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Sehgal A, Henderson R, Murry A, Crowshoe LL, Barnabe C. Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework. BMC PRIMARY CARE 2024; 25:144. [PMID: 38684966 PMCID: PMC11057171 DOI: 10.1186/s12875-024-02362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. METHODS A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. RESULTS A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. CONCLUSIONS The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.
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Affiliation(s)
- Anika Sehgal
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Rita Henderson
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Adam Murry
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Lynden Lindsay Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Chase-Begay DM, Peterson JC, Liddell J, Belcourt A. Traditional Ceremonial Practices as a Strategy to Reduce Problem Substance Use in American Indian Communities: A Systematic Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2023; 29:408-419. [PMID: 37229620 PMCID: PMC10280199 DOI: 10.1089/jicm.2022.0655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Objective: This systematic review assessed the feasibility of American Indian traditional ceremonial practices (TCPs) to address problem substance use in both reservation and urban settings. Methods: Between September 24, 2021, and January 14, 2022, culturally specific review protocols were applied to articles retrieved from over 160 electronic databases-including PubMed, Global Health, Global Health Archive, CINAHL Complete, PsychInfo, Web of Science, Health and Wellness (Gale), Sage Online Journals, and ScienceDirect. Results: A total of 10 studies met the criteria for inclusion in the review. Studies were conducted with both urban (n = 7) and reservation (n = 3) American Indian and Alaska Native (AIAN) populations. The most common TCP activities reported were drumming (n = 9), sweat lodge (n = 7), and talking circles (n = 6). All 10 studies reported some type of quantitative data showing a reduction of substance use associated with TCP interventions or activities. Conclusions: The current status of the literature is emerging and does not allow for meta-analysis of existing studies. However, the existing literature does indicate promise for the use of TCPs to address problem substance use in AIAN communities in a way that is effective and also culturally congruent.
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Affiliation(s)
- Damian M. Chase-Begay
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
| | | | - Jessica Liddell
- School of Social Work, University of Montana, Missoula, MT, USA
| | - Annie Belcourt
- School of Public and Community Health Sciences, University of Montana, Missoula, MT, USA
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3
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Passos-Castilho AM, Udhesister STP, Fontaine G, Jeong D, Dickie M, Lund C, Russell R, Kronfli N. The 11th Canadian Symposium on Hepatitis C Virus: 'Getting back on track towards hepatitis C elimination'. CANADIAN LIVER JOURNAL 2023; 6:56-69. [PMID: 36908576 PMCID: PMC9997521 DOI: 10.3138/canlivj-2022-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/20/2022] [Indexed: 11/05/2022]
Abstract
Hepatitis C virus (HCV) affects approximately 204,000 Canadians. Safe and effective direct-acting antiviral therapies have contributed to decreased rates of chronic HCV infection and increased treatment uptake in Canada, but major challenges for HCV elimination remain. The 11th Canadian Symposium on Hepatitis C Virus took place in Ottawa, Ontario on May 13, 2022 as a hybrid conference themed 'Getting back on track towards hepatitis C elimination.' It brought together research scientists, clinicians, community health workers, patient advocates, community members, and public health officials to discuss priorities for HCV elimination in the wake of the COVID-19 pandemic, which had devastating effects on HCV care in Canada, particularly on priority populations. Plenary sessions showcased topical research from prominent international and national researchers, complemented by select abstract presentations. This event was hosted by the Canadian Network on Hepatitis C (CanHepC), with support from the Public Health Agency of Canada and the Canadian Institutes of Health Research and in partnership with the Canadian Liver Meeting. CanHepC has an established record in HCV research and in advocacy activities to address improved diagnosis and treatment, and immediate and long-term needs of those affected by HCV infection. The Symposium addressed the remaining challenges and barriers to HCV elimination in priority populations and principles for meaningful engagement of Indigenous communities and individuals with living and lived experience in HCV research. It emphasized the need for disaggregated data and simplified pathways for creating and monitoring interventions for equitably achieving elimination targets.
