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Meechan E, Geia L, Taylor M, Murray D, Stothers K, Gibson P, Devine S, Barker R. Culturally responsive occupational therapy practice with First Nations Peoples-A scoping review. Aust J Rural Health 2024. [PMID: 38888234 DOI: 10.1111/ajr.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/16/2024] [Accepted: 05/19/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION First Nations Peoples consistently demonstrate strength and resilience in navigating systemic health care inequities. Acknowledging racism as a health determinant underscores the urgent need for a counterforce-cultural safety. Indigenous Allied Health Australia (IAHA) contends that with cultural responsiveness, the health workforce can take action to create a culturally safe environment. OBJECTIVE To explore features of culturally responsive occupational therapy (OT) practice when providing a service with First Nations People and examine alignment of those features with the IAHA Cultural Responsiveness in Action Framework. DESIGN A systematic scoping review was undertaken using CINAHL, Emcare, MEDLINE, PsychInfo and Scopus databases. Examples of culturally responsive OT practice with First Nations Peoples were mapped to the six IAHA Framework capabilities and confirmed by First Nations co-authors. FINDINGS OT practice with First Nations Peoples aligned with the six capabilities to varying degrees. The importance of OTs establishing relationships with First Nations People, applying self-reflection to uncover cultural biases, and addressing limitations of the profession's Western foundations was evident. DISCUSSION Recognising the interrelatedness of the six capabilities, the absence of some may result in a culturally unsafe experience for First Nations People. OTs must acknowledge the leadership of First Nations Peoples by privileging their voices and consider how established practices may reinforce oppressive systems. CONCLUSION To ensure a culturally safe environment for First Nations People, the OT profession must respect the leadership of First Nations Peoples and address the limitations of the profession's Western foundations to uphold the profession's core value of client-centred care.
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Affiliation(s)
| | - Lynore Geia
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Marayah Taylor
- Townsville University Hospital, Douglas, Queensland, Australia
| | - Donna Murray
- Indigenous Allied Health Australia, Deakin, Australian Capital Territory, Australia
| | - Kylie Stothers
- Indigenous Allied Health Australia, Deakin, Australian Capital Territory, Australia
| | - Paul Gibson
- Indigenous Allied Health Australia, Deakin, Australian Capital Territory, Australia
| | - Sue Devine
- James Cook University, Douglas, Queensland, Australia
| | - Ruth Barker
- James Cook University, Smithfield, Queensland, Australia
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Brubacher LJ, Berrang-Ford L, Clark SN, Patterson K, Lwasa S, Namanya D, Twesigomwe S, Harper SL. Place, displacement, and health-seeking behaviour among the Ugandan Batwa: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003321. [PMID: 38865306 PMCID: PMC11168611 DOI: 10.1371/journal.pgph.0003321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
For many Indigenous Peoples, relationships to the land are inherent in identity and culture, and to all facets of health and wellbeing, physically, emotionally, psychologically, and spiritually. The Batwa are Indigenous Peoples of rural, southwest Uganda who have experienced tremendous social and economic upheaval, due to relatively recent forced displacement and land dispossession. This loss of physical connection to their ancestral lands has significantly impacted Batwa health, and also affected available healthcare options for Batwa. This exploratory study (1) identified and characterized factors that influence Batwa health-seeking behaviour, using acute gastrointestinal illness, a critical public health issue, as a focal point for analysis; and (2) explored possible intersections between the Batwa's connection to place-and displacement-and their health-seeking behaviour for acute gastrointestinal illness. Twenty focus group discussions, stratified by gender, were conducted in ten Batwa settlements in Kanungu District, Uganda and eleven semi-structured interviews were conducted with primary healthcare workers, community health coordinators, clinical officers, and development program coordinators. Qualitative data were thematically analyzed using a constant comparative method. Batwa identified several significant motivators to engage with Indigenous and/or biomedical forms of healthcare, including transition to life outside the forest and their reflections on health in the forest; 'intellectual access' to care and generational knowledge-sharing on the use of Indigenous medicines; and Batwa identity and way of life. These nuanced explanations for health-seeking behaviour underscore the significance of place-and displacement-to Batwa health and wellbeing, and its relationship to their health-seeking behaviour for acute gastrointestinal illness. As such, the results of this study can be used to inform healthcare practice and policy and support the development of a culturally- and contextually-appropriate healthcare system, as well as to reduce the burden of acute gastrointestinal illness among Batwa.
