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Corso M, DeSouza A, Brunton G, Yu H, Cancelliere C, Mior S, Taylor-Vaisey A, MacLeod-Beaver K, Côté P. Integrating Indigenous healing practices within collaborative care models in primary healthcare in Canada: a rapid scoping review. BMJ Open 2022; 12:e059323. [PMID: 35710234 PMCID: PMC9207893 DOI: 10.1136/bmjopen-2021-059323] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES In November 2020, a series of reports, In Plain Sight, described widespread Indigenous-specific stereotyping, racism and discrimination limiting access to medical treatment and negatively impacting the health and wellness of Indigenous Peoples in British Columbia, Canada. To address the health inequalities experienced by Indigenous peoples, Indigenous healing practices must be integrated within the delivery of care. This rapid scoping review aimed to identify and synthesise strategies used to integrate Indigenous healing practices within collaborative care models available in community-based primary healthcare, delivered by regulated health professionals in Canada. ELIGIBILITY CRITERIA We included quantitative, qualitative and mixed-methods studies conducted in community-based primary healthcare practices that used strategies to integrate Indigenous healing practices within collaborative care models. SOURCES OF EVIDENCE We searched MEDLINE, Embase, Indigenous Studies Portal, Informit Indigenous Collection and Native Health Database for studies published from 2015 to 2021. CHARTING METHODS Our data extraction used three frameworks to categorise the findings. These frameworks defined elements of integrated healthcare (ie, functional, organisational, normative and professional), culturally appropriate primary healthcare and the extent of community engagement. We narratively summarised the included study characteristics. RESULTS We identified 2573 citations and included 31 in our review. Thirty-nine per cent of reported strategies used functional integration (n=12), 26% organisational (n=8), 19% normative (n=6) and 16% professional (n=5). Eighteen studies (58%) integrated all characteristics of culturally appropriate Indigenous healing practices into primary healthcare. Twenty-four studies (77%) involved Indigenous leadership or collaboration at each phase of the study and, seven (23%) included consultation only or the level of engagement was unclear. CONCLUSIONS We found that collaborative and Indigenous-led strategies were more likely to facilitate and implement the integration of Indigenous healing practices. Commonalities across strategies included community engagement, elder support or Indigenous ceremony or traditions. However, we did not evaluate the effectiveness of these strategies.
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Affiliation(s)
- Melissa Corso
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Astrid DeSouza
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
- EPPI-Centre, UCL Institute of Education, University College London, London, UK
| | - Hainan Yu
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Carolina Cancelliere
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Silvano Mior
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
- Research, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Anne Taylor-Vaisey
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
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Velez C, Nuechterlein B, Connors S, RedShirt Tyon G, Roane TM, Mays DC. Application of the Indigenous evaluation framework to a university certificate program for building cultural awareness in science, technology, engineering, and mathematics. EVALUATION AND PROGRAM PLANNING 2022; 92:102066. [PMID: 35298956 DOI: 10.1016/j.evalprogplan.2022.102066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 09/23/2021] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
This paper presents a case example of the Indigenous Evaluation Framework as applied to a science, technology, engineering, and mathematics (STEM) education pilot program. Indigenous methodologies include knowledge and data that are inclusive of historically marginalized groups, are highly meaningful, valid, and useful for all. A paradigm shift from Western evaluation methodologies to Indigenous evaluation is necessary when evaluating STEM programs that are committed to increasing recruitment, retention, and graduation of students from historically marginalized groups. This paper describes the use of the Indigenous Evaluation Framework during the first two years of the newly created Environmental Stewardship of Indigenous Lands program at the University of Colorado Denver. We discuss the importance of the Indigenous Evaluation Framework and how it informs the development and continued improvements to the program that also provides agency to program leads and participants.
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Affiliation(s)
- Christine Velez
- The Evaluation Center, University of Colorado Denver, 1391 Speer Boulevard, Suite 340, Denver CO 80204, United States
| | - Bridget Nuechterlein
- The Evaluation Center, University of Colorado Denver, 1391 Speer Boulevard, Suite 340, Denver CO 80204, United States
| | - Susan Connors
- The Evaluation Center, University of Colorado Denver, 1391 Speer Boulevard, Suite 340, Denver CO 80204, United States
| | - Grace RedShirt Tyon
- University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Centers for American Indian & Alaska Native Health, Nighthorse Campbell Native Health Building, 13055 East 17th Avenue, Mail Stop F800, Aurora, CO 80045, United States
| | - Timberley M Roane
- University of Colorado Denver, Department of Integrative Biology, Campus Box 171, PO Box 173364, Denver, CO 80217, United States
| | - David C Mays
- University of Colorado Denver, Department of Civil Engineering, Campus Box 113, PO Box 173364, Denver, CO 80217, United States.
