach. New York: McGraw-Hill.

Holt Community Partnership. (2010). How the HCP developed. Retrieved from https://holtcommunitypartnership.wordpress.com/about/.

Israel, B.A., Schulz, A.J., Parker, E.A., Becker, A.B., Allen, A.J., & Guzman, J.R. (2008). Critical issues in developing and following community based participatory research principles. In M. Minkler & N. Wallerstein (Eds.), Community-based participatory research for health: From process to outcomes (pp. 53–76). San Francisco: John Wiley & Sons.

Jacob, W.J., Sutin, S.E., Weidman, J.C., & Yeager, J.I. (2015). Community engagement in higher education. In Community Engagement in Higher Education (pp. 1–28). SensePublishers.

King, B., Williams, W., Howard, S., Proffitt, F., Belcher, K., & McLean, J.E. (2004). Creating the bridge: The community’s view of the expanding community partnerships. In B.A. Behringer, B.C. Bach, H. Daudistel, J.W. Fraser, J. Kriesky, & G.E. Lang, (Eds.), Pursuing opportunities through partnerships: Higher education and communities (pp. 75–85). Morgantown, WV: West Virginia University Press.

Minkler, M., & Wallerstein, N. (Eds.). (2011). Community-based participatory research for health: From process to outcomes (2nd ed.). San Francisco, CA: Jossey-Bass.

McLean, J.E., & Behringer, B.A. (2008). Establishing and evaluating equitable partnerships. Journal of Community Engagement and Scholarship,1(1): 66-71.

Powell, B., & Conrad, E. (2015). Utilizing the CIPP model as a means to develop an integrated service-learning component in a university health course. Journal of Health Education Teaching, 6(1), 21-32.

Rhodes, S. D., Malow, R. M., & Jolly, C. (2010). Community-based participatory research (CBPR): A new and not-so-new approach to HIV/AIDS prevention, care, and treatment. AIDS Education and Prevention, 22(3), 173-183.

Sandy, M., & Holland, B. A. (2006). Different worlds and common ground: Community partner perspectives on campus-community partnerships. Michigan Journal of Community Service Learning, 13(1), 30-43.

Yawah Awolowo, Debra Clark, and Darlene Robinson

Project UNITED is a federally funded grant that addresses obesity issues in the Alabama Black Belt. The Black Belt represents some of the poorest counties in the United States and is plagued with chronic health conditions—obesity, diabetes, high blood pressure, cancer—which are predominantly found in African Americans. Community leaders from the Black Belt Community Foundation, a 501(c)3 nonprofit corporation whose purpose is to help improve the quality of life of residents in the Alabama Black Belt, participated in the project as community health scholars. Project UNITED partnered community health scholars and academic scholars to develop proposals that addressed obesity issues in rural communities. A team of three community health scholars and three academic scholars collaborated and formed, Home Sweet Home, a two-year, $50,000, multigenerational obesity intervention in Greene and Sumter counties. This paper provides reflections from the three community health scholars regarding their experience in a community based participatory research (CBPR) project.

The paper is presented as first person testimonials describing the experiences of each participant.

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Darlene Robinson, Greene County

Being one who is always looking for ways to improve myself and my community, I took a step of faith in response to the invitation I received to become a community health scholar with Project UNITED. I also believed I would acquire knowledge that would help my community. In the community my mission is to improve everyday life of parents and their children. Even though my plate was already full, I felt it would be an opportunity to find ways to improve myself and my community.

The Project UNITED journey introduced us to individuals from around the state who also wanted to improve themselves and their communities. I could tell the training was well thought out, as we visited a small garden at a rural school where the youth were being introduced to growing their own foods. This was the Project UNITED pilot project. Educating our community about healthy lifestyle changes is very important and we learned ways to take it home. Project UNITED brought professors from the University of Alabama and community people together as a learning tool that showed that we all share the same passion of making Alabama a healthier place to live.

The circle was complete when our team formed. We had three members from the community and three members from academia, with a mission of curtailing obesity by educating ourselves. As a group we merged our thoughts, hashed out our ideas, made a plan, found an audience—the preschoolers and their parents—and formed a roadmap to get us where we wanted to go. We named our program “Home Sweet Home.” Our mission was to introduce and teach a new way of thinking about eating. We sought to change current statistics that says we are an obese society.