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Affiliation(s)
- Laura Jane Brubacher
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Lea Berrang-Ford
- School of Earth and Environment, University of Leeds, Leeds, United Kingdom
| | - Sierra Nicole Clark
- Environmental and Social Epidemiology Section, Population Health Research Institute, St. George’s, University of London, London, United Kingdom
| | - Kaitlin Patterson
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Shuaib Lwasa
- Department of Geography, Makerere University, Kampala, Uganda
| | - Didacus Namanya
- Ugandan Ministry of Health, Kampala, Uganda
- Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | | | | | - Sherilee L. Harper
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Anishinabek sources of strength: Learning from First Nations people who have experienced mental health and substance use challenges. Soc Sci Med 2022; 309:115197. [DOI: 10.1016/j.socscimed.2022.115197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 04/09/2022] [Accepted: 07/03/2022] [Indexed: 11/23/2022]
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Slater M, Bruser G, Sutherland R, Andrew MK, Warry W, Jacklin KM, Walker JD. Wellness in the Face of Frailty Among Older Adults in First Nations Communities. J Aging Health 2022; 34:996-1004. [PMID: 35426332 PMCID: PMC9483700 DOI: 10.1177/08982643221085107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives First Nations people report high levels of wellness despite high rates of chronic illness. Our goal was to understand the factors associated with wellness among First Nations adults in Ontario who were considered frail. Methods Using the First Nations Regional Health Survey, we created a profile of First Nations adults (aged 45+) who were categorized as “frail” (weighted sample size = 8121). We used multivariate logistic regression to determine associations between wellness (as measured by self-reported physical, emotional, mental, and spiritual balance) and determinants of health. Results Rates of reported wellness were high among those who were frail, ranging from 56.7% reporting physical balance to 71.6% reporting mental balance. Three key elements were associated with wellness: the availability of resources, individual lifestyle factors, and cultural connection and identity. Discussion Our findings provide a profile of strength and wellness among older First Nations adults living with frailty.
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Affiliation(s)
- Morgan Slater
- Health Services and Policy Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gabrielle Bruser
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
| | | | - Melissa K. Andrew
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, NS, Canada
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Wayne Warry
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, MN, USA
| | - Kristen M Jacklin
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN, USA
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, MN, USA
| | - Jennifer D. Walker
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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Understanding Social Determinants of First Nations Health Using a Four-Domain Model of Health and Wellness Based on the Medicine Wheel: Findings from a Community Survey in One First Nation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052836. [PMID: 35270529 PMCID: PMC8910369 DOI: 10.3390/ijerph19052836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
We examined the explanatory roles of social determinants of health (SDOH) for First Nations people using a four-domain model of health and wellness based on the Medicine Wheel (i.e., physical, mental, emotional, and spiritual health), including colonial-linked stressors (i.e., historical trauma, childhood adversities, racial discrimination) and cultural resilience factors (i.e., cultural strengths, traditional healing practices, social support). Data were collected in partnership with a First Nation in Ontario, Canada in 2013 through a community survey (n = 194). For each outcome (physical, mental, emotional, and spiritual health), a modified Poisson regression model estimated prevalence ratios for the SDOH, adjusting for age, sex, education, and marital status. Negative associations were found for historical trauma with physical, mental, emotional, and spiritual health; for childhood adversities with mental health; and for racial discrimination with physical, mental, and emotional health. Positive associations were found for cultural strengths with physical, mental, and emotional health and for social support with physical, mental, emotional, and spiritual health. We observed negative associations between use of traditional healing practices and mental and emotional health. Our findings suggest that these SDOH may play important roles in relation to wellness through associations with the domains of health modelled by the Medicine Wheel.
