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Iveniuk J, Wilder J, Monk E. The Threefold Path to Equity: Approaches for Health and Aging Researchers. THE GERONTOLOGIST 2024; 64:gnad068. [PMID: 37326609 PMCID: PMC10943508 DOI: 10.1093/geront/gnad068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Indexed: 06/17/2023] Open
Abstract
The authors present a model for pursuing equity in research on health and aging, in terms of: (a) community-driven research governance, with reference to examples inside and outside of the United States, (b) a focus on policy change, where policy is defined broadly in terms of all legislative and regulatory change, and (c) equity-focused research practices, at the level of measurement, analysis, and study design. The model is visualized as a "threefold path" that researchers may walk, to achieve changes within our field, and changes in how we interface with other fields, and communities.
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Affiliation(s)
- James Iveniuk
- The Bridge at NORC, National Opinion Research Center, Chicago, Illinois, USA
| | - Jocelyn Wilder
- The Bridge at NORC, National Opinion Research Center, Chicago, Illinois, USA
| | - Ellis Monk
- Department of Sociology, Harvard University, Cambridge, Massachusetts, USA
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2
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Willows N, Blanchet R, Wasonti Io Delormier T. Decolonizing research in high-income countries improves Indigenous peoples' health and wellbeing. Appl Physiol Nutr Metab 2023; 48:1-4. [PMID: 36472342 DOI: 10.1139/apnm-2022-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Noreen Willows
- 4-378 Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 2P5, Canada
| | - Rosanne Blanchet
- Department of Social and Preventive Medicine (DMSP), School of Public Health, Université de Montréal (ESPUM), Montréal, QC H3N 1X9, Canada
| | - Treena Wasonti Io Delormier
- School of Human Nutrition, Centre for Indigenous Peoples' Nutrition & Environment (CINE), McGill University, Ste. Anne de Bellevue, QC, H9X 3V9, Canada
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3
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Thomas SN, Weber S, Bradbury-Jones C. Using Participatory and Creative Methods to Research Gender-Based Violence in the Global South and With Indigenous Communities: Findings From a Scoping Review. TRAUMA, VIOLENCE & ABUSE 2022; 23:342-355. [PMID: 32441215 PMCID: PMC8905117 DOI: 10.1177/1524838020925775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This review provides a synthesis of existing research on best practice recommendations for the use of participatory and creative methods to research gender-based violence in the Global South. Following a five-stage scoping review process, 44 papers, which each related to at least two of the three parts of the topic, were selected for inclusion. A frequency table was compiled to identify the elements of best practice, which were most common across the literature. Qualitative content analysis was then used to group these elements into inductive themes. An overarching theme of safety was identified, along with four broad and intersecting domains underpinning ethical research approaches in this area: contextual, reflexive, relational, and transformative. The validity of these themes was confirmed through consultation with partners, who also emphasized the importance of a survivor-centered approach. The aims, methods, barriers, evidence for practice, and research recommendations (AMBER) framework was developed for this project as an innovative tool for analyzing the data collected and drawing out the relevance for research practice. The framework draws out the aims, methods, and barriers involved in participatory research in this context and sets out best practice recommendations and directions for future research in the following areas: (1) ensuring safety of participants and researchers, (2) redressing power inequalities within the research process, (3) embedding locally responsive ethical frameworks, and (4) understanding cultural context and respecting cultural norms.
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Affiliation(s)
| | - Sanne Weber
- International Development Department, University of Birmingham, United Kingdom
| | - Caroline Bradbury-Jones
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, United Kingdom
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4
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The essential conditions needed to implement the Indigenous Youth Mentorship Program: a focused ethnography. BMC Public Health 2022; 22:213. [PMID: 35105323 PMCID: PMC8808991 DOI: 10.1186/s12889-021-12412-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022] Open
Abstract
Background The Indigenous Youth Mentorship Program (IYMP) is a 20-week communal, relationship-based afterschool healthy living program for Indigenous youth in Canada. IYMP embraces the Anishnaabe/Nehiyawak concepts of Mino-Bimaadiziwin/miyo-pimâtisiwin (“living in a good way”) via its core components of physical activities/games, healthy snacks, and relationship-building. A strength of IYMP is that it values autonomy, adaptability, and the school community context. However, this presents challenges when evaluating its implementation, given that traditional implementation science methods tend to oversimplify the process. In response, essential conditions for the implementation of school-based healthy living programs across diverse contexts have been developed. The purpose of this research was to understand the applicability of these essential conditions within the context of IYMP. Methods 15 participants (n = 10 Young Adult Health Leaders; n = 5 coordinators) with experience implementing IYMP in the provinces of Alberta, Saskatchewan, Manitoba, and Quebec were purposefully sampled. Focused ethnography was the guiding method and one-on-one semi-structured interviews were used as the data generation strategy. The purpose of the interviews was to understand what conditions are needed to implement IYMP. The interview guide was based on previously established essential conditions developed by the research team. Interviews were audio-recorded and transcribed, and content analysis was used to identify patterns in the data. Results The overarching theme that emerged from the interviews was the applicability of the essential conditions when implementing IYMP. Participants felt the eight core conditions (students as change agents, school/community-specific autonomy, demonstrated administrative leadership, higher-level support, dedicated champion(s) to engage school community, community support, quality and use of evidence, and professional development) and four contextual conditions (time, funding and project support, readiness and understanding, and prior community connectivity) were necessary, but made suggestions to modify two conditions (youth led and learning opportunities) to better reflect their experiences implementing IYMP. In addition, a new core condition, rooted in relationship, emerged as necessary for implementation. Conclusions This research adds to the literature by identifying and describing what is needed in practice to implement a communal, relationship-based afterschool healthy living program. The essential conditions may support other researchers and communities interested in implementing and rippling similar programs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12412-1.
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Haring RC, Blanchard JW, Korchmaros JD, Lund JR, Haozous EA, Raphaelito J, Hudson M, Tsosie KS. Empowering Equitable Data Use Partnerships and Indigenous Data Sovereignties Amid Pandemic Genomics. Front Public Health 2021; 9:742467. [PMID: 34858924 PMCID: PMC8632014 DOI: 10.3389/fpubh.2021.742467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has inequitably impacted Indigenous communities in the United States. In this emergency state that highlighted existing inadequacies in US government and tribal public health infrastructures, many tribal nations contracted with commercial entities and other organization types to conduct rapid diagnostic and antibody testing, often based on proprietary technologies specific to the novel pathogen. They also partnered with public-private enterprises on clinical trials to further the development of vaccines. Indigenous people contributed biological samples for assessment and, in many cases, broadly consented for indefinite use for future genomics research. A concern is that the need for crisis aid may have placed Indigenous communities in a position to forego critical review of data use agreements by tribal research governances. In effect, tribal nations were placed in the unenviable position of trading short-term public health assistance for long-term, unrestricted access to Indigenous genomes that may disempower future tribal sovereignties over community members' data. Diagnostic testing, specimen collection, and vaccine research is ongoing; thus, our aim is to outline pathways to trust that center current and future equitable relationship-building between tribal entities and public-private interests. These pathways can be utilized to increase Indigenous communities' trust of external partners and share understanding of expectations for and execution of data protections. We discuss how to navigate genomic-based data use agreements in the context of pathogen genomics. While we focus on US tribal nations, Indigenous genomic data sovereignties relate to global Indigenous nations regardless of colonial government recognition.
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Affiliation(s)
- Rodney C Haring
- Center for Indigenous Cancer Research, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Jessica W Blanchard
- Center for Applied Social Research, University of Oklahoma, Norman, OK, United States
| | - Josephine D Korchmaros
- Southwest Institute for Research on Women, University of Arizona, Tucson, AZ, United States
| | - Justin R Lund
- Department of Anthropology, University of Oklahoma, Norman, OK, United States
| | - Emily A Haozous
- Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - Josie Raphaelito
- Center for Indigenous Cancer Research, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Maui Hudson
- Te Kotahi Research Institute, University of Waikato, Hamilton, New Zealand
| | - Krystal S Tsosie
- Vanderbilt University, Nashville, TN, United States.,Native BioData Consortium, Eagle Butte, SD, United States
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6
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Lopresti S, Willows ND, Storey KE, McHugh TLF. Indigenous Youth Mentorship Program: key implementation characteristics of a school peer mentorship program in Canada. Health Promot Int 2021; 36:913-923. [PMID: 33166996 DOI: 10.1093/heapro/daaa090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program developed for elementary school students in Indigenous school communities in Canada. A local young adult health leader (YAHL) and high school mentors offer students healthy snacks, physical activity games, relationship building activities and cultural teachings. IYMP aims to improve children's health and wellbeing and empower Indigenous youth and communities. The purpose of this focused ethnography was to describe the key characteristics of successful IYMP delivery. Two focus groups were conducted with 16 participants (8 YAHLS and 8 youth mentors) from 7 schools followed by 4 individual interviews (3 YAHLs, 1 youth peer mentor). Transcripts were analyzed using content analysis. Findings were triangulated with IYMP program field observations and notes from IYMP national team meetings. The five characteristics identified as important for IYMP delivery were a sense of ownership by those delivering the program, inclusion of Indigenous Elders/knowledge keepers, establishing trusting relationships, open communication among all stakeholder groups, including community and academic partners, and adequate program supports in the form of program funding, manuals that described program activities, and local and national gatherings between academic and community partners for sharing ideas about the program and its components. This study indicates the importance of respectful partnerships between community and academic leads for program success and sustainability. As IYMP is implemented in more communities and becomes community autonomous, program sustainability may be ensured and implementation challenges mitigated by embedding the identified five essential characteristics within the fabric of IYMP.