If you’re busy, think you have that all you can handle, feel you know all you need to know, then CBPR is probably for you, because it takes all you’re doing and all you can handle and turns it into a mission that you’ve been on all the time but gives you directions to get to a better place. Then it will not just be your idea of what the community needs, but the community will be able to tell you what they want.

Debra Clark, Sumter County

In 2013, I was chosen by the Black Belt Community Foundation to be a community health scholar. This was because of my health-related awareness work at the Health and Wellness Education Center (HWEC) Disease Management Program. At the first meeting my first thought was “Why am I here?” realizing that I did’t have time to take on an additional project. But my second thought was “how can I not participate?” considering the impact this project could have on my community. Certainty, it is through strong community partnerships with local agencies that has made HWEC successful. The agency has made great strides to implement initiatives to address obesity, diabetes, cardiovascular disease, and other chronic illnesses to improve the health of local residents.

As a result of this project, I

1. Was invited to present a paper entitled “Fighting Obesity for the Health of It” at the Rural Health Conference in Tuscaloosa in 2013.

2. Received the Rural Heroes Award from the UA College of Community Health Sciences.

3. Was able to expand the Jump To It (what is it?) program for additional communities.

4. Produced a simple handout on the traffic light diet to promote healthy eating for distribution at health fairs and community events.

5. Have witnessed the greatest impact within my own family. My 5-year old grandson was never introduced to yogurt, but now eats yogurt and encourages his mom to “add stuff” to make it good.

Although this fight has been tedious and time consuming, I must admit that rewards have been greater than the struggle. The program has helped build capacity and strengthen my agency by connecting me with a team of experts with genuine concern and interest, which correlates with the agency’s mission of promoting healthier lifestyles through education and prevention.

Yawah Awolowo, Sumter County

As a community health scholar participating in Project UNITED, I have enjoyed adding to what I already knew about health-related issues and unhealthy eating. I nurtured my family in an organic, self-sufficient, natural homebirth/home schooled permaculture environment and have sustained five seriously committed years of organic farming on a 66-acre, family-owned farm. My journey with CBPR and the development of a partnership with academic researchers not only expands my baseline knowledge, but the collaborative process has also allowed me to continue to put into practice my knowledge in a way to benefit my community. I have learned that while academic researchers are very knowledgeable about health and treatment, I also bring a great deal of knowledge about nutrition and health. Additionally, I have expertise about the rural community where I live, which I know is valuable for eliminating obesity in this community.

My participation in Project UNITED enlightened my interest in heart disease and obesity, major health concerns in my family. My mother, who was 90 years young developed heart disease. She had no hypertension, diabetes, no medicines for her entire life. The doctors informed the family that there was a blockage in one of her heart valves; surgery was necessary to remove the blockage. One of the major reasons I chose to be involved as a community health scholar in Project UNITED was because I watched my 90-year-old mother go through heart surgery and witnessed her spectacular recovery as she completely changed her eating habits. The other reason for my interest is because there are so many people in my family who have serious health conditions. My sister had surgery two weeks prior to my mother and my daughter has also had medical issues. For these reasons, my desire has been fueled to establish alternative eating habits as a means to prevent disease, especially with kids at an early age. I believe this can be done by letting them be involved with the purchase, preparation, cooking, and serving of good healthy foods.

Project United was the right program for my personal and community needs to learn more about prevention of this disease in our community. I realized that the cultural normality of food intake always consists of some type of animal products on a daily basis that cause blockages and slow down the process of the heart pumping blood and oxygen.

Involvement in Home Sweet Home Project

Debra Clark

As a community health scholar I have been able to work with a team of people who share my interest of eliminating diseases through education and awareness. We met as a group utilizing a tool called speed dating to develop a professional relationship/marriage that has grown into a big happy family. Consider the three-legged stool; one cannot stand without the other. Each of us brings so much to table that I wonder how we could have been so close without ever crossing paths. Nevertheless, we have bonded and now look for ways to improve our efforts by enhancing our writing skills and seeking additional resources to promote sustainability to enhance our community for a better future. Community health scholars: What better name can you give to such individuals who are a community’s first choice when it comes to health care. We are the movers and shakers in our community.