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Affiliation(s)
- Ana Maria Passos-Castilho
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sasha Tejna Persaud Udhesister
- Faculté de Médecine, Université de Montréal, Centre de Recherche du Centre hospitalier de l'Université de Montré (CRCHUM), Montréal, Québec, Canada
| | - Guillaume Fontaine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dahn Jeong
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melisa Dickie
- Community Health Programming, CATIE, Toronto, Ontario, Canada
| | | | - Rodney Russell
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Nadine Kronfli
- Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University Health Centre, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Vigouroux M, Amja K, Bertolizio G, Ingelmo P, Hovey R. Reflecting back to move forward: Lessons learned about COVID-19 safety protocols from pediatric anesthesiologists. Paediatr Anaesth 2022; 32:1138-1143. [PMID: 35852924 PMCID: PMC9349821 DOI: 10.1111/pan.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/17/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic brought about the immediate need for enhanced safety protocols in health care centers. These protocols had to evolve as knowledge and understanding of the disease quickly broadened. AIMS Through this study, the researchers aimed to understand the experiences of pediatric anesthesiologists at the Montreal Children's Hospital and the Shriners' Hospital Canada as they navigated the first wave of COVID-19 at their institutions. METHODS Nine participants from the Montreal Children's Hospital and the Shriners' Hospital were interviewed. Interviews were recorded, transcribed verbatim, and then analyzed using an applied philosophical hermeneutics approach. FINDINGS Participants expressed their wish for simple and easy-to-apply protocols while recognizing the challenge of keeping up with evolving knowledge on the disease and its transmission. They pointed to some limitations and unintended consequences of the safety protocols and the system-wide flaws that the COVID-19 pandemic helped bring to light. They described their frustrations with some aspects of the safety protocols, which they at times felt could be more efficient or better suited for their daily practice. CONCLUSIONS The findings of this study highlighted the importance of listening to and empowering anesthesiology staff working in the field during crises, the implications of shifting from patient-centered care to community-centered care, and the fine line between sharing as much emerging information as possible and overwhelming staff with information.
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Affiliation(s)
- Marie Vigouroux
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada,Edwards Family Interdisciplinary Centre for Complex PainMontreal Children's HospitalMontrealQuebecCanada
| | - Kristina Amja
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Gianluca Bertolizio
- Department of AnesthesiaMontreal Children's HospitalMontrealQuebecCanada,Department of Anesthesia, Faculty of Medicine and Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Centre for Complex PainMontreal Children's HospitalMontrealQuebecCanada,Department of Anesthesia, Faculty of Medicine and Health SciencesMcGill UniversityMontrealQuebecCanada
| | - Richard Hovey
- Faculty of Dental Medicine and Oral Health SciencesMcGill UniversityMontrealQuebecCanada
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Santella C, Tratt E, Nyamiaka J, Whiteley Tukkiapik L, Styffe C, Gamelin R, Macdonald ME, Brassard P. Perceptions of Inuit Women and Non-Inuit Healthcare Providers on the Implementation of Human Papillomavirus Self-Sampling as an Alternative Cervical Cancer Screening Method in Nunavik, Northern Quebec. QUALITATIVE HEALTH RESEARCH 2022; 32:1259-1272. [PMID: 35621363 DOI: 10.1177/10497323221090805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities.
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Affiliation(s)
- Christina Santella
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Elyse Tratt
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Joy Nyamiaka
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | | | - Claire Styffe
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Rachel Gamelin
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
| | - Mary Ellen Macdonald
- Oral Health and Society Research Unit, Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Paul Brassard
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
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6
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Dunn KPR, Williams KP, Egan CE, Potestio ML, Lee SS. ECHO+: Improving access to hepatitis C care within Indigenous communities in Alberta, Canada. CANADIAN LIVER JOURNAL 2022; 5:113-123. [PMID: 35991479 PMCID: PMC9236587 DOI: 10.3138/canlivj-2021-0027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 07/29/2023]
Abstract
BACKGROUND Indigenous populations experience higher rates of hepatitis C virus (HCV) infections in Canada. The Extension for Community Health Outcomes+ (ECHO+) telehealth model was implemented in Alberta to support HCV screening and treatment, using Zoom technology to support Indigenous patient access to specialist care closer to home. Our goal was to expand this program to more Indigenous communities in Alberta, using various Indigenous-led or co-designed methods. METHODS The ECHO+ team implemented a Two-Eyed Seeing framework, incorporating Indigenous wholistic approaches alongside Western treatment. This approach works with principles of respect, reciprocity, and relationality. The ECHO+ team identified Indigenous-specific challenges, including access to liver specialist care, HCV awareness, stigma, barriers to screening and lack of culturally relevant approaches. RESULTS Access to HCV care via this program significantly increased HCV antiviral use in the past 5 years. Key lessons learned include Indigenous-led relationship building and development of project outputs in response to community needs influences impact and increases relevant changes increasing access to HCV care. Implementation of ECHO+ was carried out through biweekly telehealth sessions, problem solving in partnership with Indigenous communities, increased HCV awareness, and flexibility resulting from the impacts of COVID-19. CONCLUSION Improving Indigenous patient lives and reducing inequity requires supporting local primary health care providers to create and sustain integrated HCV prevention, diagnosis, treatment, and support services within a culturally safe and reciprocal model. ECHO+ uses telehealth and culturally appropriate methodology and interventions alongside multiple stakeholder collaborations to improve health outcomes for HCV.