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Affiliation(s)
- Sabrina Lopresti
- Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, Canada T6G 2P5
| | - Noreen D Willows
- Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, Canada T6G 2P5
| | - Kate E Storey
- School of Public Health, University of Alberta, 8303 - 112 Street, Edmonton, Alberta, Canada T6G 2P5
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 1-111 University Hall, Edmonton, Alberta, Canada T6G 2P5
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Sarmiento I, Zuluaga G, Paredes-Solís S, Chomat AM, Loutfi D, Cockcroft A, Andersson N. Bridging Western and Indigenous knowledge through intercultural dialogue: lessons from participatory research in Mexico. BMJ Glob Health 2021; 5:bmjgh-2020-002488. [PMID: 32994227 PMCID: PMC7526303 DOI: 10.1136/bmjgh-2020-002488] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/05/2020] [Accepted: 06/08/2020] [Indexed: 12/12/2022] Open
Abstract
Indigenous communities in Latin America and elsewhere have complex bodies of knowledge, but Western health services generally approach them as vulnerable people in need of external solutions. Intercultural dialogue recognises the validity and value of Indigenous standpoints, and participatory research promotes reciprocal respect for stakeholder input in knowledge creation.As part of their decades-long community-based work in Mexico's Guerrero State, researchers at the Centro de Investigación de Enfermedades Tropicales responded to the request from Indigenous communities to help them address poor maternal health. We present the experience from this participatory research in which both parties contributed to finding solutions for a shared concern. The aim was to open an intercultural dialogue by respecting Indigenous skills and customs, recognising the needs of health service stakeholders for scientific evidence.Three steps summarise the opening of intercultural dialogue. Trust building and partnership based on mutual respect and principles of cultural safety. This focused on understanding traditional midwifery and the cultural conflicts in healthcare for Indigenous women. A pilot randomised controlled trial was an opportunity to listen and to adjust the lexicon identifying and testing culturally coherent responses for maternal health led by traditional midwives. Codesign, evaluation and discussion happened during a full cluster randomised trial to identify benefits of supporting traditional midwifery on maternal outcomes. A narrative mid-term evaluation and cognitive mapping of traditional knowledge offered additional evidence to discuss with other stakeholders the benefits of intercultural dialogue. These steps are not mechanistic or invariable. Other contexts might require additional steps. In Guerrero, intercultural dialogue included recovering traditional midwifery and producing high-level epidemiological evidence of the value of traditional midwives, allowing service providers to draw on the strengths of different cultures.
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Affiliation(s)
- Iván Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada .,Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Germán Zuluaga
- Grupo de Estudios en Sistemas Tradicionales de Salud (GESTS), Universidad del Rosario, Bogotá, Cundinamarca, Colombia
| | - Sergio Paredes-Solís
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Anne Marie Chomat
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - David Loutfi
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada.,Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
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Lopresti S, Willows ND, Storey KE, McHugh TLF. Indigenous Youth Mentorship Program: essential characteristics of a Canadian multi-site community-university partnership with Indigenous communities. Health Promot Int 2021; 37:6278427. [PMID: 34010391 DOI: 10.1093/heapro/daab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Indigenous Youth Mentorship Program (IYMP) is a peer-led health promotion program grounded in the teachings of Indigenous scholars. IYMP is delivered as a multi-sited community-university partnership (CUP) with Indigenous communities across Canada for elementary students. A local young adult health leader and high school youth mentors offer students healthy snacks, physical activity games, relationship building activities and traditional cultural teachings. IYMP aims to improve children's health and wellbeing and empower Indigenous youth and communities. The purpose of this descriptive qualitative study was to describe the essential characteristics of this multi-sited CUP as perceived by the IYMP principal investigators (PIs). Key informant interviews were conducted with 5 IYMP PIs (2 Indigenous) and analysed using content analysis. The overarching theme was forming a community of practice (CoP), where people with a common interest share best practices as they interact regularly. Four sub-themes were shared interest for Indigenous health/wellbeing and social justice, relationships, mentorship and taking a decolonizing research approach. The IYMP CoP allowed mentorship to occur across regions. The essential characteristics that made the IYMP CUPs successful could be used to inform other multi-sited CUPs with Indigenous communities. Those with mutual interests in Indigenous health and partnership with Indigenous communities could consider forming a CoP. Within a newly formed CoP, relationships and mentorship can be developed through discussion and activities. It is imperative within the CoP to take a decolonizing approach to research and acknowledge the impact that colonial policies and practices have had on generations of Indigenous peoples.
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Affiliation(s)
- Sabrina Lopresti
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - Noreen D Willows
- Department of Agricultural, Food & Nutritional Science, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - Kate E Storey
- School of Public Health, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
| | - Tara-Leigh F McHugh
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 4-378 Edmonton Clinic Health Academy, Mailbox #54, 11405 87 Avenue, Edmonton, AB T6G 2P5, Canada
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Affleck W, Chawky N, Beauchamp G, Inukpuk MM, Annanack E, Paradis V, Séguin M. Suicides in Nunavik: a life course study. Int J Circumpolar Health 2021; 80:1880143. [PMID: 33691591 PMCID: PMC7954501 DOI: 10.1080/22423982.2021.1880143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study reports results of a life course study conducted with Inuit in Nunavik to obtain information on the life adversities and cumulative burden of adversity for three groups: those who died by suicide, those who attempted suicide, and those who experienced suicidal ideation but never attempted. The study involved different levels of collaboration between health authorities, front-line health workers and the research team. Results indicate that substance misuse and relational difficulties are most associated with the burden of adversity for those people who died by suicide, while bullying is most associated with the burden of adversity for those people who have made suicide attempts and those who have never made a suicide attempt. Specifically targeting parent–child relations, substance misuse, and bullying may be an important upstream strategy for reducing future suicidality in Nunavik.
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Affiliation(s)
- William Affleck
- Department of Psychology and Psycho-education, Institut Universitaire En Santé Mentale Douglas, Montreal, Canada.,Université Du Québec En Outaouais (UQO), Gatineau, Canada
| | - Nadia Chawky
- Department of Psychology and Psycho-education, Institut Universitaire En Santé Mentale Douglas, Montreal, Canada
| | - Guy Beauchamp
- Université Du Québec En Outaouais (UQO), Gatineau, Canada
| | - Martha Malaya Inukpuk
- Sungirtuivik Family House, Inukjuaq, Canada.,Nunavik Regional Board of Health and Social Services, Kuujuaq, Canada
| | | | - Véronique Paradis
- Nunavik Regional Board of Health and Social Services, Kuujuaq, Canada
| | - Monique Séguin
- Department of Psychology and Psycho-education, Institut Universitaire En Santé Mentale Douglas, Montreal, Canada.,Université Du Québec En Outaouais (UQO), Gatineau, Canada
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10
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Ferguson LJ, Girolami T, Thorstad R, Rodgers CD, Humbert ML. "That's What the Program Is All about… Building Relationships": Exploring Experiences in an Urban Offering of the Indigenous Youth Mentorship Program in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020733. [PMID: 33467020 PMCID: PMC7830795 DOI: 10.3390/ijerph18020733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
Peer mentorship is an effective approach for delivering health promotion programs that may be particularly useful among underrepresented populations. Advancing the peer-led approach, the Indigenous Youth Mentorship Program (IYMP) is a communal-led program rooted in Indigenous values aimed at the promotion of healthy lifestyles in children and youth. The program includes layers of multi-age mentoring (i.e., elementary students, high school student mentors, and young adult health leaders [YAHLs]) and incorporates three core components: physical activity, healthy eating, and cultural teachings. The purpose of this study was to qualitatively explore elementary student, mentor, and YAHL experiences in an urban IYMP offering. Eleven sharing circles were conducted; six with elementary students (n = 23; grade 4 and 5 students), two with mentors (n = 3; students enrolled in a grade 10 wellness girls class), and three with YAHLs (n = 6; undergraduate university students). Focus groups were also held with respective school teachers and principals. An inductive content analysis generated three themes that represent the perceived impacts of this urban IYMP offering: (1) Fostering Wellness, (2) Strengthening Meaningful Connections, and (3) Exploring Leadership. Findings are positioned within a communal mentorship framework that is circular and multi-directional. By bringing together Indigenous and non-Indigenous peoples, this program offering supports Indigenous cultural relevance in an urban-based wellness program.
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Affiliation(s)
- Leah J. Ferguson
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (R.T.); (M.L.H.)
- Correspondence:
| | | | - Reed Thorstad
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (R.T.); (M.L.H.)
| | - Carol D. Rodgers
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON L1G 0C5, Canada;
| | - M. Louise Humbert
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada; (R.T.); (M.L.H.)
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Abstract
The rapidly decreasing costs of generating genetic data sequencing and the ease of new DNA collection technologies have opened up new opportunities for anthropologists to conduct field-based genetic studies. An exciting aspect of this work comes from linking genetic data with the kinds of individual-level traits evolutionary anthropologists often rely on, such as those collected in long-term demographic and ethnographic studies. However, combining these two types of data raises a host of ethical questions related to the collection, analysis and reporting of such data. Here we address this conundrum by examining one particular case, the collection and analysis of paternity data. We are particularly interested in the logistics and ethics involved in genetic paternity testing in the localized settings where anthropologists often work. We discuss the particular issues related to paternity testing in these settings, including consent and disclosure, consideration of local identity and beliefs and developing a process of continued community engagement. We then present a case study of our own research in Namibia, where we developed a multi-tiered strategy for consent and community engagement, built around a double-blind procedure for data collection, analysis and reporting. Paternity testing in anthropology raises ethical and methodological issues. We summarize these and describe a novel double-blind method used in our work.