Darlene Robinson

Home Sweet Home is our project. We named it, we designed the program, we listened to the community, we respected the community, we educated ourselves, and we educated the community. The program was not handed to us; it was made by us for us with the mission in mind of changing lifestyles by teaching our families how to spend time together, talk to each other, share with others, cook with love, train our children how to prepare a dish and making home truly Home Sweet Home. The mission of introducing new ways of cooking to our parents was well received. The preschoolers enjoyed the experience and the parents appreciated the information because our eating habits have led to many health improvements. The traffic light playing cards (red light = foods to avoid; eat; yellow = sometimes foods; green = go foods) were designed as a way for families to learn what foods to stop eating, for example cautiously eating the yellow foods and eating lots of all the green foods. Each family received a deck of Home Sweet Home cards designed by the team.

The program was introduced in the communities represented by the community health scholars. The team was glued together by a passion to make a difference, and we believe it is the start of great things to come. Our coming together was not by accident; it was time for academia and the community to unite on a mission of bringing the idea of healthy eating to the community.

Yawah Awolowo

Project United has been a perfect learning catalyst. One of the major goals of the project was to partner community leaders with academic researchers to develop and pilot test an obesity intervention program. We spent the year getting to know each other’s interests and personalities with an emphasis on building trust and working toward sustaining a lasting relationship. This was important to me because I have had several business encounters where I have shared ideas and people have either ignored or taken my ideas. These experiences have made me wary to trust experts sometimes. Therefore, any emphasis on building trust and sustainability are going to be important for me and my community.

I eventually ended up working with a team of six. We talked about potential projects based on our interests where we would be competitive for funding internally. We also evaluated the best approaches to write the grant using all our strengths. As a member of the team, I also earned my IRB certificate, which builds on the training I received in medical ethics and research. We titled our submission: Home Sweet Home, with a focus on home food environment. This project addresses obesity in the age group 2 to 5 years (pre-k). Our primary goal was to get 2-5-year-old children, along with their parents, to learn how to choose good, healthy produce, prepare food in a clean area, practice safety measures, make it a child friendly environment, create their own recipes using the things they like to eat, and spark their interest in healthy eating habits from an early age.
Thankfully, our collaborative proposal received funding for one year through a competitive internal grant process.

As I reflect on the past year of my role as a Community health scholar and the value that CBPR has added to my life, I believe that the time invested in the program will save lives in my community. And that is time well spent. As the program began its journey into the community, the best began to happen with children and the parents. We prepared familiar food with new twist, collards greens with no meat; to make home-cooked foods with fresh herbs and olive oil; the children preparing salads, constructing parfaits and serving their parents and grandparents; providing chef hats and aprons and gifts for families to continue their healthy journeys.

About the Authors

Yawah Awolowo is an organic farmer and chef at Mahalah Farms in Cuba (Sumter County), Alabama.

Debra Clark is founder and executive director of the Health and Wellness Education Center in Livingston (Sumter County), Alabama.

Darlene Robinson is founder of Imagine Me Youth Development Program in Greene County, Alabama.

Lola Baydala, Fay Fletcher, Melissa Tremblay, Natasha Rabbit, Jennilee Louis, Kisikaw Ksay-yin, and Caitlin Sinclair

Abstract

In response to high rates of substance abuse in their communities, members of the Maskwacis four Nations invited university researchers to partner in culturally adapting, implementing, and evaluating an evidence-based substance abuse and violence prevention program, the Life Skills Training program (Botvin & Griffin, 2014). This project used a community-based participatory research (Israel, Schulz, Parker, & Becker, 1998; Minkler & Wallerstein, 2003) approach, and was carried out by university and First Nation community partners. To evaluate the impact of the adapted program, students completed pre and post questionnaires, and community members participated in focus groups. The adapted Maskwacis Life Skills Training program was delivered in schools for three years. Students’ knowledge increased significantly during program delivery, and strong support was documented from community members. This project demonstrates the impact that can be facilitated by culturally adapting and delivering a prevention program, and by forming a community-university partnership.

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Introduction

The Maskwacis First Nations, located in central Alberta, Canada, include four communities: LouisBull, Montana, Samson, and Ermineskin. These neighboring Plains Cree Nations have a combined population of approximately 15,000 with roughly 53% of the population aged 17 or under (Grekul & Sanderson, 2011). The Nations are governed by independent chief and councils, and have separate education directors and schools.

National media attention has focused on high rates of crime and gang violence in Maskwacis, largely ignoring the rich and vibrant Cree culture that threads the four Nations together. In Maskwacis, Cree history, culture, and language are featured prominently in traditional community ceremonies and cultural events that regularly take place. Community Elders view their culture and language as a means to combat the social and public health problems that face Maskwacis community members as a result of the destructive impact of colonization, residential schools, and forced assimilation. Research evidence supports this perspective, demonstrating that a positive cultural identity can be a protective factor against substance abuse and violence for Indigenous
children and youth (French, Kim, & Pillado, 2006; Gazis, Connor, & Ho, 2009; Kulis, Napoli, & Marsiglia, 2002).