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Affiliation(s)
- Kate PR Dunn
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- These authors contributed equally and are co-first authors
| | - Kienan P Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- These authors contributed equally and are co-first authors
| | - Cari E Egan
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Melissa L Potestio
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Co-senior authors
| | - Samuel S Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Co-senior authors
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Abstract
Although many medical and dental journals publish qualitative research this does not mean
they are being read by those who could directly benefit from their scholarly
contributions. From clinician to the patient. This perspective on qualitative research for
medical and dental education was written with the intention of introducing qualitative
research to those who may be unaware of its possibilities and utility for clinical
education. Its task is to inform others about life conditions they may not have
experienced themselves other than in a biomedical context. As researchers, clinicians, and
especially for students who read academic, medical, and clinical research papers which are
appropriately discipline-and methodology-specific. We may find ourselves encultured to
privileging one type of research methodology over others. For example, exclusively
considering quantitative research methodologies as being more rigorous and trustworthy.
This brief commentary may offer the opportunity for interested healthcare providers and
researchers to expand their understanding of the purpose of qualitative research, its role
and application in enhancing patient engagement, clinical practices, and person-centered
research.
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Affiliation(s)
- Richard B Hovey
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
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Redvers N, Wilkinson M, Fischer C. Colorectal cancer community engagement: a qualitative exploration of American Indian voices from North Dakota. BMC Cancer 2022; 22:158. [PMID: 35139807 PMCID: PMC8827199 DOI: 10.1186/s12885-021-09119-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 11/24/2022] Open
Abstract
Background American Indians (AI) in North Dakota present with higher rates of advanced-stage disease for screening detectable colorectal cancers and have lower overall baseline colorectal cancer screening rates than non-AIs. We sought to identify the perceived barriers and facilitators for the engagement with colorectal cancer prevention within North Dakota tribal communities. Methods Twelve semi-structured interviews were carried out across four tribal reservation communities in the state of North Dakota with American Indian adults between the ages of 30 and 75 years. We utilized purposive sampling to ensure maximum variation in age, sex, and tribal community until data saturation was achieved. The interviews were transcribed, and thematic analysis was carried out to identify consistent themes rooted within the data. Ethical approval was gained for this project from all relevant institutional review boards. Results Four main themes were identified as barriers for the engagement with colorectal cancer prevention, including: colorectal cancer screening barriers, focused on other health problems, lack of colorectal cancer tailored health promotion, and socio-cultural factors affecting colorectal cancer prevention. Three main themes were identified as facilitators for the engagement with colorectal cancer prevention, including: reasons for getting colorectal cancer screening, role of culture, and getting out into the community. Conclusion There is need for more community-rooted, strengths-based approaches to colorectal cancer prevention activities in AI communities in North Dakota. Socio-cultural factors, such as the use of storytelling, and the use of traditional knowledge have been demonstrated to be an important element of consideration for colorectal cancer tribal community engagement and prevention planning in the state. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09119-2.