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12
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Woodbury RB, Beans JA, Hiratsuka VY, Burke W. Data Management in Health-Related Research Involving Indigenous Communities in the United States and Canada: A Scoping Review. Front Genet 2019; 10:942. [PMID: 31649725 PMCID: PMC6796238 DOI: 10.3389/fgene.2019.00942] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Multiple factors, including experiences with unethical research practices, have made some Indigenous groups in the United States and Canada reticent to participate in potentially beneficial health-related research. Yet, Indigenous peoples have also expressed a willingness to participate in research when certain conditions related to the components of data management-including data collection, analysis, security and storage, sharing, dissemination, and withdrawal-are met. A scoping review was conducted to better understand the terms of data management employed in health-related research involving Indigenous communities in the United States and Canada. Methods: PubMed, Embase, PsychINFO, and Web of Science were searched using terms related to the populations and topics of interest. Results were screened and articles deemed eligible for inclusion were extracted for content on data management, community engagement, and community-level research governance. Results: The search strategy returned 734 articles. 31 total articles were extracted, of which nine contained in-depth information on data management and underwent detailed extraction. All nine articles reported the development and implementation of data management tools, including research ethics codes, data-sharing agreements, and biobank access policies. These articles reported that communities were involved in activities and decisions related to data collection (n=7), data analysis (n=5), data-sharing (n=9), dissemination (n=7), withdrawal (n=4), and development of data management tools (n=9). The articles also reported that communities had full or shared ownership of (n=5), control over (n=9), access to (n=1), and possession of data (n=5). All nine articles discussed the role of community engagement in research and community-level research governance as means for aligning the terms of data management with the values, needs, and interests of communities. Conclusions: There is need for more research and improved reporting on data management in health-related research involving Indigenous peoples in the United States and Canada. Findings from this review can provide guidance for the identification of data management terms and practices that may be acceptable to Indigenous communities considering participation in health-related research.
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Affiliation(s)
- R Brian Woodbury
- Research Department, Southcentral Foundation, Anchorage, Alaska, United States
| | - Julie A Beans
- Research Department, Southcentral Foundation, Anchorage, Alaska, United States
| | - Vanessa Y Hiratsuka
- Research Department, Southcentral Foundation, Anchorage, Alaska, United States
| | - Wylie Burke
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, United States
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Rasmus SM, Charles B, John S, Allen J. With a Spirit that Understands: Reflections on a Long-term Community Science Initiative to End Suicide in Alaska. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:34-45. [PMID: 31343758 PMCID: PMC6750997 DOI: 10.1002/ajcp.12356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This retrospective analysis of a long-term community-based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to indigenously drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup'ik region of Alaska. We examine more deeply the major episodes and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup'ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence into coalescing and transformation can occur.
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Affiliation(s)
- Stacy M. Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Billy Charles
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - Simeon John
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, 99775-7000
| | - James Allen
- Department of Family Medicine and Biobehavioral Health & Memory Keepers Medical Discovery Team - American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth Campus, 624 E. 1st St., Suite 201, Duluth, MN 55805
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Murdoch-Flowers J, Tremblay MC, Hovey R, Delormier T, Gray-Donald K, Delaronde E, Macaulay AC. Understanding how Indigenous culturally-based interventions can improve participants' health in Canada. Health Promot Int 2019; 34:154-165. [PMID: 28973378 DOI: 10.1093/heapro/dax059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
There is increasing recognition that culturally-based diabetes prevention programs can facilitate the adoption and maintenance of healthy behaviours in the communities in which they are implemented. The Kahnawake School Diabetes Prevention Project (KSDPP) is a health promotion, community-based participatory research project aiming to reduce the incidence of Type 2 diabetes in the community of Kahnawake (Mohawk territory, Canada), with a large range of interventions integrating a Haudenosaunee perspective of health. Building on a qualitative, naturalistic and interpretative inquiry, this study aimed to assess the outcomes of a suite of culturally-based interventions on participants' life and experience of health. Data were collected through semi-structured qualitative interviews of 1 key informant and 17 adult, female Kahnawake community members who participated in KSDPP's suite of interventions from 2007 to 2010. Grounded theory was chosen as an analytical strategy. A theoretical framework that covered the experiences of all study participants was developed from the grounded theory analysis. KSDPP's suite of interventions provided opportunities for participants to experience five different change processes: (i) Learning traditional cooking and healthy eating; (ii) Learning physical activity; (iii) Learning mind focusing and breathing techniques; (iv) Learning cultural traditions and spirituality; (v) Socializing and interacting with other participants during activities. These processes improved participants' health in four aspects: mental, physical, spiritual and social. Results of this study show how culturally-based health promotion can bring about healthy changes addressing the mental, physical, spiritual and social dimensions of a holistic concept of health, relevant to the Indigenous perspective of well-being.
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Affiliation(s)
- Jayne Murdoch-Flowers
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Office of Education and Continuing Professional Development, Université Laval, QC, Canada
| | - Richard Hovey
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, QC, Canada
| | - Treena Delormier
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Office of Public Health Studies, University of Hawai'i, Honolulu, HI, USA
| | - Katherine Gray-Donald
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,School of Dietetics and Human Nutrition, McGill University, Montréal, QC, Canada
| | - Elaine Delaronde
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada
| | - Ann C Macaulay
- Kahnawake Schools Diabetes Prevention Project, Kahnawake Territory, Kanien'keha, Mohawk Nation, QC, Canada.,Participatory Research at McGill, Department of Family Medicine, McGill University, Montréal, QC, Canada
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Guta A, Murray SJ, Strike C, Flicker S, Upshur R, Myers T. Governing Well in Community-Based Research: Lessons from Canada's HIV Research Sector on Ethics, Publics and the Care of the Self. Public Health Ethics 2018; 10:315-328. [PMID: 29731810 DOI: 10.1093/phe/phw024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this paper, we extend Michel Foucault's final works on the 'care of the self' to an empirical examination of research practice in community-based research (CBR). We use Foucault's 'morality of behaviors' to analyze interview data from a national sample of Canadian CBR practitioners working with communities affected by HIV. Despite claims in the literature that ethics review is overly burdensome for non-traditional forms of research, our findings suggest that many researchers using CBR have an ambivalent but ultimately productive relationship with institutional research ethics review requirements. They understand and use prescribed codes, but adapt them in practice to account for the needs of participating community members, members of their research teams and the larger communities with whom they work. Complying with ethics protocols was seen as only the beginning, a minimum standard; our research suggests that the real ethical work happens in the field, where CBR practitioners encounter community members in diverse public roles and must forge ethical consensus across communities. CBR represents an ethical terrain in which practitioners challenge themselves to work differently, and as a result they care for themselves-and others-in ways that often resist the propensity for domination through public health research. '…there are different ways to "conduct oneself" morally, different ways for the acting individual to operate, not just as an agent, but as an ethical subject of action.' (Foucault, 1985: 26).
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Affiliation(s)
- Adrian Guta
- Department of Health Sciences, Carleton University; Dalla Lana School of Public Health, University of Toronto
| | - Stuart J Murray
- Department of English Language and Literature, Carleton University; Department of Health Sciences, Carleton University
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto
| | | | - Ross Upshur
- Dalla Lana School of Public Health, University of Toronto
| | - Ted Myers
- Dalla Lana School of Public Health, University of Toronto
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Tremblay MC, Martin DH, McComber AM, McGregor A, Macaulay AC. Understanding community-based participatory research through a social movement framework: a case study of the Kahnawake Schools Diabetes Prevention Project. BMC Public Health 2018; 18:487. [PMID: 29650020 PMCID: PMC5897940 DOI: 10.1186/s12889-018-5412-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A longstanding challenge of community-based participatory research (CBPR) has been to anchor evaluation and practice in a relevant theoretical framework of community change, which articulates specific and concrete evaluative benchmarks. Social movement theories provide a broad range of theoretical tools to understand and facilitate social change processes, such as those involved in CBPR. Social movement theories have the potential to provide a coherent representation of how mobilization and collective action is gradually developed and leads to systemic change in the context of CBPR. The current study builds on a social movement perspective to assess the processes and intermediate outcomes of a longstanding health promotion CBPR project with an Indigenous community, the Kahnawake Schools Diabetes Prevention Project (KDSPP). METHODS This research uses a case study design layered on a movement-building evaluation framework, which allows progress to be tracked over time. Data collection strategies included document (scientific and organizational) review (n = 51) and talking circles with four important community stakeholder groups (n = 24). RESULTS Findings provide an innovative and chronological perspective of the evolution of KSDPP as seen through a social movement lens, and identify intermediate outcomes associated with different dimensions of movement building achieved by the project over time (mobilization, leadership, vision and frames, alliance and partnerships, as well as advocacy and action strategies). It also points to areas of improvement for KSDPP in building its potential for action. CONCLUSION While this study's results are directly relevant and applicable to the local context of KSDPP, they also highlight useful lessons and conclusions for the planning and evaluation of other long-standing and sustainable CBPR initiatives. The conceptual framework provides meaningful benchmarks to track evidence of progress in the context of CBPR. Findings from the study offer new ways of thinking about the evaluation of CBPR projects and their progress by drawing on frameworks that guide other forms of collective action.
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Affiliation(s)
- Marie-Claude Tremblay
- Department of Family Medicine and Emergency Medicine, Office of Education and Continuing Professional Development, Université Laval, 1050, de la Médecine, Pavillon Ferdinand-Vandry, 2881-F, Québec, QC, G1V 0A6, Canada.
| | - Debbie H Martin
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Alex M McComber
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada.,Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Amelia McGregor
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada
| | - Ann C Macaulay
- Department of Family Medicine, McGill University, Montreal, QC, Canada
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Hovey RB, Delormier T, McComber AM, Lévesque L, Martin D. Enhancing Indigenous Health Promotion Research Through Two-Eyed Seeing: A Hermeneutic Relational Process. QUALITATIVE HEALTH RESEARCH 2017; 27:1278-1287. [PMID: 28682710 DOI: 10.1177/1049732317697948] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The intention of this article is to demonstrate how Indigenous and allied health promotion researchers learned to work together through a process of Two-Eyed Seeing. This process was first introduced as a philosophical hermeneutic research project on diabetes prevention within an Indigenous community in Quebec Canada. We, as a research team, became aware that hermeneutics and the principles of Haudenosaunee decision making were characteristic of Two-Eyed Seeing. This article describes our experiences while working with each other. Our learning from these interactions emphasized the relational aspects needed to ensure that we became a highly functional research team while working together and becoming Two-Eyed Seeing partners.