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Lauzière J, Fletcher C, Gaboury I. Cultural Safety as an Outcome of a Dynamic Relational Process: The Experience of Inuit in a Mainstream Residential Addiction Rehabilitation Centre in Southern Canada. QUALITATIVE HEALTH RESEARCH 2022; 32:970-984. [PMID: 35350939 PMCID: PMC9189595 DOI: 10.1177/10497323221087540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Few addiction treatment options are available in Arctic Canada, leading many Inuit to seek treatment programs in southern cities. We conducted a case study to understand what contributes to a culturally safe experience for Inuit in a mainstream addiction rehabilitation centre in Southern Canada. We carried out more than 700 hours of participant observation, in addition to semi-structured interviews and member-checking activities with 20 Inuit residents, 18 staff and four managers. Data were analysed using an inductive interpretative process. Throughout their journey in the program, Inuit navigated through contrasting situations and feelings that we grouped under six broad themes: having Inuit peers, having limitations imposed on one's ways of being and doing, facing ignorance and misperceptions, having conversations and dialogue, facing language barriers and being in a supportive and caring environment. This study highlights how cultural safety varies according to people, context and time, and relates to developing trustful relationships.
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Affiliation(s)
- Julie Lauzière
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Longueuil, QC, Canada
| | - Christopher Fletcher
- Département de médecine sociale et préventive, Université Laval, Quebec, QC, Canada
| | - Isabelle Gaboury
- Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Longueuil, QC, Canada
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Chando S, Howell M, Young C, Craig JC, Eades SJ, Dickson M, Howard K. Outcomes reported in evaluations of programs designed to improve health in Indigenous people. Health Serv Res 2021; 56:1114-1125. [PMID: 33748978 PMCID: PMC8586489 DOI: 10.1111/1475-6773.13653] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the outcomes reported and measured in evaluations of complex health interventions in Indigenous communities. DATA SOURCES We searched all publications indexed in MEDLINE, PreMEDLINE, EMBASE, PsycINFO, EconLit, and CINAHL until January 2020 and reference lists from included papers were hand-searched for additional articles. STUDY DESIGN Systematic review. DATA COLLECTION/EXTRACTION METHODS We included all primary studies, published in peer-reviewed journals, where the main objective was to evaluate a complex health intervention developed specifically for an Indigenous community residing in a high-income country. Only studies published in English were included. Quantitative and qualitative data were extracted and summarized. PRINCIPAL FINDINGS Of the 3523 publications retrieved, 62 evaluation studies were included from Australia, the United States, Canada, and New Zealand. Most studies involved less than 100 participants and were mainly adults. We identified outcomes across 13 domains: clinical, behavioral, process-related, economic, quality of life, knowledge/awareness, social, empowerment, access, environmental, attitude, trust, and community. Evaluations using quantitative methods primarily measured outcomes from the clinical and behavioral domains, while the outcomes reported in the qualitative studies were mostly from the process-related and empowerment domains. CONCLUSION The outcomes from qualitative evaluations, which better reflect the impact of the intervention on participant health, remain different from the outcomes routinely measured in quantitative evaluations. Measuring the outcomes from qualitative evaluations alongside outcomes from quantitative evaluations could result in more relevant evaluations to inform decision making in Indigenous health.
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Affiliation(s)
- Shingisai Chando
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | - Martin Howell
- University of SydneySydneyNew South WalesAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadWestmeadNew South WalesAustralia
| | | | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideSouth AustraliaAustralia
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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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Barnabe C. Towards attainment of Indigenous health through empowerment: resetting health systems, services and provider approaches. BMJ Glob Health 2021; 6:bmjgh-2020-004052. [PMID: 33547176 PMCID: PMC7871239 DOI: 10.1136/bmjgh-2020-004052] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
Colonial policies and practices have introduced significant health challenges for Indigenous populations in commonwealth countries. Health systems and models of care were shaped for dominant society, and were not contextualised for Indigenous communities nor with provision of Indigenous cultural approaches to maintain health and wellness. Shifts to support Indigenous health outcomes have been challenged by debate on identifying which system and service components are to be included, implementation approaches, the lack of contextualised evaluation of implemented models to justify financial investments, but most importantly lack of effort in ensuring equity and participation by affected communities to uphold Indigenous rights to health. Prioritising the involvement, collaboration and empowerment of Indigenous communities and leadership are critical to successful transformation of healthcare in Indigenous communities. Locally determined priorities and solutions can be enacted to meet community and individual needs, and advance health attainment. In this paper, existing successful and sustainable models that demonstrate the empowerment of Indigenous peoples and communities in advocating for, designing, delivering and leading health and wellness supports are shared.