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Affiliation(s)
- Nicole Redvers
- Department of Family & Community Medicine, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA. .,Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA.
| | - Mia Wilkinson
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
| | - Courtney Fischer
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, ND, Grand Forks, USA
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Sylliboy JR. Coming Out is Part of the Life Cycle: A Qualitative Study using Two-Eyed Seeing to Understand A Two-Spirits Coming Out Process. Glob Public Health 2021; 17:2428-2446. [PMID: 34710346 DOI: 10.1080/17441692.2021.1993953] [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: 10/20/2022]
Abstract
In two co-related studies about Two-spirit people in Atlantic Canada, the coming out stories share critical cultural perspectives about gender identity and sexuality from a L'nuwey (Mi'kmaw) perspective. This qualitative research implemented Etuaptmumk or Two-Eyed Seeing, a co-learning methodology using Indigenous and western perspectives for data collection and analysis. The findings surface stories about resiliency among Two-spirit people who face distress and anxiety, with supports mainly coming from family and community. According to their narratives, coming out is part of their cultural awakening process. The paper shares that Two-spirited people come out in intervals or phases, especially trans people. Sexuality and gender identity development are in flux until they reach a balanced and spiritual state. The Two-spirit identity process is non-linear that may evolve in a life cycle. The study captures the ongoing resurgence of regional Indigenous perspectives of gender identity and sexuality. The narratives share the physical, emotional, mental, and spiritual states of Two-spirit people during their coming out process. The stories are a source of hope and empowerment for the Two-spirit community relating to gender and sexuality. This study is the only current community-based evidence about coming out experiences of Two-spirit people in Atlantic Canada.
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Affiliation(s)
- John R Sylliboy
- Department of Integrated Studies in Education, McGill University, Montreal, Canada
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10
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Amja K, Vigouroux M, Pagé MG, Hovey RB. The Experiences of People Living With Chronic Pain During a Pandemic: "Crumbling Dreams With Uncertain Futures". QUALITATIVE HEALTH RESEARCH 2021; 31:2019-2028. [PMID: 34137325 PMCID: PMC8552407 DOI: 10.1177/10497323211014858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
People living with chronic pain experience multiple challenges in their daily activities. Chronic pain is complex and often provokes life circumstances that create increased social isolation. Living with chronic pain during the pandemic may add additional layers of complexity to their daily lives. The researchers endeavored to explore the experiences of people living with chronic pain during the COVID-19 pandemic. Researchers conducted semi-structured, open-ended interviews about how the pandemic influenced participants' lives. The interviews were recorded and analyzed using an applied philosophical hermeneutics approach. The findings were feeling socially isolated, losing their sense of livinghood, and experiencing augmented stress levels which, in most cases, aggravated their chronic pain. In addition to gaining an in-depth understanding of the needs of people living with chronic pain, these findings may guide policy decisions with the intention of improving health care access and the overall experiences of people living with chronic conditions during a pandemic.
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Affiliation(s)
| | - Marie Vigouroux
- McGill University, Montreal, Quebec, Canada
- Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - M. Gabrielle Pagé
- Centre de Recherche du CHUM, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
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11
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Roher SIG, Yu Z, Martin DH, Benoit AC. How is Etuaptmumk/Two-Eyed Seeing characterized in Indigenous health research? A scoping review. PLoS One 2021; 16:e0254612. [PMID: 34283831 PMCID: PMC8291645 DOI: 10.1371/journal.pone.0254612] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Our scoping review sought to consider how Etuaptmumk or Two-Eyed Seeing is described in Indigenous health research and to compare descriptions of Two-Eyed Seeing between original authors (Elders Albert and Murdena Marshall, and Dr. Cheryl Bartlett) and new authors. Using the JBI scoping review methodology and qualitative thematic coding, we identified seven categories describing the meaning of Two-Eyed Seeing from 80 articles: guide for life, responsibility for the greater good and future generations, co-learning journey, multiple or diverse perspectives, spirit, decolonization and self-determination, and humans being part of ecosystems. We discuss inconsistencies between the original and new authors, important observations across the thematic categories, and our reflections from the review process. We intend to contribute to a wider dialogue about how Two-Eyed Seeing is understood in Indigenous health research and to encourage thoughtful and rich descriptions of the guiding principle.