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Affiliation(s)
- Richard B Hovey
- 1 McGill University, Montreal, Quebec, Canada
- 2 Kahnawake Schools Diabetes Prevention Project, Kahnawake Mohawk Territory, Quebec, Canada
| | - Treena Delormier
- 2 Kahnawake Schools Diabetes Prevention Project, Kahnawake Mohawk Territory, Quebec, Canada
- 3 University of Hawaii at Mānoa, Honolulu, Hawaii, USA
| | - Alex M McComber
- 2 Kahnawake Schools Diabetes Prevention Project, Kahnawake Mohawk Territory, Quebec, Canada
| | - Lucie Lévesque
- 2 Kahnawake Schools Diabetes Prevention Project, Kahnawake Mohawk Territory, Quebec, Canada
- 4 Queen's University, Kingston, Ontario, Canada
| | - Debbie Martin
- 5 Dalhousie University, Halifax, Nova Scotia, Canada
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Allen ML, Salsberg J, Knot M, LeMaster JW, Felzien M, Westfall JM, Herbert CP, Vickery K, Culhane-Pera KA, Ramsden VR, Zittleman L, Martin RE, Macaulay AC. Engaging with communities, engaging with patients: amendment to the NAPCRG 1998 Policy Statement on Responsible Research With Communities. Fam Pract 2017; 34:313-321. [PMID: 27543087 DOI: 10.1093/fampra/cmw074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In 1998, the North American Primary Care Research Group (NAPCRG) adopted a groundbreaking Policy Statement endorsing responsible participatory research (PR) with communities. Since that time, PR gained prominence in primary care research. OBJECTIVES To reconsider the original 1998 Policy Statement in light of increased uptake of PR, and suggest future directions and applications for PR in primary care. This work contributed to an updated Policy Statement endorsed by NAPCRG in 2015. METHODS 32 university and 30 community NAPCRG-affiliated research partners, convened a workshop to document lessons learned about implementing processes and principles of PR. This document emerged from that session and reflection and discussion regarding the original Policy Statement, the emerging PR literature, and our own experiences. RESULTS The foundational principles articulated in the 1998 Policy Statement remain relevant to the current PR environment. Lessons learned since its publication include that the maturation of partnerships is facilitated by participatory processes that support increased community responsibility for research projects, and benefits generated through PR extend beyond research outcomes. Future directions that will move forward the field of PR in primary care include: (i) improve assessment of PR processes to better delineate the links between how PR teams work together and diverse PR outcomes, (ii) increase the number of models incorporating PR into translational research from project inception to dissemination, and (iii) increase application of PR approaches that support patient engagement in clinical settings to patient-provider relationship and practice change research. CONCLUSION PR has markedly altered the manner in which primary care research is undertaken in partnership with communities and its principles and philosophies continue to offer means to assure that research results and processes improve the health of all communities.
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Affiliation(s)
- Michele L Allen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Jon Salsberg
- Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Michaela Knot
- Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Joseph W LeMaster
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | | | - John M Westfall
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - Carol P Herbert
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Katherine Vickery
- Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.,Department of Family Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
| | | | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, Saskatchewan,Canada and
| | - Linda Zittleman
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - Ruth Elwood Martin
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ann C Macaulay
- Participatory Research at McGill, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Fraser S, Vrakas G, Laliberté A, Mickpegak R. Everyday ethics of participation: a case study of a CBPR in Nunavik. Glob Health Promot 2017; 25:82-90. [PMID: 28353402 DOI: 10.1177/1757975917690496] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Multiple reports highlight the need for community-based family-oriented prevention services for Aboriginal peoples in order to address important health and social inequalities. Participatory, empowerment-based approaches are generally favoured for these means. Faced with important social issues, in a context of colonisation and complex power dynamics, we question how community members experience participation, as well as the everyday dynamics that take place when attempting to create community-level change. CONTEXT The initial steps of this community-based participatory research (CBPR) took place over a two-year period in a community of Nunavik, a large northern region of the province of Quebec. The objective of the CBPR was to develop a community-driven project aimed at supporting families to be able to keep children within their homes or communities, rather than having to be placed under child welfare services. METHOD We participated in, and documented, various group meetings, community workshops, informal reflexive discussions, and formal interviews with community partners to explore their everyday experiences of participation in community-based change. RESULTS We describe some of the initial actions taken in this project. We describe how certain social and power dynamics infiltrated into the process of participation leading to various tensions, personal and interpersonal experiences and needs. DISCUSSION We discuss how these experiences led to everyday ethical dilemmas regarding participation. We conclude that although participatory approaches towards community change may be effective, they are also ethically challenging and at times disempowering for those who participate. We describe some of the approaches used to work with these ethical challenges.
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Affiliation(s)
- Sarah Fraser
- 1 Department of Psychoeducation, University of Montreal, Montreal, Quebec, Canada.,2 Institut Universitaire SHERPA, CSSS de la Montagne, Quebec, Canada
| | - Georgia Vrakas
- 3 Department of Psychoeducation, University of Quebec in Trois-Rivières, Quebec City, Quebec, Canada
| | - Arlene Laliberté
- 4 Department of Psychoeducation, Université du Québec en Abitibi-Témiscamingue, Saint-Jérôme, Quebec, Canada
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Holden K, Akintobi T, Hopkins J, Belton A, McGregor B, Blanks S, Wrenn G. Community Engaged Leadership to Advance Health Equity and Build Healthier Communities. SOCIAL SCIENCES (BASEL, SWITZERLAND) 2016; 5:2. [PMID: 27713839 PMCID: PMC5048675 DOI: 10.3390/socsci5010002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Health is a human right. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential. Addressing the multi-faceted health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities; and with significant changes in the constellation of multiple of risk factors that can influence health outcomes, it is imperative that we delineate strategic efforts that encourage better access to primary care, focused community-based programs, multi-disciplinary clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals' longevity and quality of life.
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Affiliation(s)
- Kisha Holden
- Department of Psychiatry & Behavioral Science, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Tabia Akintobi
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Prevention Research Center, Morehouse School of Medicine, 720Westview Drive, Atlanta, GA 30310, USA
| | - Jammie Hopkins
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Allyson Belton
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Brian McGregor
- Department of Psychiatry & Behavioral Science, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Starla Blanks
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
| | - Glenda Wrenn
- Department of Psychiatry & Behavioral Science, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
- Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive, Atlanta, GA 30310, USA
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Beyond Dissemination: Generating and Applying Qualitative Evidence Through Community-Based Participatory Research. HANDBOOKS IN HEALTH, WORK, AND DISABILITY 2016. [DOI: 10.1007/978-1-4939-2920-7_26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Goodyear-Smith F, Jackson C, Greenhalgh T. Co-design and implementation research: challenges and solutions for ethics committees. BMC Med Ethics 2015; 16:78. [PMID: 26573410 PMCID: PMC4647576 DOI: 10.1186/s12910-015-0072-2] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 11/12/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Implementation science research, especially when using participatory and co-design approaches, raises unique challenges for research ethics committees. Such challenges may be poorly addressed by approval and governance mechanisms that were developed for more traditional research approaches such as randomised controlled trials. DISCUSSION Implementation science commonly involves the partnership of researchers and stakeholders, attempting to understand and encourage uptake of completed or piloted research. A co-creation approach involves collaboration between researchers and end users from the onset, in question framing, research design and delivery, and influencing strategy, with implementation and broader dissemination strategies part of its design from gestation. A defining feature of co-creation is its emergent and adaptive nature, making detailed pre-specification of interventions and outcome measures impossible. This methodology sits oddly with ethics committee protocols that require precise pre-definition of interventions, mode of delivery, outcome measurements, and the role of study participants. But the strict (and, some would say, inflexible) requirements of ethics committees were developed for a purpose - to protect participants from harm and help ensure the rigour and transparency of studies. We propose some guiding principles to help square this circle. First, ethics committees should acknowledge and celebrate the diversity of research approaches, both formally (through training) and informally (by promoting debate and discussion); without active support, their members may not understand or value participatory designs. Second, ground rules should be established for co-design applications (e.g. how to judge when 'consultation' or 'engagement' becomes research) and communicated to committee members and stakeholders. Third, the benefits of power-sharing should be recognised and credit given to measures likely to support this important goal, especially in research with vulnerable communities. Co-design is considered best practice, for example, in research involving indigenous peoples in New Zealand, Australia and Canada.
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Affiliation(s)
- Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, PB, 920919, Auckland, New Zealand.
| | - Claire Jackson
- Centre for Primary Care Reform Research Excellence, School of Medicine, University of Queensland, Brisbane, Australia.
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Successful strategies to engage research partners for translating evidence into action in community health: a critical review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2015; 2015:191856. [PMID: 25815016 PMCID: PMC4359847 DOI: 10.1155/2015/191856] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/01/2015] [Indexed: 11/18/2022]
Abstract
Objectives. To undertake a critical review describing key strategies supporting development of participatory research (PR) teams to engage partners for creation and translation of action-oriented knowledge. Methods. Sources are four leading PR practitioners identified via bibliometric analysis. Authors' publications were identified in January 1995–October 2009 in PubMed, Embase, ISI Web of Science and CAB databases, and books. Works were limited to those with a process description describing a research project and practitioners were first, second, third, or last author. Results. Adapting and applying the “Reliability Tested Guidelines for Assessing Participatory Research Projects” to retained records identified five key strategies: developing advisory committees of researchers and intended research users; developing research agreements; using formal and informal group facilitation techniques; hiring co-researchers/partners from community; and ensuring frequent communication. Other less frequently mentioned strategies were also identified. Conclusion. This review is the first time these guidelines were used to identify key strategies supporting PR projects. They proved effective at identifying and evaluating engagement strategies as reported by completed research projects. Adapting these guidelines identified gaps where the tool was unable to assess fundamental PR elements of power dynamics, equity of resources, and member turnover. Our resulting template serves as a new tool to measure partnerships.