Project Initiation

The current project stemmed from a previous pilot project led by a partnership between university researchers and Alexis Nakota Sioux Nation members (Baydala, Fletcher, Worrell, Kajner, Letendre, & Rasmussen, 2014). Alexis community members sought to address the root causes of fetal alcohol spectrum disorder, and invited university researchers to partner with them in working toward substance abuse prevention. This pilot project involved the cultural adaptation, delivery, and evaluation of a substance abuse and violence prevention program in the Alexis community. The Botvin Life Skills Training (LST) program (Botvin, Baker, Renick, Filazzola, & Botvin, 1984; Botvin & Griffin, 2014) was chosen for the project, based on the results of a literature review that identified the program as having extensive, high-quality evidence to support its effectiveness, including multiple randomized control trials (National Registry of Evidence-based Programs and Practices, 2008). The three-year LST program has three levels, each including between 8 and 14 one-hour modules, and begins in either elementary or junior high school (see Table 1).

In 2010, a Maskwacis community member attended a presentation delivered by university researchers and Alexis community members. Following this presentation, Maskwacis community members invited university researchers to partner in introducing and adapting the LST program in their own community.

Project Objectives

The partners identified three broad objectives for the current project: (1) culturally adapt the LST program to reflect the language, culture, and visual images of the Maskwacis community; (2) deliver the adapted program in Maskwacis schools; and (3) evaluate the impact of the adapted program. Given the established effectiveness of the LST program in reducing substance abuse and violence and increasing skills related to prevention, the aim of the current project was to deliver the culturally adapted program with fidelity to the original curriculum, and to document the impact of the adapted program.

Program Adaptations

Research has demonstrated the importance of programming for Indigenous children to reflect Indigenous worldviews and culture (Hare, 2011). Further, the cultural content of programming has been correlated with enhanced learning for Indigenous children (Tsethlikai & Rogoff, 2013). A recent policy report also declared that the representation of Indigenous cultures, languages, and traditions in school classrooms is essential for promoting the academic success of Canadian Indigenous children and youth (Toulouse, 2008). For minority populations in general, culturally adapted evidence-based programs have been shown to be more effective than standard programs (Kumpfer, Magalhaes, & Xie, 2012).

The LST program is a generic program proven highly effective with students from different geographic regions, socioeconomic circumstances, and racial-ethnic backgrounds (Botvin, Griffin, Diaz, & Ifill-Williams, 2001). However, because the LST program does not incorporate Cree values, language, culture, and identity, Maskwacis community members and Elders decided to culturally adapt the program. In keeping with the principles of knowledge to action research (Graham, Logan, Harrison, Straus, Tetroe, Caswell, & Robinson, 2006), adaptations to the LST program, and the corresponding creation of the Maskwacis Life Skills Training (MLST) program, began in the first year of the project.

During the first year, a six-member adaptation committee was formed consisting of Elders from each of the Maskwacis four Nations. This committee met weekly to complete adaptations to the first level of manuals. Adaptations to the second and third levels were completed by a rotating group of Elders. During adaptation meetings, over 30 different Elders from all four communities reviewed the original LST curriculum and provided recommendations for adaptations, consisting of Cree language and syllabics, Elders’ teachings, and personal life stories. Following committee meetings, community and university partners worked together to adapt the manuals. Additionally, a community member created visual images for the manuals that reflected the Maskwacis culture and community. After adaptations were completed, Elders reviewed and provided approval for the adapted manuals.

Throughout the adaptation process, Elders were instrumental in ensuring that the adapted program accurately reflected the Cree culture. For example, one of the modules in the original LST curriculum focused on the harmful effects of tobacco use. However, Elders shared the importance of distinguishing between “poison tobacco” and “sacred tobacco” (i.e., kistemaw). In Maskwacis, kistemaw has important spiritual, cultural, and ceremonial purposes, such as being offered to communicate gratitude in advance of a request. Accordingly, the original LST module on smoking was adapted to focus on both the detrimental effects of poison tobacco as well as the healthy traditional use of kistemaw. Additionally, in order to reinforce program adaptations, MLST staff created digital stories to accompany each program module; these were guided and narrated by community Elders.