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Affiliation(s)
- Sophie I. G. Roher
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Circumpolar Health Research, Yellowknife, Northwest Territories, Canada
| | - Ziwa Yu
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Debbie H. Martin
- Health Promotion Division, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anita C. Benoit
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute-Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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12
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Sylliboy JR, Latimer M, Marshall EA, MacLeod E. Communities take the lead: exploring Indigenous health research practices through Two-Eyed Seeing & kinship. Int J Circumpolar Health 2021; 80:1929755. [PMID: 34061729 PMCID: PMC8172214 DOI: 10.1080/22423982.2021.1929755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Etuaptmumk or Two-Eyed Seeing (E/TES) is foundational in ensuring that Indigenous ways of knowing are respected, honoured, and acknowledged in health research practices with Indigenous Peoples of Canada. This paper will outline new knowledge gleaned from the Canadian Institute of Health Research and Chronic Pain Network funded Aboriginal Children’s Hurt & Healing (ACHH) Initiative that embraces E/TES for respectful research. We share the ACHH exemplar to show how Indigenous community partners take the lead to address their health priorities by integrating cultural values of kinship and interconnectedness as essential components to enhance the process of community-led research. E/TES is conceptualised into eight essential considerations to know in conducting Indigenous health research shared from a L’nuwey (Mi’kmaw) perspective. L’nu knowledge underscores the importance of working from an Indigenous perspective or specifically from a L’nuwey perspective. L’nuwey perspectives are a strength of E/TES. The ACHH Initiative grew from one community and evolved into collective community knowledge about pain perspectives and the process of understanding community-led practices, health perspectives, and research protocols that can only be understood through the Two-Eyed Seeing approach.
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Affiliation(s)
- John R Sylliboy
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Margot Latimer
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada.,Dalhousie University, Faculty of Health, Halifax, Nova Scotia, Canada
| | | | - Emily MacLeod
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
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Lewis D, Francis S, Francis-Strickland K, Castleden H, Apostle R. If only they had accessed the data: Governmental failure to monitor pulp mill impacts on human health in Pictou Landing First Nation. Soc Sci Med 2020; 288:113184. [PMID: 33218887 DOI: 10.1016/j.socscimed.2020.113184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/09/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022]
Abstract
For over fifty years, Pictou Landing First Nation (PLFN), a small Mi'kmaw community on the northern shore of mainland Nova Scotia, Canada, has been told by a Joint Environmental Health Monitoring Committee (JEHMC) mandated to oversee the health of the community that their health has not been impacted by exposure to 85 million litres of pulp mill effluent dumped every day into what was once a culturally significant body of water bordering their community. Yet, based on lived experience, the community knows otherwise, and despite countless dollars spent on government and industry-sponsored research, their concerns have not gone away. Using biopolitical theory, we explore why JEHMC never fully implemented its mandate. We will use a Mi'kmaw environmental 'theoretical' framework to demonstrate that indicators of a relational epistemology and ontology that have been consistently and persistently overlooked in Indigenous environmental health research demands that Indigenous connections to the air, land and water must be taken into consideration to get a full understanding of environmental health impacts. Guided by the principle of Etuaptmumk (Two-Eyed Seeing), which brings together the strengths of both western and Indigenous knowledge, and employing a community-based participatory research approach, we use data that could have been accessed by the JEHMC that might have signaled that human health studies were warranted. Further, we developed an environmental health survey that more appropriately assesses the impacts on the community. Finally, we will discuss how an Indigenous-developed framework can adequately assess the impacts of land displacement and environmental dispossession on the health of Indigenous communities and illustrate how our framework can serve as a guide to others when exploring Indigenous environmental health more broadly.
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Affiliation(s)
- Diana Lewis
- Western University, 1151 Richmond Street, Room 3213, Social Science Centre, London, ON, N6A 5C2, Canada.
| | - Sheila Francis
- Pictou Landing Native Women's Group, Pictou Landing First Nation, 6533 Pictou Landing Rd #6, Trenton, NS B0K 1X0, Canada.
| | - Kim Francis-Strickland
- Pictou Landing Native Women's Group, Pictou Landing First Nation, 6533 Pictou Landing Rd #6, Trenton, NS B0K 1X0, Canada.
| | - Heather Castleden
- Canada Research Chair in Reconciling Relations for Health, Environments, and Communities, Queen's University, Mackintosh-Corry Hall, Room E330, Kingston, ON K7L 3N6, Canada.
| | - Richard Apostle
- Department of Sociology and Social Anthropology, Room 1128, Marion McCain Arts and Social Sciences Building, Halifax, Nova Scotia B3H 4R2, Canada.