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Charania NA, Martin ID, Liberda EN, Meldrum R, Tsuji LJS. Bird harvesting practices and knowledge, risk perceptions, and attitudes regarding avian influenza among Canadian First Nations subsistence hunters: implications for influenza pandemic plans. BMC Public Health 2014; 14:1113. [PMID: 25347949 PMCID: PMC4223741 DOI: 10.1186/1471-2458-14-1113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 10/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is concern of avian influenza virus (AIV) infections in humans. Subsistence hunters may be a potential risk group for AIV infections as they frequently come into close contact with wild birds and the aquatic habitats of birds while harvesting. This study aimed to examine if knowledge and risk perception of avian influenza influenced the use of protective measures and attitudes about hunting influenza-infected birds among subsistence hunters. METHODS Using a community-based participatory research approach, a cross-sectional survey was conducted with current subsistence hunters (n = 106) residing in a remote and isolated First Nations community in northern Ontario, Canada from November 10-25, 2013. Simple descriptive statistics, cross-tabulations, and analysis of variance (ANOVA) were used to examine the distributions and relationships between variables. Written responses were deductively analyzed. RESULTS ANOVA showed that males hunted significantly more birds per year than did females (F1,96 = 12.1; p = 0.001) and that those who hunted significantly more days per year did not perceive a risk of AIV infection (F1,94 = 4.4; p = 0.040). Hunters engaged in bird harvesting practices that could expose them to AIVs, namely by cleaning, plucking, and gutting birds and having direct contact with water. It was reported that 18 (17.0%) hunters wore gloves and 2 (1.9%) hunters wore goggles while processing birds. The majority of hunters washed their hands (n = 105; 99.1%) and sanitized their equipment (n = 69; 65.1%) after processing birds. More than half of the participants reported being aware of avian influenza, while almost one third perceived a risk of AIV infection while harvesting birds. Participants aware of avian influenza were more likely to perceive a risk of AIV infection while harvesting birds. Our results suggest that knowledge positively influenced the use of a recommended protective measure. Regarding attitudes, the frequency of participants who would cease harvesting birds was highest if avian influenza was detected in regional birds (n = 55; 51.9%). CONCLUSIONS Our study indicated a need for more education about avian influenza and precautionary behaviours that are culturally-appropriate. First Nations subsistence hunters should be considered an avian influenza risk group and have associated special considerations included in future influenza pandemic plans.
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Affiliation(s)
- Nadia A Charania
- Department of Environment and Resource Studies, University of Waterloo, 200 University Avenue West, N2L 3G1 Waterloo, Ontario, Canada.
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Abstract
BACKGROUND The medical research enterprise depends on public recognition of its societal value. In light of evidence indicating public mistrust, especially among minorities, inadequate enrollment as well as diversity of research participants, and poor uptake of findings, medical research seems to fall short of sufficient public regard. Community engagement in medical research, with special attention to minority communities, may help to remedy this shortfall by demonstrating respect for the communities in practical ways. APPROACH We provided 3 case examples that illustrate how specific approaches to community-engaged research can build trust between researchers and communities, encourage participation among underrepresented groups, and enhance the relevance as well as the uptake of research findings. DISCUSSION A common attribute of the specific approaches discussed here is that they enable the researchers to demonstrate respect by recognizing community values and interests. The demonstration of respect for the communities has intrinsic ethical importance. CONCLUSIONS The 2 potential outgrowths of demonstrating respect specifically through community engagement are (1) the production of research that is more relevant to the community and (2) the mitigation of asymmetry in the researcher-community relationship. We summarized practical resources available to researchers who seek to incorporate community engagement in their research.
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Affiliation(s)
- Jessica K. Holzer
- Postdoctoral Fellow, Yale University School of Public Health Department of Health Policy and Management
| | - Lauren Ellis
- PhD student in the Bioethics and Health Policy Track, Johns Hopkins University Bloomberg School of Public Health Department of Health Policy and Management, and Berman Institute of Bioethics
| | - Maria W. Merritt
- Associate Professor, Johns Hopkins University Berman Institute of Bioethics and Bloomberg School of Public Health Department of International Health
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Gribble MO, Around Him DM. Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review. AJOB Empir Bioeth 2014; 5:1-24. [PMID: 25089283 DOI: 10.1080/21507716.2013.848956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health. METHODS Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached. RESULTS We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research. CONCLUSIONS Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.
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Affiliation(s)
- Matthew O Gribble
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Deana M Around Him
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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Mikesell L, Bromley E, Khodyakov D. Ethical community-engaged research: a literature review. Am J Public Health 2013; 103:e7-e14. [PMID: 24134352 PMCID: PMC3828990 DOI: 10.2105/ajph.2013.301605] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2013] [Indexed: 11/04/2022]
Abstract
Health research has relied on ethical principles, such as those of the Belmont Report, to protect the rights and well-being of research participants. Community-based participatory research (CBPR), however, must also consider the rights and well-being of communities. This requires additional ethical considerations that have been extensively discussed but not synthesized in the CBPR literature. We conducted a comprehensive thematic literature review and summarized empirically grounded discussions of ethics in CBPR, with a focus on the value of the Belmont principles in CBPR, additional essential components of ethical CBPR, the ethical challenges CBPR practitioners face, and strategies to ensure that CBPR meets ethical standards. Our study provides a foundation for developing a working definition and a conceptual model of ethical CBPR.
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Affiliation(s)
- Lisa Mikesell
- Lisa Mikesell is with the Communication Department, School of Communication and Information, Rutgers University, New Brunswick, NJ. Elizabeth Bromley is with the Semel Institute Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and the Greater Los Angeles VA Healthcare System. Dmitry Khodyakov is with the RAND Corporation, Santa Monica, CA
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Willows N. Ethical principles of health research involving Indigenous peoples. Appl Physiol Nutr Metab 2013; 38:iii-v. [DOI: 10.1139/apnm-2013-0381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Noreen Willows
- Department of Agricultural, Food, and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Chachamovich E, Haggarty J, Cargo M, Hicks J, Kirmayer LJ, Turecki G. A psychological autopsy study of suicide among Inuit in Nunavut: methodological and ethical considerations, feasibility and acceptability. Int J Circumpolar Health 2013; 72:20078. [PMID: 23539438 PMCID: PMC3609997 DOI: 10.3402/ijch.v72i0.20078] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/21/2013] [Accepted: 01/22/2013] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The increasing global prevalence of suicide has made it a major public health concern. Research designed to retrospectively study suicide cases is now being conducted in populations around the world. This field of research is especially crucial in Aboriginal populations, as they often have higher suicide rates than the rest of the country. OBJECTIVE This article presents the methodological aspects of the first psychological autopsy study on suicide among Inuit in Nunavut. Qaujivallianiq Inuusirijauvalauqtunik (Learning from lives that have been lived) is a large case-control study, including all 120 cases of suicide by Inuit that occurred in Nunavut between 1 January 2003 and 31 December 2006. The article describes the research design, ethical considerations and strategies used to adapt the psychological autopsy method to Nunavut Inuit. Specifically, we present local social and cultural issues; data collection procedures; and the acceptability, reliability and validity of the method. METHOD A retrospective case-control study using the psychological autopsy approach was carried out in 22 communities in Nunavut. A total of 498 individuals were directly interviewed, and medical and correctional charts were also reviewed. RESULTS The psychological autopsy method was well received by participants as they appreciated the opportunity to discuss the loss of a family member or friend by suicide. During interviews, informants readily identified symptoms of psychiatric disorders, although culture-specific rather than clinical explanations were sometimes provided. Results suggest that the psychological autopsy method can be effectively used in Inuit populations.
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Affiliation(s)
- Eduardo Chachamovich
- Department of Psychiatry, McGill Group for Suicide Studies, McGill University, Montreal, Quebec, Canada.
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Mercille G, Receveur O, Potvin L. Household food insecurity and Canadian Aboriginal women's self-efficacy in food preparation. CAN J DIET PRACT RES 2013; 73:134-40. [PMID: 22958631 DOI: 10.3148/73.3.2012.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
PURPOSE Determinants of self-efficacy related to food preparation using store-bought food were examined in women belonging to the Atikamekw Nation. Also examined was whether self-efficacy was associated with household food insecurity. METHODS A cross-sectional survey was conducted with 107 women responsible for household food supplies. Two self-efficacy scores were calculated, one for healthy food preparation and one for food preparation in general. Household food insecurity was measured with an adapted version of the United States Food Security Core Module. The other variables were household composition, income sources, food supplies, tobacco use, participants' health status, and lifestyle and sociodemographic characteristics. Multiple linear regression was used to analyze associations between self-efficacy and household food insecurity in 99 participants. RESULTS Severe household food insecurity was associated with significantly lower healthy food preparation scores in Atikamekw women. Other associated variables were food supplies, marital status, alcohol consumption, weight status, and understanding of the native language. CONCLUSIONS Application of the concept of self-efficacy contributes to a better understanding of the factors influencing food preparation in Atikamekw women. In this study, self-efficacy in healthy food preparation was linked to food insecurity and obesity, particularly in the most serious cases. Efforts to improve diet will require not only behavioural interventions, but public policies.