As Figure 1 shows, the adaptation process resulted in a program that incorporated both Western and Indigenous foundations of substance abuse and violence prevention. Rather than infusing Indigenous pillars of effective substance abuse prevention into an existing Western framework, the integrity of the lessons from each worldview was maintained.

Methods

Community-Based Participatory Research

This project used a community-based participatory research (CBPR) approach (Israel, Schulz, Parker, & Becker, 1998; Minkler & Wallerstein, 2003). With an emphasis on tangible benefits for communities, co-learning, equitable involvement, and respect for multiple forms of knowledge, CBPR can contribute to leveling power imbalances between community and university partners.
Because Indigenous peoples are calling for research to be done with and for Indigenous communities rather than on Indigenous communities, CBPR has been recognized as particularly suitable for research involving Indigenous peoples (Castleden, Morgan, & Lamb, 2012; Koster, Baccar, & Lemelin, 2012; Smith,1999). The partners in this project applied the principles of CBPR in multiple ways. In particular, academic team members traveled to the community each week to engage in team meetings; meetings began with smudging and a prayer conducted in the local Cree language; a consensus-based decision-making model was followed with contributions from all team members; program evaluation was participatory, with input and guidance from all partners; and all reports and program materials were created collaboratively and approved by all partners. The project was approved by the research ethics board at the partner university and by the Maskwacis First Nations through a Band Council Resolution (the authority mechanism by which elected representatives in First Nation communities support and authorize an action).

Focus Groups

A total of 25 focus groups were held over the course of the three-year project with 42 school personnel, 102 students, 18 Elders, four parents, and 12 MLST facilitators. With the exception of student focus groups, which were held with classes of approximately 20 students, focus groups included between six and eight participants to enable effective information sharing (Kreuger & Casey, 2015). Focus groups took place at the end of each of the three program years, and were held separately with school personnel from each school, students from each school, Elders, parents, and facilitators. The length of focus groups was between one and two hours.

Using purposive sampling, university partners recruited MLST facilitators, school personnel, and students to participate in focus groups, while community partners recruited Elders and parents. Community and university partners worked together to gather consent for participation. Although university partners facilitated all focus groups, community partners were present during Elder focus groups to translate from Cree to English where necessary. University research team members who conducted focus groups had graduate-level training in research methods and focus group facilitation as well as specific experience working with Indigenous communities.

Different focus group guides were developed for school personnel, students, Elders, parents, and MLST facilitators. Questions focused on participants’ experiences with the program adaptation and delivery, program impact on students, schools, and the community, unanticipated successes and challenges, and suggestions for improvement. Focus groups were conducted using a conversational style whereby participants were invited to speak to one another rather than directly to the facilitator, disagreements were encouraged, and participants were guided to express their thoughts in their own words and on their own terms (Kitzinger, 2005).

With participants’ permission, focus groups were audio recorded and transcribed verbatim. Data were managed with ATLAS.ti software, and analyses were completed using content analysis. Data were grouped according to common content, and a preliminary coding scheme was developed. The coding scheme was refined during discussions among partners, and themes were subsequently identified. Transcripts and preliminary data analyses were presented to participants as a means of member checking.

Questionnaires

To evaluate learning of program content, questionnaires were distributed to students before and after each year of program delivery. The LST questionnaire (National Health Promotion Associates, 2011a; 2011b) and Piers-Harris Self-Concept Scale, Second Edition (Piers & Herzberg, 2002) were distributed to students. The wording of LST questionnaires was adjusted to accommodate students’ reading levels. The elementary school version of the LST questionnaire included items regarding knowledge and attitudes toward smoking and drinking, as well as social and personal self-management skills. The junior high version of the LST questionnaire included similar content with an added focus on drug refusal skills. Additionally, LST questionnaires were adapted to include a cultural knowledge scale consisting of items created by community members and Elders. From the initial stages of the project, community partners emphasized the importance of using a strengths-based approach. Accordingly, questionnaire items that directly questioned frequency of substance use were eliminated. Instead, questionnaire items
focused on constructs that are highly related to decreased substance use (i.e., knowledge, attitudes, self-management, refusal, and social skills).

Children who provided verbal assent and whose parents provided written consent for participation completed questionnaires before and after each year of program delivery (see Table 2). Where assent and/ or consent was not provided, children still received the MLST program but did not complete questionnaires.