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Antony C, Campbell M, Côté S, Bruno G, Tinglin C, Lai J. Informing care pathways and policies for children and youth with Indigenous perspectives to advance Canada's National Autism Strategy. Front Psychiatry 2022; 13:916256. [PMID: 36186886 PMCID: PMC9520311 DOI: 10.3389/fpsyt.2022.916256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
In Canada, most services for Autistic people are provided by provincial and territorial governments. However, support for Indigenous Peoples (First Nations, Inuit, and Métis) are under federal responsibility and are outlined by a set of treaties and agreements with the Crown and a few regional governments. This patchwork results in barriers in service access and navigation challenges in many under-resourced communities, including under-diagnosis and potentially life-threatening outcomes. Designing equitable policy structures and processes would reduce harms and meaningfully interface with Indigenous and other racialized communities. The objective of this Policy Practice Review is to provide a framework for the discovery of appropriate care strategies addressing the conceptualization of autism in Indigenous Peoples and to understand the interactions between racialized Autistic peoples and the Criminal Justice System. First, we conducted environmental scans of publicly-accessible government services available in Canada pertaining to autism in Indigenous communities and the justice system, and explored the dissonance with beliefs and perceptions of autism in Northern Indigenous communities. Second, we focused on the interactions of Indigenous and other racialized populations, with an emphasis on Autistic children and youth with the justice system, an interaction that is often life-altering, downstream, and detrimental to health and wellbeing. The implications of this work include identifying the need for Indigenous-led knowledge and policy recommendations for Canada's upcoming National Autism Strategy, informing the need for culturally appropriate multidisciplinary care and facilitating the coordination between health and social services for these communities.
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Affiliation(s)
- Celina Antony
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Madison Campbell
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Grant Bruno
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Samson Cree Nation, Maskwacis, AB, Canada
| | - Carolyn Tinglin
- Department of Education, Law, and Society, Simon Fraser University, Burnaby, BC, Canada
| | - Jonathan Lai
- Autism Alliance of Canada, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Kyoon Achan G, Eni R, Kinew KA, Phillips-Beck W, Lavoie JG, Katz A. The Two Great Healing Traditions: Issues, Opportunities, and Recommendations for an Integrated First Nations Healthcare System in Canada. Health Syst Reform 2021; 7:e1943814. [PMID: 34375567 DOI: 10.1080/23288604.2021.1943814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The First Nations in Manitoba, Canada, are calling for active recognition and incorporation of holistic traditional healing and medicine ways and approaches by the mainstream healthcare system that has hitherto tended to ignore all but biomedical approaches. This request for recognition requires elaboration on areas of opportunity for collaboration that could positively influence both Indigenous and allopathic medicine. We discuss pathways to an integrated healthcare system as community-based primary healthcare transformation. A community-based participatory research approach was used to engage eight Manitoba First Nations communities. One hundred and eighty-three (183) in-depth, semi-structured key informant interviews were completed in all communities. Grounded theory guided data analysis using NVivo 10 software. We learned that increased recognition and incorporation of traditional healing and medical methods would enhance a newly envisioned funded health system. Elders and healers will be meaningfully involved in the delivery of community-based primary health care. Funding for traditional healing and medicines are necessary components of primary health care. An overall respect for Indigenous health knowledge would aid transformation in community-based primary health care. Recognition of and respect for traditional healing, healers, medicines, therapies, and approaches is also recommended as part of addressing the legacy and intergenerational impact of assimilative policies including Indian residential schools as the Truth and Reconciliation Commission of Canada has stated in its Calls to Action.