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Affiliation(s)
- Genevieve Mercille
- Institut de recherche en santé publique de l'Université de Montréal, Montréal, QC, Canada
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Skinner K, Hanning RM, Sutherland C, Edwards-Wheesk R, Tsuji LJS. Using a SWOT analysis to inform healthy eating and physical activity strategies for a remote First Nations community in Canada. Am J Health Promot 2012; 26:e159-70. [PMID: 22747324 DOI: 10.4278/ajhp.061019136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To plan community-driven health promotion strategies based on a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the healthy eating and physical activity patterns of First Nation (FN) youth. DESIGN Cross-sectional qualitative and quantitative data used to develop SWOT themes and strategies. SETTING Remote, subarctic FN community of Fort Albany, Ontario, Canada. SUBJECTS Adult (n = 25) and youth (n = 66, grades 6-11) community members. MEASURES Qualitative data were collected using five focus groups with adults (two focus groups) and youth (three focus groups), seven individual interviews with adults, and an environmental scan of 13 direct observations of events/locations (e.g., the grocery store). Quantitative data on food/physical activity behaviors were collected using a validated Web-based survey with youth. ANALYSIS Themes were identified from qualitative and quantitative data and were analyzed and interpreted within a SWOT matrix. RESULTS Thirty-two SWOT themes were identified (e.g., accessibility of existing facilities, such as the gymnasium). The SWOT analysis showed how these themes could be combined and transformed into 12 strategies (e.g., expanding and enhancing the school snack/breakfast program) while integrating suggestions from the community. CONCLUSION SWOT analysis was a beneficial tool that facilitated the combination of local data and community ideas in the development of targeted health promotion strategies for the FN community of Fort Albany.
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Affiliation(s)
- Kelly Skinner
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
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Born K, Orkin A, VanderBurgh D, Beardy J. Teaching wilderness first aid in a remote First Nations community: the story of the Sachigo Lake Wilderness Emergency Response Education Initiative. Int J Circumpolar Health 2012; 71:19002. [PMID: 23110258 PMCID: PMC3482695 DOI: 10.3402/ijch.v71i0.19002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/11/2012] [Accepted: 09/15/2012] [Indexed: 11/26/2022] Open
Abstract
Objective To understand how community members of a remote First Nations community respond to an emergency first aid education programme. Study design A qualitative study involving focus groups and participant observation as part of a community-based participatory research project, which involved the development and implementation of a wilderness first aid course in collaboration with the community. Methods Twenty community members participated in the course and agreed to be part of the research focus groups. Three community research partners validated and reviewed the data collected from this process. These data were coded and analysed using open coding. Results Community members responded to the course in ways related to their past experiences with injury and first aid, both as individuals and as members of the community. Feelings of confidence and self-efficacy related access to care and treatment of injury surfaced during the course. Findings also highlighted how the context of the remote First Nations community influenced the delivery and development of course materials. Conclusions Developing and delivering a first aid course in a remote community requires sensitivity towards the response of participants to the course, as well as the context in which it is being delivered. Employing collaborative approaches to teaching first aid can aim to address these unique needs. Though delivery of a first response training programme in a small remote community will probably not impact the morbidity and mortality associated with injury, it has the potential to impact community self-efficacy and confidence when responding to an emergency situation.
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Affiliation(s)
- Karen Born
- Institute of Health Policy & Management, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Glass KC, Kaufert J. Research Ethics Review and Aboriginal Community Values: Can the Two be Reconciled? J Empir Res Hum Res Ethics 2012; 2:25-40. [PMID: 19385793 DOI: 10.1525/jer.2007.2.2.25] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
CONTEMPORARY RESEARCH ETHICS REVIEW COMMITTEES (RECs) are heavily influenced by the established academic or health care institutional frameworks in which they operate, sharing a cultural, methodological and ethical perspective on the conduct of research involving humans. The principle of autonomous choice carries great weight in what is a highly individualistic decision-making process in medical practice and research. This assumes that the best protection lies in the ability of patients or research participants to make competent, voluntary, informed choices, evaluating the risks and benefits from a personal perspective. Over the past two decades, North American and international indigenous researchers, policy makers and communities have identified key issues of relevance to them, but ignored by most institutional or university-based RECs. They critique the current research review structure, and propose changes on a variety of levels in an attempt to develop more community sensitive research ethics review processes. In doing so, they have emphasized recognition of collective rights including community consent. Critics see alternative policy guidelines and community-based review bodies as challenging the current system of ethics review. Some view them as reflecting a fundamental difference in values. In this paper, we explore these developments in the context of the political, legal and ethical frameworks that have informed REC review. We examine the process and content of these frameworks and ask how this contrasts with emerging Aboriginal proposals for community-based research ethics review. We follow this with recommendations on how current REC review models might accommodate the requirements of both communities and RECs.
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Mantoura P, Potvin L. A realist-constructionist perspective on participatory research in health promotion. Health Promot Int 2012; 28:61-72. [PMID: 22952337 DOI: 10.1093/heapro/das037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Clarifying the contours of research in health promotion (HP) is an ongoing challenge. Research in this action-oriented field has traditionally been developed based on values such as participation and empowerment. Consequently, many forms of participatory research have emerged throughout the years, and participatory research has positioned itself as a core competency of HP and public health. This paper argues that participation as a normative stance guiding methodology, or as value, is a fragile posture upon which to position research practices. The argument is based on a realist-constructionist perspective of science and specifically uses Law and Latour's notion of inscription device and Callon's actor-network theory to suggest that participation is an epistemological necessity and that participatory research practices may be considered as inscription devices. These theoretical notions help clarify the consequences of participation on knowledge production. Finally, the article refers to Stengers's work to propose an ecology of research practices that defines obligations and exigencies for HP with respect to knowledge production and that are more consistent with the field's values of social justice and equity.
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Affiliation(s)
- Pascale Mantoura
- Institut de recherche en santé publique de l'Université de Montreal, Public Health Montreal, Quebec, Canada.
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Charania NA, Tsuji LJS. A community-based participatory approach and engagement process creates culturally appropriate and community informed pandemic plans after the 2009 H1N1 influenza pandemic: remote and isolated First Nations communities of sub-arctic Ontario, Canada. BMC Public Health 2012; 12:268. [PMID: 22472012 PMCID: PMC3434059 DOI: 10.1186/1471-2458-12-268] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 04/03/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health emergencies have the potential to disproportionately impact disadvantaged populations due to pre-established social and economic inequalities. Internationally, prior to the 2009 H1N1 influenza pandemic, existing pandemic plans were created with limited public consultation; therefore, the unique needs and characteristics of some First Nations communities may not be ethically and adequately addressed. Engaging the public in pandemic planning can provide vital information regarding local values and beliefs that may ultimately lead to increased acceptability, feasibility, and implementation of pandemic plans. Thus, the objective of the present study was to elicit and address First Nations community members' suggested modifications to their community-level pandemic plans after the 2009 H1N1 influenza pandemic. METHODS The study area included three remote and isolated First Nations communities located in sub-arctic Ontario, Canada. A community-based participatory approach and community engagement process (i.e., semi-directed interviews (n = 13), unstructured interviews (n = 4), and meetings (n = 27)) were employed. Participants were purposively sampled and represented various community stakeholders (e.g., local government, health care, clergy, education, etc.) involved in the community's pandemic response. Collected data were manually transcribed and coded using deductive and inductive thematic analysis. The data subsequently informed the modification of the community-level pandemic plans. RESULTS The primary modifications incorporated in the community-level pandemic plans involved adding community-specific detail. For example, 'supplies' emerged as an additional category of pandemic preparedness and response, since including details about supplies and resources was important due to the geographical remoteness of the study communities. Furthermore, it was important to add details of how, when, where, and who was responsible for implementing recommendations outlined in the pandemic plans. Additionally, the roles and responsibilities of the involved organizations were further clarified. CONCLUSIONS Our results illustrate the importance of engaging the public, especially First Nations, in pandemic planning to address local perspectives. The community engagement process used was successful in incorporating community-based input to create up-to-date and culturally-appropriate community-level pandemic plans. Since these pandemic plans are dynamic in nature, we recommend that the plans are continuously updated to address the communities' evolving needs. It is hoped that these modified plans will lead to an improved pandemic response capacity and health outcomes, during the next public health emergency, for these remote and isolated First Nations communities. Furthermore, the suggested modifications presented in this paper may help inform updates to the community-level pandemic plans of other similar communities.
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Affiliation(s)
- Nadia A Charania
- Department of Environment and Resource Studies, University of Waterloo, Waterloo, ON, Canada.
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Tomlin D, Naylor PJ, McKay H, Zorzi A, Mitchell M, Panagiotopoulos C. The impact of Action Schools! BC on the health of Aboriginal children and youth living in rural and remote communities in British Columbia. Int J Circumpolar Health 2012; 71:17999. [PMID: 22456048 PMCID: PMC3417517 DOI: 10.3402/ijch.v71i0.17999] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of the study was to determine the short-term impact of a 7-month whole-school physical activity and healthy eating intervention (Action Schools! BC) over the 2007–2008 school year for children and youth in 3 remote First Nations villages in northwestern British Columbia. Study design A pre-experimental pre/post design was conducted with 148 children and youth (77 males, 71 females; age 12.5±2.2 yrs). Methods We evaluated changes in obesity (body mass index [wt/ht2] and waist circumference z-scores: zBMI and zWC), aerobic fitness (20-m shuttle run), physical activity (PA; physical activity questionnaire and accelerometry), healthy eating (dietary recall) and cardiovascular risk (CV risk). Results zBMI remained unchanged while zWC increased from 0.46±1.07 to 0.57±1.04 (p<0.05). No change was detected in PA or CV risk but aerobic fitness increased by 22% (25.4±15.8 to 30.9±20.0 laps; p<0.01). There was an increase in the variety of vegetables consumed (1.10±1.18 to 1.45±1.24; p<0.05) but otherwise no dietary changes were detected. Conclusions While no changes were seen in PA or overall CV risk, zWC increased, zBMI remained stable and aerobic fitness improved during a 7-month intervention.1
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Affiliation(s)
- Dona Tomlin
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, Canada
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Harding A, Harper B, Stone D, O'Neill C, Berger P, Harris S, Donatuto J. Conducting research with tribal communities: sovereignty, ethics, and data-sharing issues. ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:6-10. [PMID: 21890450 PMCID: PMC3261947 DOI: 10.1289/ehp.1103904] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 09/02/2011] [Indexed: 05/20/2023]
Abstract
BACKGROUND When conducting research with American Indian tribes, informed consent beyond conventional institutional review board (IRB) review is needed because of the potential for adverse consequences at a community or governmental level that are unrecognized by academic researchers. OBJECTIVES In this article, we review sovereignty, research ethics, and data-sharing considerations when doing community-based participatory health-related or natural-resource-related research with American Indian nations and present a model material and data-sharing agreement that meets tribal and university requirements. DISCUSSION Only tribal nations themselves can identify potential adverse outcomes, and they can do this only if they understand the assumptions and methods of the proposed research. Tribes must be truly equal partners in study design, data collection, interpretation, and publication. Advances in protection of intellectual property rights (IPR) are also applicable to IRB reviews, as are principles of sovereignty and indigenous rights, all of which affect data ownership and control. CONCLUSIONS Academic researchers engaged in tribal projects should become familiar with all three areas: sovereignty, ethics and informed consent, and IPR. We recommend developing an agreement with tribal partners that reflects both health-related IRB and natural-resource-related IPR considerations.