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Affiliation(s)
- Cheryl Barnabe
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Johnson R, Fiddler T, Pirozek J, Gordon J, Sodhi S, Poirier J, Kattini R, Kelly L. Traditional Medicine and Type 2 Diabetes in First Nations Patients. Can J Diabetes 2021; 46:53-59. [PMID: 34303621 DOI: 10.1016/j.jcjd.2021.05.007] [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: 01/11/2021] [Revised: 04/09/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Diabetes may be a cultural experience for many First Nations patients. In this study, we explore the potential role for traditional medicine in the treatment of diabetes. METHODS A responsive interviewing qualitative methodology was used for 10 First Nations key informant interviews. The first objective was to accurately "re-tell" participants' stories. The second was to develop an overview of traditional medicine and its role in health and diabetes management by synthesizing academic literature, pre-existing local knowledge and perspectives, and stories shared by elders and traditional healers. The traditional medicine healers gave specific permission for this study and its publication. RESULTS There is a strong cultural and historic context for the experience of diabetes in First Nations. Political and cultural suppression, lifestyle change and ongoing social determinants of health place diabetes in a unique context and generate a sense of fatalism. Traditional medicine can facilitate individual empowerment by connecting a patient with the lessons of previous generations and traditional beliefs and practices. CONCLUSIONS Traditional medicine can be a valuable resource for First Nations patients living with diabetes and should be considered as a therapeutic modality.
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Affiliation(s)
| | | | | | - Janet Gordon
- Sioux Lookout First Nations Health Authority, Sioux Lookout, Ontario, Canada
| | - Sumeet Sodhi
- Toronto Western Hospital, University Health Network, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Poirier
- Sioux Lookout Local Education Group, Sioux Lookout, Ontario, Canada
| | - Ribal Kattini
- Sioux Lookout Local Education Group, Sioux Lookout, Ontario, Canada
| | - Len Kelly
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada.
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Chando S, Tong A, Howell M, Dickson M, Craig JC, DeLacy J, Eades SJ, Howard K. Stakeholder perspectives on the implementation and impact of Indigenous health interventions: A systematic review of qualitative studies. Health Expect 2021; 24:731-743. [PMID: 33729648 PMCID: PMC8235882 DOI: 10.1111/hex.13230] [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] [Received: 09/11/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. Aim To describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes. Methods We conducted a systematic review of qualitative studies evaluating complex health interventions designed for Indigenous communities in high‐income countries. We searched 6 electronic databases (through to January 2020): MEDLINE, PreMEDLINE, Embase, PsycINFO, EconLit and CINAHL and hand‐searched reference lists of relevant articles. Results From 28 studies involving 677 stakeholders (mostly clinical staff and participants), six main themes were identified: enabling engagement, regaining control of health, improving social health and belonging, preserving community and culture, cultivating hope for a better life, and threats to long‐term programme viability. Conclusion The prominence of social, emotional and spiritual well‐being as important aspects of the health journey for participants in this review highlights the need to reframe evaluations of health programmes implemented in Indigenous communities away from assessments that focus on commonly used biomedical measures. Evaluators, in consultation with the community, should consistently assess the capacity of health professionals to meet community needs and expectations throughout the life of the programme. Evaluations that include qualitative data on participant and community‐level outcomes can improve decision‐makers' understanding of the impact that health programmes have on communities. Patient or public contribution This paper is a review of evaluation studies and did not involve patients or the public.
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Affiliation(s)
- Shingisai Chando
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Michelle Dickson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Jack DeLacy
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | | | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
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Kyoon-Achan G, Schroth RJ, DeMaré D, Sturym M, Edwards J, Lavoie JG, Sanguins J, Campbell R, Chartrand F, Bertone MF, Singh S, Moffatt MEK. Indigenous community members' views on silver diamine fluoride to manage early childhood caries. J Public Health Dent 2020; 80:208-216. [PMID: 32400029 DOI: 10.1111/jphd.12370] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non-restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward SDF. AIM To understand Indigenous community members' views on pediatric dental surgery to treat ECC under general anesthesia (GA) and receptivity to SDF as an alternative to restorative surgery. METHODS Focus groups and sharing circles congruent with an Indigenous ways of gathering information were conducted. Three interviewers engaged eight groups of First Nation and Metis communities in three rural Indigenous communities and ne metropolitan urban setting in Manitoba, Canada. Overall, 59 individuals participated. Open coding was guided by grounded theory and further analysis using Nvivo 12 software™. RESULTS Participants mean age was 35.6 years, 88 percent (52 individuals) had a least one child, and 32 percent (19 individuals) were employed. Eight themes emerged, including respondents' fear of dental surgery under GA, fear of pain after dental surgery, parents' need for more information before accepting SDF treatment, and concern about the black staining of treated lesions. CONCLUSIONS Indigenous parents' acceptance of SDF as a treatment option is contingent on having more information and assurance that treatment under GA can be avoided. Understanding Indigenous parents' views may ensure better acceptance of SDF as a minimally invasive treatment option to manage ECC. A cautious and informative approach to SDF implementation in Indigenous communities is recommended.
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Affiliation(s)
- Grace Kyoon-Achan
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Robert J Schroth
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Winnipeg Regional Health Authority, Section of Pediatric Dentistry, Winnipeg, Canada
| | - Daniella DeMaré
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Melina Sturym
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | - Josée G Lavoie
- Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Julianne Sanguins
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Manitoba Metis Federation, Winnipeg, Canada
| | - Rhonda Campbell
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | | | - Mary F Bertone
- School of Dental Hygiene, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarbjeet Singh
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Michael E K Moffatt
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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