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Sylliboy JR, Hovey RB. Humanizing Indigenous Peoples' engagement in health care. CMAJ 2020; 192:E70-E72. [PMID: 31959659 DOI: 10.1503/cmaj.190754] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- John R Sylliboy
- Aboriginal Children's Hurt and Healing Initiative, Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | - Richard B Hovey
- Faculty of Dentistry, Division of Oral Health & Society, McGill University, Montréal, Que
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15
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Tratt E, Sarmiento I, Gamelin R, Nayoumealuk J, Andersson N, Brassard P. Fuzzy cognitive mapping with Inuit women: what needs to change to improve cervical cancer screening in Nunavik, northern Quebec? BMC Health Serv Res 2020; 20:529. [PMID: 32527254 PMCID: PMC7291667 DOI: 10.1186/s12913-020-05399-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/03/2020] [Indexed: 11/29/2022] Open
Abstract
Background Among Canadian Inuit, cervical cancer incidence and mortality rates are up to three times higher than the Canadian average. Cervical cancer is preventable through regular screening which, in Quebec, is opportunistic and requires physical examination and Papanicolaou (“Pap”) smears. Since Human Papillomavirus (HPV) is the necessary cause of cervical cancer, HPV testing is a plausible screening alternative. HPV testing by self-sampling also addresses several barriers associated with physical examination and access to healthcare. In a participatory research paradigm, we worked with two communities of Nunavik to explore the possible implementation of HPV self-sampling. Method Key community stakeholders formed an Advisory Committee to guide direct discussions with Inuit women. We presented available facts around cervical cancer, HPV and the female anatomy, and used Fuzzy Cognitive Mapping to collate women’s views. A thematic analysis summarized data, adding links and weights to represent the relationship of each factor on the outcome: screening for cervical cancer. Results According to the 27 Inuit women who participated, the most influential factor in using health services was the cultural awareness of the healthcare provider. A significant barrier to screening was patient lack of information. The principal vector of change – the factor most likely to influence other factors – was the means of communication between the healthcare provider and the patient: visual communication was told to be the most effective. Conclusion Fuzzy Cognitive Mapping is a practical tool for discussing possible health actions with stakeholders and to inform future research. The tool offers a visual aid for discussion across cultural and educational differences. It can help to build the partnerships that incorporate community voices into co-design of interventions that are relevant to and aligned with the needs of those who use them.
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Affiliation(s)
- Elyse Tratt
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ivan Sarmiento
- Department of Family Medicine, CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rachel Gamelin
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada
| | | | - Neil Andersson
- Department of Family Medicine, CIET-Participatory Research at McGill, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Paul Brassard
- Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada. .,Department of Medicine, McGill University, Montreal, Quebec, Canada.
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16
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Fuzzy cognitive mapping and soft models of indigenous knowledge on maternal health in Guerrero, Mexico. BMC Med Res Methodol 2020; 20:125. [PMID: 32429974 PMCID: PMC7238543 DOI: 10.1186/s12874-020-00998-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/28/2020] [Indexed: 12/19/2022] Open
Abstract
Background Effective health care requires services that are responsive to local needs and contexts. Achieving this in indigenous settings implies communication between traditional and conventional medicine perspectives. Adequate interaction is especially relevant for maternal health because cultural practices have a notable role during pregnancy, childbirth and the postpartum period. Our work with indigenous communities in the Mexican state of Guerrero used fuzzy cognitive mapping to identify actionable factors for maternal health from the perspective of traditional midwives. Methods We worked with twenty-nine indigenous women and men whose communities recognized them as traditional midwives. A group session for each ethnicity explored risks and protective factors for maternal health among the Me’phaa and Nancue ñomndaa midwives. Participants mapped factors associated with maternal health and weighted the influence of each factor on others. Transitive closure summarized the overall influence of each node with all other factors in the map. Using categories set in discussions with the midwives, the authors condensed the relationships with thematic analysis. The composite map combined categories in the Me’phaa and the Nancue ñomndaa maps. Results Traditional midwives in this setting attend to pregnant women’s physical, mental, and spiritual conditions and the corresponding conditions of their offspring and family. The maps described a complex web of cultural interpretations of disease – “frío” (cold or coldness of the womb), “espanto” (fright), and “coraje” (anger) – abandonment of traditional practices of self-care, women’s mental health, and gender violence as influential risk factors. Protective factors included increased male involvement in maternal health (having a caring, working, and loving husband), receiving support from traditional healers, following protective rituals, and better nutrition. Conclusions The maps offer a visual language to present and to discuss indigenous knowledge and to incorporate participant voices into research and decision making. Factors with higher perceived influence in the eyes of the indigenous groups could be a starting point for additional research. Contrasting these maps with other stakeholder views can inform theories of change and support co-design of culturally appropriate interventions.