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Affiliation(s)
- Anna Harding
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR 97331, USA.
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Haddad S, Narayana D, Mohindra K. Reducing inequalities in health and access to health care in a rural Indian community: an India-Canada collaborative action research project. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2011; 11 Suppl 2:S3. [PMID: 22165825 PMCID: PMC3247834 DOI: 10.1186/1472-698x-11-s2-s3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background Inadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs). The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala, women’s lives are constrained by gender-based inequalities and certain indigenous groups are marginalized such that their health and welfare lag behind other social groups. The research The goal of this socially-engaged, action-research initiative was to reduce social inequalities in access to health care in a rural community. Specific objectives were: 1) design and implement a community-based health insurance scheme to reduce financial barriers to health care, 2) strengthen local governance in monitoring and evidence-based decision-making, and 3) develop an evidence base for appropriate health interventions. Results and outcomes Health and social inequities have been masked by Kerala’s overall progress. Key findings illustrated large inequalities between different social groups. Particularly disadvantaged are lower-caste women and Paniyas (a marginalized indigenous group), for whom inequalities exist across education, employment status, landholdings, and health. The most vulnerable populations are the least likely to receive state support, which has broader implications for the entire country. A community based health solidarity scheme (SNEHA), under the leadership of local women, was developed and implemented yielding some benefits to health equity in the community—although inclusion of the Paniyas has been a challenge. The partnership The Canadian-Indian action research team has worked collaboratively for over a decade. An initial focus on surveys and data analysis has transformed into a focus on socially engaged, participatory action research. Challenges and successes Adapting to unanticipated external forces, maintaining a strong team in the rural village, retaining human resources capable of analyzing the data, and encouraging Paniya participation in the health insurance scheme were challenges. Successes were at least partially enabled by the length of the funding (this was a two-phase project over an eight year period).
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Affiliation(s)
- Slim Haddad
- Centre de recherche du Centre Hospitalier de l'Université de Montreal (CHUM), Université de Montréal, 3850 rue Saint-Urbain, Montréal, Québec, Canada.
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Charania NA, Tsuji LJS. The 2009 H1N1 pandemic response in remote First Nation communities of Subarctic Ontario: barriers and improvements from a health care services perspective. Int J Circumpolar Health 2011; 70:564-75. [PMID: 22030007 DOI: 10.3402/ijch.v70i5.17849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To retrospectively examine the barriers faced and opportunities for improvement during the 2009 H1N1 pandemic response experienced by participants responsible for the delivery of health care services in 3 remote and isolated Subarctic First Nation communities of northern Ontario, Canada. STUDY DESIGN A qualitative community-based participatory approach. METHODS Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the 3 main sectors responsible for health care services (i.e., federal health centres, provincial hospitals and Band Councils). Data were manually transcribed and coded using deductive and inductive thematic analysis. RESULTS Primary barriers reported were issues with overcrowding in houses, insufficient human resources and inadequate community awareness. Main areas for improvement included increasing human resources (i.e., nurses and trained health care professionals), funding for supplies and general community awareness regarding disease processes and prevention. CONCLUSIONS Government bodies should consider focusing efforts to provide more support in terms of human resources, monies and education. In addition, various government organizations should collaborate to improve housing conditions and timely access to resources. These recommendations should be addressed in future pandemic plans, so that remote western James Bay First Nation communities of Subarctic Ontario and other similar communities can be better prepared for the next public health emergency.
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Affiliation(s)
- Nadia A Charania
- Department of Environment and Resource Studies, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
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Mohammed SA, Walters KL, Lamarr J, Evans-Campbell T, Fryberg S. Finding middle ground: negotiating university and tribal community interests in community-based participatory research. Nurs Inq 2011; 19:116-27. [PMID: 22530859 DOI: 10.1111/j.1440-1800.2011.00557.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community-based participatory research (CBPR) has been hailed as an alternative approach to one-sided research endeavors that have traditionally been conducted on communities as opposed to with them. Although CBPR engenders numerous relationship strengths, through its emphasis on co-sharing, mutual benefit, and community capacity building, it is often challenging as well. In this article, we describe some of the challenges of implementing CBPR in a research project designed to prevent cardiovascular disease among an indigenous community in the Pacific Northwest of the United States and how we addressed them. Specifically, we highlight the process of collaboratively constructing a Research Protocol/Data Sharing Agreement and qualitative interview guide that addressed the concerns of both university and tribal community constituents. Establishing these two items was a process of negotiation that required: (i) balancing of individual, occupational, research, and community interests; (ii) definition of terminology (e.g., ownership of data); and (iii) extensive consideration of how to best protect research participants. Finding middle ground in CBPR requires research partners to examine and articulate their own assumptions and expectations, and nurture a relationship based on compromise to effectively meet the needs of each group.
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Green AR, Tan-McGrory A, Cervantes MC, Betancourt JR. Leveraging quality improvement to achieve equity in health care. Jt Comm J Qual Patient Saf 2011; 36:435-42. [PMID: 21548504 DOI: 10.1016/s1553-7250(10)36065-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED INEQUALITY IN QUALITY: Disparities in health care and quality for racial, ethnic, linguistic, and other disadvantaged groups are widespread and persistent. Health care organizations are engaged in efforts to improve quality in general but often make little attempt to address disparities. STANDARD VERSUS CULTURALLY COMPETENT QUALITY IMPROVEMENT (QI) Most QI interventions are broadly targeted to the general population-a "one-size-fits-all" approach. These standard QI efforts may preferentially improve quality for more advantaged patients and maintain or even worsen existing disparities. Culturally competent QI interventions place specific emphasis on addressing the unique needs of minority groups and the root causes of disparities. HOW QI CAN REDUCE DISPARITIES QI interventions can reduce disparities in at least three ways: (1) In some cases, standard QI interventions can improve quality more for those with the lowest quality, but this is unreliable; (2) group-targeted QI interventions can reduce disparities by preferentially targeting disparity groups; and (3) culturally competent QI interventions, by tailoring care to cultural and linguistic barriers that cause disparities, can improve care for everyone but especially for disparity groups. GUIDELINES FOR CULTURALLY COMPETENT QI A culturally competent approach to QI should (1) identify disparities and use disparities data to guide and monitor interventions, (2) address barriers unique to specific disparity groups, and (3) address barriers common to many disparity group. CONCLUSIONS To achieve equity in health care, hospitals and other health care organizations should move toward culturally competent QI and disparities-targeted QI interventions to achieve equity in health care, a key pillar of quality.
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Guta A, Wilson MG, Flicker S, Travers R, Mason C, Wenyeve G, O'Campo P. Are we asking the right questions? A review of Canadian REB practices in relation to community-based participatory research. J Empir Res Hum Res Ethics 2010; 5:35-46. [PMID: 20569148 DOI: 10.1525/jer.2010.5.2.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Access barriers to effective ethics review continue to be a significant challenge for researchers and community-based organizations undertaking community-based participatory research (CBPR). This article reports on findings from a content analysis of select (Behavioural, Biomedical, Social Sciences, Humanities) research ethics boards (REBs) in the Canadian research context (n = 86). Existing ethics review documentation was evaluated using 30 CBPR related criteria for their sensitivity to relevant approaches, processes, and outcomes. A linear regression was conducted to determine whether specific organizational characteristics have an impact on the CBPR sensitivity: (1) region of Canada, (2) type of institution (university or a healthcare organization), (3) primary institutional language (English or French) and (4) national ranking with respect to research intensiveness. While only research intensiveness proved statistically significant (p = .001), we recognize REB protocol forms may not actually reflect how CBPR is reviewed. Despite using a single guiding ethical framework, REBs across Canada employ a variety of techniques to review research studies. We report on these differences and varying levels of sensitivity to CBPR. Finally, we highlight best practices and make recommendations for integrating CBPR principles into existing ethics review.
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Affiliation(s)
- Adrian Guta
- University of Toronto, Toronto, Ontario, Canada.
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Paniya Voices: a Participatory Poverty and Health Assessment among a marginalized South Indian tribal population. BMC Public Health 2010; 10:149. [PMID: 20307290 PMCID: PMC2848202 DOI: 10.1186/1471-2458-10-149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 03/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In India, indigenous populations, known as Adivasi or Scheduled Tribes (STs), are among the poorest and most marginalized groups. 'Deprived' ST groups tend to display high levels of resignation and to lack the capacity to aspire; consequently their health perceptions often do not adequately correspond to their real health needs. Moreover, similar to indigenous populations elsewhere, STs often have little opportunity to voice perspectives framed within their own cultural worldviews. We undertook a study to gather policy-relevant data on the views, experiences, and priorities of a marginalized and previously enslaved tribal group in South India, the Paniyas, who have little 'voice' or power over their own situation. METHODS/DESIGN We implemented a Participatory Poverty and Health Assessment (PPHA). We adopted guiding principles and an ethical code that promote respect for Paniya culture and values. The PPHA, informed by a vulnerability framework, addressed five key themes (health and illness, well-being, institutions, education, gender) using participatory approaches and qualitative methods. We implemented the PPHA in five Paniya colonies (clusters of houses in a small geographical area) in a gram panchayat (lowest level decentralized territorial unit) to generate data that can be quickly disseminated to decision-makers through interactive workshops and public forums. PRELIMINARY FINDINGS: Findings indicated that the Paniyas are caught in multiple 'vulnerability traps', that is, they view their situation as vicious cycles from which it is difficult to break free. CONCLUSION The PPHA is a potentially useful approach for global health researchers working with marginalized communities to implement research initiatives that will address those communities' health needs in an ethical and culturally appropriate manner.