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Affiliation(s)
- Grace Kyoon Achan
- Children's Hospital Research Institute of Manitoba & Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rachel Eni
- Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Snuneymuxw First Nation, Nanaimo, British Columbia, Canada
| | - Kathi Avery Kinew
- First Nation Health and Social Secretariat Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- First Nation Health and Social Secretariat Manitoba, Winnipeg, Manitoba, Canada
| | - Josée G Lavoie
- Ongomiizwin- Indigenous Institute of Health and Healing, Department of Community Health Sciences, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- Manitoba Centre for Health Policy/Max Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
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Traditional Indigenous medicine in North America: A scoping review. PLoS One 2020; 15:e0237531. [PMID: 32790714 PMCID: PMC7425891 DOI: 10.1371/journal.pone.0237531] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background Despite the documented continued use of traditional healing methods, modalities and its associated practitioners by Indigenous groups across North America, it is presumed that widespread knowledge is elusive amongst most Western trained health professionals and systems. This despite that the approximately 7.5 million Indigenous peoples who currently reside in Canada and the United States (US) are most often served by Western systems of medicine. A state of the literature is currently needed in this area to provide an accessible resource tool for medical practitioners, scholars, and communities to better understand Indigenous traditional medicine in the context of current clinical care delivery and future policy making. Methods A systematic search of multiple databases was performed utilizing an established scoping review framework. A consequent title and abstract review of articles published on traditional Indigenous medicine in the North American context was completed. Findings Of the 4,277 published studies identified, 249 met the inclusion criteria divided into the following five categorical themes: General traditional medicine, integration of traditional and Western medicine systems, ceremonial practice for healing, usage of traditional medicine, and traditional healer perspectives. Conclusions This scoping review was an attempt to catalogue the wide array of published research in the peer-reviewed and online grey literature on traditional Indigenous medicine in North America in order to provide an accessible database for medical practitioners, scholars, and communities to better inform practice, policymaking, and research in Indigenous communities.
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Morton Ninomiya M, George N(P, George J, Linklater R, Bull J, Plain S, Graham K, Bernards S, Peach L, Stergiopoulos V, Kurdyak P, McKinley G, Donnelly P, Wells S. A community-driven and evidence-based approach to developing mental wellness strategies in First Nations: a program protocol. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:5. [PMID: 32082614 PMCID: PMC7017570 DOI: 10.1186/s40900-020-0176-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 01/03/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Mental health, substance use/addiction and violence (MSV) are important issues affecting the well-being of Indigenous People in Canada. This paper outlines the protocol for a research-to-action program called the Mental Wellness Program (MWP). The MWP aims to increase community capacity, promote relationship-building among communities, and close gaps in services through processes that place value on and supports Indigenous communities' rights to self-determination and control. The MWP involves collecting and using local data to develop and implement community-specific mental wellness strategies in five First Nations in Ontario. METHODS The MWP has four key phases. Phase 1 (data collection) includes a community-wide survey to understand MSV issues, service needs and community strengths; in-depth interviews with individuals with lived experiences with MSV issues to understand, health system strengths, service gaps and challenges, as well as individual and community resilience factors; and focus groups with service providers to improve understanding of system weaknesses and strengths in addressing MSV. Phase 2 (review and synthesis) involves analysis of results from these local data sources and knowledge-sharing events to identify a priority area for strategic development based on local strengths and need. Phase 3 (participatory action research approach) involves community members, including persons with lived experience, working with the community and local service providers to develop, implement, and evaluate the MWP to address the selected priority area. Phase 4 (share) is focused on developing and implementing effective knowledge-sharing initiatives. Guidelines and models for building the MWP are shared regionally and provincially through forums, webinars, and social media, as well as cross-community mentoring. DISCUSSION MWP uses local community data to address MSV challenges by building on community supports and resilience factors. Drawing on local data and each community's system of formal and informal supports, the program includes sharing exemplary knowledge-to-action models and wellness strategies developed by and for First Nations people that can be used by other First Nations to identify shared wellness priorities in each community, and determine and execute next steps in addressing areas of main concern.
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Affiliation(s)
- Melody Morton Ninomiya
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
- Health Sciences, Wilfrid Laurier University, Waterloo, Ontario Canada
| | | | - Julie George
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
- Kettle & Stony Point Health Centre, Kettle & Stony Point First Nation, Toronto, Ontario Canada
| | - Renee Linklater
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
| | - Julie Bull
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
| | - Sara Plain
- E’Mino Bmaad-Zijig Gamig, Aamjiwnaang First Nation Health Centre, Aamjiwnaang First Nation, Toronto, Ontario Canada
| | - Kathryn Graham
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria Australia
- National Drug Research Institute, Curtin University, Perth, Western Australia Australia
| | - Sharon Bernards
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
| | - Laura Peach
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario Canada
- Institute for Clinical Evaluative Science, Toronto, Ontario Canada
| | | | - Peter Donnelly
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Samantha Wells
- Centre for Addiction and Mental Health, Toronto and London, Ontario Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
- School of Psychology, Faculty of Health, Deakin University, Melbourne, Victoria Australia
- University of Western Ontario, London, Ontario Canada
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