A sequential longitudinal cohort design was used, and a linear mixed model was used to analyze the questionnaire data. The linear mixed model has advantages over repeated measures ANOVA for working with repeated measures data (Kreuger & Tian, 2004). Primarily, a linear mixed model gives structure to the error term by adding additional random-effect terms. This is important to properly account for error that can arise due to correlations between data points within the same subject (intra-subject correlation). Also, the linear mixed effects model can accommodate missing data points, and is less likely to lead to spurious results (both Type I and Type II error) with categorical data.

Results

Focus Groups

Focus group findings were grouped into three overarching themes, consisting of (i) program impact; (ii) factors that contributed to the program’s success; and (iii) suggestions for improvement.

Program impact. Focus group participants described the impact of the MLST program in a number of areas. School impact was a particular
area of focus. Participants described how the program allowed for traditional Elders’ teachings to be brought in to the schools; that the program facilitated both student and teacher learning about Cree culture and the Maskwacis community; and how the program had resulted in positive classroom changes. As one teacher commented, “there’s a more positive environment in the classroom…we’re all communicating and we’re talking and there’s no yelling.”

Student impact was also described. Participants not only discussed how students had demonstrated learning of program content; they also described how the program had contributed to
elevating students’ self-esteem, respectful attitudes, and listening skills. According to one student, “I learned to like myself for who I am.” Similarly, as a school staff member stated, “I noticed their self-esteem was brought up…I noticed with their attitudes, they’ve been more respectful…to the class teacher and they’ve learned to respect themselves and their fellow peers…” Additionally, focus group participants reported that the MLST program had contributed to students’ enhanced sense of pride in their identity. One teacher described how the program had “opened up a lot of doors for them to try and realize that being who they are is okay.” Similarly, Elders reported an increase in youth attendance at cultural events in the community.

Focus group participants also described Elder impact. Elders recounted how the program had facilitated their own learning by reminding them about ancestral teachings shared by other Elders. Elders also felt that their participation in the program allowed them to contribute to their community in meaningful ways, resulting in positive personal impact. As one Elder described, “it warmed my heart to make me feel wanted.”

Similarly, facilitator impact was described. Facilitators felt that they had benefited from being immersed in cultural teachings, and described bringing traditional teachings into their own homes for their children and grandchildren to learn: “I had pride in what I was teaching. And for my personal life…I’m raising my grandson, and he gets to have a bulk of what I teach.” Additionally,
facilitators were impacted by the opportunity to build strong relationships with Elders, and also described feeling proud to make a difference in their community.

Factors contributing to program success. Among the multiple contributors to the MLST program’s success, participants described the focus on cultural teachings as paramount. According to participants, it was critical for facilitators and Elders to teach students about the importance of respect, honoring the Creator, speaking Cree, learning Maskwacis history, and developing cultural pride. These teachings were fundamental to student engagement and overall program acceptability. One teacher described how,

This content would not have worked had it not been presented culturally…we prayed before every class, we burned sweet grass…and the Elder led them in prayer and that just locked them in, they knew they were home once they did that.

In order to enrich the program’s cultural content, Elder involvement was also critical. Facilitators felt that Elders’ guidance and knowledge made program adaptations successful, while students, facilitators, and school personnel appreciated Elders’ presence in the classroom. As one facilitator described, “it seems like the more we bring the Elders in, the more the children benefit.”

Additionally, focus group participants commended the program’s community relevance.
Because the program was adapted specifically for the Maskwacis community by Maskwacis Elders and community members, the program incorporated community relevant language and visual images as well as local knowledge. Additionally, because MLST facilitators were community members, they were familiar to many students; even where facilitators and students did not have pre-existing relationships, focus group participants reported that students could easily identify with facilitators from their own community.

Facilitator skills were also important for the program’s success. Equipping facilitators with the necessary skills was a challenge in the first year of the program, with school personnel noting steady improvements in the second year of implementation, and providing exclusively positive feedback in the third year. The most important facilitator skills described by focus group participants were sincerity, confidence, the ability to engage students, the flexibility to accommodate students’ learning and reading levels, and classroom management competence. One teacher noted that, “it was really great that [the facilitator] was so enthusiastic about the program…it got the kids engaged, and they could sense that she really cared.”