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Delormier T, Horn-Miller K, McComber AM, Marquis K. Reclaiming food security in the Mohawk community of Kahnawà:ke through Haudenosaunee responsibilities. MATERNAL AND CHILD NUTRITION 2019; 13 Suppl 3. [PMID: 29359439 DOI: 10.1111/mcn.12556] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/22/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022]
Abstract
Indigenous Peoples are reclaiming their food security, nutrition, and well-being by revitalizing food systems, livelihoods, knowledge-systems, and governance. Our food security research is guided by sustainable self-determination that focuses on restoring Indigenous cultural responsibilities and relationships to land, each other, and the natural world (Corntassel, 2008). Our Kanien'kehá:ka (Mohawk) research team from Kahnawà:ke, in Quebec, Canada, examines food insecurity experiences in our community to explore ways of upholding our Haudenosaunee responsibilities and enhancing local food security. We collaboratively designed the study and interviewed Kahnawakehró:non (people from the Kahnawake community) with traditional knowledge, extensive community experience, and interests in food and culture. Interviews were audio-recorded, transcribed, and analysed by the team. Analysis characterized food insecurity experiences and conditions that challenge and enable food security with attention to traditional food systems, relationships to land, and gender-related responsibilities. Findings show that communal responsibilities generate resilient strategies that provide for all in times of crisis, and long-term food insecurity is managed through social programs, organized charities, and family support. Enhancing food security involves healing and protecting a limited land-base for food production, integrating food production with community priorities for education, training, health, economic development, and scientific innovation. Nurturing spiritual connections with tionhnhéhkwen (life sustaining foods), the natural world, and each other calls for accelerated teaching and practicing our original instructions. Challenges in developing food security leadership, balancing capitalism and subsistence economies, and strengthening social relationships are rooted in the historical colonial and current settler-colonial context that disrupts all aspects of Kanien'kehá:ka society.
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Affiliation(s)
- Treena Delormier
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA
| | - Kahente Horn-Miller
- School of Indigenous and Canadian Studies, Carleton University, Ottawa, ON, Canada
| | - Alex M McComber
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada
| | - Kaylia Marquis
- Kahnawake Schools Diabetes Prevention Project, Kahnawake, QC, Canada
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18
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Howard HA. Settler Colonial Biogovernance and the Logic of a Surgical Cure for Diabetes. AMERICAN ANTHROPOLOGIST 2018. [DOI: 10.1111/aman.13140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Arkles R, Jankelson C, Radford K, Jackson Pulver L. Family caregiving for older Aboriginal people in urban Australia: Disclosing worlds of meaning in the dementia experience. DEMENTIA 2018; 19:397-415. [PMID: 29877735 DOI: 10.1177/1471301218776761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia in Australia’s Aboriginal and Torres Strait Islander population is an area of significant health and community concern. In this article, we use a hermeneutic mode of interpretation to deepen understanding of experience and meaning in dementia for family carers of older Aboriginal people in urban Australia. Specifically, we draw from the hermeneutic concept of “world disclosure” to illuminate the dementia experience in three ways: through an artwork of the brain and dementia; through concrete description of the lived relation of caregiving; and through an epochal perspective on the significance of contemporary caregiving in dementia. Using narrative and visual knowledge, this three-fold approach brings to the forefront the importance of ontological and existential meanings which resonate for Aboriginal families in the dementia caregiving experience.