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Shoultz J, Oneha MF, Magnussen L, Hla MM, Brees-Saunders Z, Cruz MD, Douglas M. Finding solutions to challenges faced in community-based participatory research between academic and community organizations. J Interprof Care 2009; 20:133-44. [PMID: 16608716 DOI: 10.1080/13561820600577576] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Partnerships between communities and academic institutions have been vital in addressing complex health and psychosocial issues faced by culturally diverse and hard-to-reach populations. Community-based participatory research (CBPR) has been suggested as a strategy to develop trust and build on the strengths of partners from various settings to address significant health issues, particularly those persistent health issues that reveal disparities among minority populations. There have been many challenges to developing these partnerships in the United States. The purpose of this paper is to discuss approaches and solutions used by this research team in response to the challenges they have faced in using CBPR. The team uses CBPR to understand and support the process of disclosure of intimate partner violence (IPV) within the context of the community health centers that provide services for multicultural and multi-lingual populations. While CBPR provides a route to develop trust and build on the strengths of partners from various settings, there are multiple challenges that arise when partnering organizations present with different infrastructures, missions, resources and populations served. Examples of common challenges and solutions from the literature and from the team's experience will be discussed. Implications for partners, partnerships, practice and research will be explored.
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Affiliation(s)
- Jan Shoultz
- School of Nursing and Dental Hygiene, University of Hawaii and University of California at Los Angeles (UCLA), Los Angeles, CA, USA.
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Laveaux D, Christopher S. Contextualizing CBPR: Key Principles of CBPR meet the Indigenous research context. PIMATISIWIN 2009; 7:1. [PMID: 20150951 PMCID: PMC2818123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper addresses two questions regarding the use of Community-based Participatory Research (CBPR) approaches with tribal communities. First, how do "gold standard" CBPR principles hold up when applied to Native American communities and what additional contextual information is necessary to understand and work with these principles in this setting? Second, what additional principles or recommendations are helpful for researchers interested in conducting research using a CBPR approach with tribal communities? We studied a variety of literature sources on CBPR and Native health research to answer these questions. We are unaware of any publications that contextualize CBPR principles for working with specific populations. This information has direct application for conducting research with tribal communities, and confirms the importance of using CBPR approaches in this setting.
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Affiliation(s)
- Deborah Laveaux
- Center for Native Health Partnerships, 319 Leon Johnson Hall, Box 173090, Montana State University, Bozeman, MT 59717
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Monasta L, Andersson N, Ledogar RJ, Cockcroft A. Minority health and small numbers epidemiology: a case study of living conditions and the health of children in 5 foreign Romá camps in Italy. Am J Public Health 2008; 98:2035-41. [PMID: 18799769 PMCID: PMC2636417 DOI: 10.2105/ajph.2007.129734] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We sought to test methods for generating epidemiological evidence on health conditions of small, dispersed minority communities. METHODS We used community-based mixed methods including a cross-sectional survey in 5 purposely selected settlements of Khorakané Romá (Gypsies of Muslim culture) in Italy to study the living conditions and health status of children aged from birth to 5 years. RESULTS In the 15 days prior to the survey, 32% of the children had suffered diarrhea and 55% had had a cough. Some 17% had experienced respiratory difficulties during the past year. Risk factors associated with these outcomes included years spent living at the camp, overcrowding, housing conditions, use of wood-burning stoves, presence of rats, and issues related to quality of sanitation and drains. Qualitative information helped define the approach and the design, and in the interpretation and consolidation of quantitative results. CONCLUSIONS Guided by the priorities expressed by dispersed minority communities, small studies with little resources can provide a solid base to advocate for evidence-based participatory planning. Exact intervals appeared to be robust and conservative enough compared with other intervals, conferring solidity to the results.
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Affiliation(s)
- Lorenzo Monasta
- Unit for Health Services Research and International Health, Institute for Maternal and Child Health, Istituto di Ricerca e Cura a Carattere Scientifico, Burlo Garofolo, Trieste, Italy.
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Cargo M, Delormier T, Lévesque L, Horn-Miller K, McComber A, Macaulay AC. Can the democratic ideal of participatory research be achieved? An inside look at an academic-indigenous community partnership. HEALTH EDUCATION RESEARCH 2008; 23:904-914. [PMID: 18187491 DOI: 10.1093/her/cym077] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Democratic or equal participation in decision making is an ideal that community and academic stakeholders engaged in participatory research strive to achieve. This ideal, however, may compete with indigenous peoples' right to self-determination. Study objectives were to assess the perceived influence of multiple community (indigenous) and academic stakeholders engaged in the Kahnawake Schools Diabetes Prevention Project (KSDPP) across six domains of project decision making and to test the hypothesis that KSDPP would be directed by community stakeholders. Self-report surveys were completed by 51 stakeholders comprising the KSDPP Community Advisory Board (CAB), KSDPP staff, academic researchers and supervisory board members. KSDPP staff were perceived to share similar levels of influence with (i) CAB on maintaining partnership ethics and CAB activities and (ii) academic researchers on research and dissemination activities. KSDPP staff were perceived to carry significantly more influence than other stakeholders on decisions related to annual activities, program operations and intervention activities. CAB and staff were the perceived owners of KSDPP. The strong community leadership aligns KSDPP with a model of community-directed research and suggests that equitable participation-distinct from democratic or equal participation-is reflected by indigenous community partners exerting greater influence than academic partners in decision making.
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Affiliation(s)
- Margaret Cargo
- Psychosocial Research Division, Douglas Hospital Research Centre-McGill University, Verdun, Québec, Canada H4H 1R3.
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Edwards K, Lund C, Mitchell S, Andersson N. Trust the Process: Community-based Researcher Partnerships. PIMATISIWIN 2008; 6:186-199. [PMID: 20862228 PMCID: PMC2942844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Smith DA, Edwards NC, Martens PJ, Varcoe C. 'Making a difference': A new care paradigm for pregnant and parenting Aboriginal people. Canadian Journal of Public Health 2007. [PMID: 17896745 DOI: 10.1007/bf03405411] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe community-based stakeholders' views of how safe and responsive care "makes a difference" to health and well-being for pregnant and parenting Aboriginal people. Community-based stakeholders included community members, providers of health and social care, and health care and community leaders. METHODS A postcolonial standpoint, participatory research principles and a case-study design were used to investigate two Aboriginal organizations' experiences improving care for pregnant and parenting Aboriginal people. Data were collected through researcher field notes, exploratory interviews and small group discussions with purposively selected community-based leaders, members and providers. Data were analyzed using an interpretive descriptive method. RESULTS Community participants' views of "making a difference" emphasized: recognizing relevant outcomes of care; acknowledging progress over time; and using a strengths-based approach in which providers appreciate individuals' efforts and the challenges of their contextual circumstances. DISCUSSION "Making a difference" to pregnant and parenting Aboriginal people would facilitate Aboriginal peoples' efforts to tackle the deeply embedded socio-historical determinants of well-being and capacity, and thus shift priorities for care upstream to focus on such determinants. Such a paradigm for care would integrate multiple perspectives on desirable outcomes within local frameworks based on values and priorities of Aboriginal parents, while also incorporating the benefits and wisdom of existing yet further downstream approaches to care. CONCLUSION Design and evaluation of care based on community values and priorities and using a strengths-based approach can improve early access to and relevance of care during pregnancy and parenting for Aboriginal people.
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Affiliation(s)
- Dawn A Smith
- School of Nursing, University of Ottawa, Room 3251b-451 Smyth Rd, Ottawa, ON K1H 8M5.
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Flicker S, Travers R, Guta A, McDonald S, Meagher A. Ethical dilemmas in community-based participatory research: recommendations for institutional review boards. J Urban Health 2007; 84:478-93. [PMID: 17436114 PMCID: PMC2219570 DOI: 10.1007/s11524-007-9165-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
National and international codes of research conduct have been established in most industrialized nations to ensure greater adherence to ethical research practices. Despite these safeguards, however, traditional research approaches often continue to stigmatize marginalized and vulnerable communities. Community-based participatory research (CBPR) has evolved as an effective new research paradigm that attempts to make research a more inclusive and democratic process by fostering the development of partnerships between communities and academics to address community-relevant research priorities. As such, it attempts to redress ethical concerns that have emerged out of more traditional paradigms. Nevertheless, new and emerging ethical dilemmas are commonly associated with CBPR and are rarely addressed in traditional ethical reviews. We conducted a content analysis of forms and guidelines commonly used by institutional review boards (IRBs) in the USA and research ethics boards (REBs) in Canada. Our intent was to see if the forms used by boards reflected common CBPR experience. We drew our sample from affiliated members of the US-based Association of Schools of Public Health and from Canadian universities that offered graduate public health training. This convenience sample (n = 30) was garnered from programs where application forms were available online for download between July and August, 2004. Results show that ethical review forms and guidelines overwhelmingly operate within a biomedical framework that rarely takes into account common CBPR experience. They are primarily focused on the principle of assessing risk to individuals and not to communities and continue to perpetuate the notion that the domain of "knowledge production" is the sole right of academic researchers. Consequently, IRBs and REBs may be unintentionally placing communities at risk by continuing to use procedures inappropriate or unsuitable for CBPR. IRB/REB procedures require a new framework more suitable for CBPR, and we propose alternative questions and procedures that may be utilized when assessing the ethical appropriateness of CBPR.
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Affiliation(s)
- Sarah Flicker
- Faculty of Environmental Studies, York University, Toronto, Canada.
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