Although it was important for facilitators to possess skills in leading students through program teachings and activities, teacher involvement was also described as essential. Facilitators noted that when teachers supported and contributed to MLST classes, students demonstrated increased engagement. It was helpful for teachers to assist with classroom management, to provide feedback to facilitators, and to supplement facilitators’ teachings with their own knowledge and experience. By the third year of implementation, all facilitators and school personnel reported strong relationships.

Finally, it was important for the MLST program to demonstrate compatibility with the school’s core curriculum. According to school personnel, the MLST program complemented students’ regular social studies curriculum, and was a suitable replacement for regularly scheduled health classes. This simplified the task of fitting MLST classes into busy classroom schedules. Even when classroom schedules were hectic, however, teachers were willing to prioritize the program: “They’re life skills, they’re things that are literally going to get them into their adulthood, so maybe math can wait a little while.”

Suggestions for improvement. Focus group participants made a number of suggestions for program improvement related to program delivery. In the first year of implementation, it was strongly suggested that facilitators take part in additional training to enhance their teaching and classroom management skills. This was addressed during the second and third years of implementation. In addition, focus group participants communicated that the program should be delivered for the full school year rather than for only four months of the year. One teacher felt that, “In order to really get the full benefit of the program, it needs to be reinforced all year long…so they are always reminded and supported.”

Suggestions for improvement were also made related to program content. During the first year of implementation, a recommendation was made to increase the involvement of Elders in program delivery, to incorporate more cultural teachings, and to improve the readability of manuals. Each of these suggestions were addressed by setting a goal to bring Elders into each MLST class, and by adapting manuals to include stronger cultural elements and lower reading levels. Suggestions were also made to add modules related to grieving and gender roles, as well as to implement a parent component. Finally, focus group participants strongly suggested that the program include more hands-on activities: “When we would do activities, it was amazing, it was the most interaction I would get out of my kids all year.”

Questionnaires

Questionnaire results are summarized below, with scores at baseline and at the final data collection point (i.e., year 3 post) depicted. Tables 3 and 4 show LST questionnaire scores for elementary and junior high students respectively. Analyses demonstrated statistically significant increases in scores for elementary students on all LST questionnaire scales. For elementary students, the Overall Knowledge scale included items relevant to anti-smoking knowledge (i.e., the harmful effects of smoking) and life skills knowledge (i.e., communication, decision-making, advertising, self-esteem, dealing with stress, and assertiveness). Items relevant to cultural content (e.g., Cree words and cultural protocol) were included in the Cultural Knowledge scale. The Attitude scale included items relevant to anti-smoking and anti-drinking attitudes. Finally, the Life Skills scale included the same content as the life skills knowledge items, but inquired about behaviors related to these content areas rather than inquiring about knowledge.

Statistically significant differences between baseline and the end of year 3 were also demonstrated for junior high students on all LST questionnaire scales with the exception of relaxation skills. For junior high students, Overall Knowledge included anti-drinking knowledge and life skills knowledge. The Cultural Knowledge scale included items with the same content as that of the elementary questionnaire. Also similar to elementary students, the Attitude scale included anti-smoking and anti-drinking attitude content. Finally, the Life Skills scale included items relevant to drug refusal skills, assertiveness skills, relaxation skills, and self-control skills.

Table 5 depicts elementary and junior high students’ scores for the Piers-Harris Children’s Self-Concept Scale-2. There were no statistically
significant differences between baseline and the end of year 3 for elementary or junior high students on the Piers-Harris-2.

Discussion

The current project demonstrates the meaningful impact that can be achieved by culturally adapting and delivering an evidence-based prevention program in a First Nations community. Quantitative results obtained from pre and post LST questionnaires showed significant positive increases in knowledge, skills, and attitudes between baseline and the end of year three. Findings reflect that students not only retained the knowledge communicated to them through the MLST program, but that students learned progressively more from the program each year. Further, because students’ scores increased related to both original program content and additional cultural content, these results demonstrate that students improved their knowledge, skills, and attitudes related to substance abuse from both Euro-Western and Indigenous perspectives.

With regard to the Piers-Harris questionnaire, there were no statistically significant differences between scores at baseline and the end of year three. This may be due in part to students’ scores being average at baseline (i.e., t scores approximated 50). It may not be realistic to expect mean self-concept scores to increase beyond an average range. Further, like other social-emotional measurement tools, the Piers-Harris-2 was validated using a U.S. sample of primarily Caucasian children (Piers & Herzberg, 2002), and its applicability to Indigenous children has not been established. Moving forward, it will be important to establish and utilize pre and post measurement tools that reflect the unique realities of Indigenous children.