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Affiliation(s)
- Rachelle Arkles
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Claire Jankelson
- Macquarie Graduate School of Management, Macquarie University, Sydney, NSW, Australia
| | - Kylie Radford
- Neuroscience Research Australia, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Jackson Pulver
- Public Health Epidemiologist, School of Medicine, Western Sydney University, Sydney, NSW, Australia
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Wallace HJ, McDonald S, Belton S, Miranda AI, da Costa E, da Conceicao Matos L, Henderson H, Taft A. Body Mapping to Explore Reproductive Ethno-Physiological Beliefs and Knowledge of Contraception in Timor-Leste. QUALITATIVE HEALTH RESEARCH 2018; 28:1171-1184. [PMID: 29290149 DOI: 10.1177/1049732317750382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Maternal mortality remains a significant public health challenge for Timor-Leste. Although access to quality family planning measures may greatly reduce such deaths, consideration of indigenous perceptions, and how they influence reproductive health decision-making and behavior, is crucial if health services are to provide initiatives that are accepted and helpful in improving reproductive health outcomes. We aimed to demonstrate that body mapping is an effective method to traverse language and culture to gain emic insights and indigenous worldviews. The authors' two qualitative research projects (2013 and 2015) used a decolonizing methodology in four districts of Timor-Leste, body mapping with 67 men and 40 women to illuminate ethno-physiology and indigenous beliefs about conception, reproduction, and contraception. Body mapping provided a beneficial conduit for identifying established indigenous reproductive perceptions, understandings, and vocabulary, plus fears surrounding contraception. This may inform health service provision and engagement, ultimately improving the reproductive health of community members.
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Affiliation(s)
| | | | - Suzanne Belton
- 2 Charles Darwin University, Darwin, The Northern Territory, Australia
| | | | | | | | | | - Angela Taft
- 1 La Trobe University, Melbourne, Victoria, Australia
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21
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Kyoon-Achan G, Lavoie J, Avery Kinew K, Phillips-Beck W, Ibrahim N, Sinclair S, Katz A. Innovating for Transformation in First Nations Health Using Community-Based Participatory Research. QUALITATIVE HEALTH RESEARCH 2018; 28:1036-1049. [PMID: 29484964 DOI: 10.1177/1049732318756056] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Community-based participatory research (CBPR) provides the opportunity to engage communities for sustainable change. We share a journey to transformation in our work with eight Manitoba First Nations seeking to improve the health of their communities and discuss lessons learned. The study used community-based participatory research approach for the conceptualization of the study, data collection, analysis, and knowledge translation. It was accomplished through a variety of methods, including qualitative interviews, administrative health data analyses, surveys, and case studies. Research relationships built on strong ethics and protocols to enhance mutual commitment to support community-driven transformation. Collaborative and respectful relationships are platforms for defining and strengthening community health care priorities. We further discuss how partnerships were forged to own and sustain innovations. This article contributes a blueprint for respectful CBPR. The outcome is a community-owned, widely recognized process that is sustainable while fulfilling researcher and funding obligations.
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Affiliation(s)
- Grace Kyoon-Achan
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Josée Lavoie
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathi Avery Kinew
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Wanda Phillips-Beck
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Naser Ibrahim
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Sinclair
- 2 Nanaandawewiwgamig-First Nations Health and Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Alan Katz
- 1 University of Manitoba, Winnipeg, Manitoba, Canada
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Chambers LA, Jackson R, Worthington C, Wilson CL, Tharao W, Greenspan NR, Masching R, Pierre-Pierre V, Mbulaheni T, Amirault M, Brownlee P. Decolonizing Scoping Review Methodologies for Literature With, for, and by Indigenous Peoples and the African Diaspora: Dialoguing With the Tensions. QUALITATIVE HEALTH RESEARCH 2018; 28:175-188. [PMID: 29182046 DOI: 10.1177/1049732317743237] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This article summarizes our deepened understanding of decolonizing research with, for, and by Indigenous peoples and peoples of African descent that emerged from conducting a scoping review of the methodological literature and reflecting on our review process. Although our review identified decolonizing methodologies as a promising approach, we questioned if our scoping review process engaged in decolonizing knowing. To unpack the epistemological tensions between decolonizing knowing and Western ways of doing scoping reviews, we engaged in individual and collective reflective processes- dialoguing with the tensions-moving from individual immersion in the literature to transformative dialogues among the team. In reflecting upon our tensions with the scoping review process, themes that emerged included (a) ontological/epistemological disjunctures, (b) tensions with concepts and language, and (c) relationships with the literature and beyond. This reflexive process provides valuable insight into ways in which review methods might be made a decolonizing research experience.
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Affiliation(s)
| | | | | | | | - Wangari Tharao
- 4 Women's Health in Women's Hands, Toronto, Ontario, Canada
| | | | - Renee Masching
- 6 Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia, Canada
| | | | - Tola Mbulaheni
- 7 African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Ontario, Canada
| | - Marni Amirault
- 6 Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia, Canada
| | - Patrick Brownlee
- 6 Canadian Aboriginal AIDS Network, Dartmouth, Nova Scotia, Canada
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