In addition to pre and post questionnaires, focus groups were implemented to provide insight regarding program impact, factors contributing to program success, and suggestions for improvement. Conducting focus groups after each year of program delivery allowed for suggestions to be addressed continually, contributing to growing community support. Overall, focus group participants communicated strong support for and investment in the program as a promising means to address substance abuse and violence and to enhance traditional culture in Maskwacis. Focus groups provided information regarding the widespread impact of the program on schools, Elders, facilitators, and students.

Key to program impact was the utilization of a community-based participatory approach that incorporated Western and Indigenous pillars of knowledge. In this way, the MLST program honored the concept of “two-eyed seeing” (Figure 2), developed by Mi’kmaw Elders Albert and Mudena Marshall. “Two-eyed seeing” recognizes multiple diverse perspectives as valid without privileging one viewpoint over another. Enacting this principle also means acknowledging that multiple perspectives can lead to a richer understanding of health issues than one perspective alone. By acknowledging the value of Western and Indigenous substance abuse prevention models, our community-university partnership provided an example of how Indigenous and Western research paradigms can co-exist in a space that honors both worldviews. Focus groups revealed that this was critical to the success of the project. In particular, schools and community members identified the central importance of cultural adaptations to the program’s acceptance by students, schools, and the wider community. Focus group participants also reported that adaptations elevated the program’s potential to reach and engage students by presenting content in a way that was relevant to their community and cultural context. Similarly, adaptation of MLST questionnaires was important to honor community partners’ perspectives regarding the importance of capturing the program’s impact on students’ cultural knowledge.

The current project also suggests that CBPR can act as a catalyst for community change. However, although pre and post questionnaires and focus groups provided the opportunity to obtain important community feedback on the MLST program, our research team identified a number of unanticipated and peripheral community impacts that were not accounted for by the use of our
conventional evaluation methods. For example, community partners took on leadership roles in the program and formed a non-profit society to sustain the MLST program beyond the terms of our original research grant. In order to more fully understand these additional impacts, we supplemented the current evaluation methods with Outcome Mapping (Earl, Carden, & Smutylo, 2001; Tremblay, Baydala, Rabbit, Louis, & Ksay-yin, submitted for publication). Outcome Mapping is a tool that is sensitive to community change and development, and that emphasizes the significant process of culturally adapting and implementing programs in the context of a CBPR partnership.

Finally, a potential limitation of this study should be acknowledged; namely, the current study does not include a control group. In order to engage all four Nations in this project, it was necessary to deliver the MLST program in all Maskwacis schools. An intervention group and control group were initially defined; however, because these groups came from the same schools, it was not possible to maintain the integrity of the control group. In particular, students often switched back and forth between control group and intervention group classrooms, and teachers indicated that students were sharing MLST teachings with students in the control group. Consistent with our experience, recent literature indicates that treating complex community change initiatives as controlled experiments may be inappropriate, particularly in the context of CBPR (Kelly, 2010). In addition, we intentionally selected an evidence-based program with extensive research to support its effectiveness. As a result, it was not necessary to once again prove the effectiveness of the program; rather the aim of this project was to deliver the culturally adapted program with fidelity to the original curriculum, and to document the impact of the adapted program.

Conclusion

Maskwacis community members and Elders established a partnership with University of Alberta researchers to culturally adapt, implement, and evaluate an evidence-based substance abuse and violence prevention program. Students’ overall knowledge increased significantly during the three years of program implementation, and strong support was documented from schools, Elders, students, and other community members. This project demonstrates the considerable impact that can be facilitated by culturally adapting and delivering a prevention program, and by forming and maintaining a strong community-university partnership.

References

About the Authors

Lola Baydala is an associate professor in the Department of Pediatrics at the University of Alberta.
Fay Fletcher is professor and associate dean academic, Faculty of Extension, the University of Alberta.
Melissa Tremblay is a program evaluator in the Department of Pediatrics at the University of Alberta.
Natasha Rabbit is the executive director of the Nehiyaw Kakeskewina Learning Society in Maskwacis, Alberta.
Jennilee Louis is a research assistant for the Nehiyaw Kakeskewina Learning Society in Maskwacis, Alberta.
Kisikaw Ksay-yin is an Elder in the Nehiyaw Kakeskewina Learning Society, Maskwacis, Alberta.
Caitlin Sinclair is research coordinator, Department of Pediatrics, University of Alberta.