Rejecting, revitalizing, and reclaiming: First Nations work to set the direction of research and policy development

Diving below the surface: A framework for arctic health research to support thriving communities

AIMS

Historically, health research in the Arctic has focused on documenting ill-health using a narrow set of deficit-oriented epidemiologic indicators (i.e., prevalence of disease and mortality rates). While useful, this type of research does not adequately capture the breadth and complexities of community health and well-being, and fails to highlight solutions. A community's context, strengths, and continued expressions of well-being need to guide inquiries, inform processes, and contextualize recommendations. In this paper, we present a conceptual framework developed to address the aforementioned concerns and inform community-led health and social research in the Arctic.

METHODS

The proposed framework is informed by our collective collaborations with circumpolar communities, and syntheses of individual and group research undertaken throughout the Circumpolar North. Our framework encourages investigation into the contextual factors that promote circumpolar communities to thrive.

RESULTS

Our framework centers on the visual imagery of an iceberg. There is a need to dive deeper than superficial indicators of health to examine individual, family, social, cultural, historical, linguistic, and environmental contexts that support communities in the Circumpolar North to thrive. A participatory community-based approach in conjunction with ongoing epidemiologic research is necessary in order to effectively support health and wellness. Conclusions: The iceberg framework is a way to conceptualize circumpolar health research and encourage investigators to both monitor epidemiologic indicators and also dive below the surface using participatory methodology to investigate contextual factors that support thriving communities.

What Is Wellbeing, and What Is Important for Wellbeing? Indigenous Voices from across Canada

Indigenous peoples' perceptions of wellbeing differ from non-Indigenous constructs. Thus, it is imperative to recognize that Indigenous peoples will conceptualize wellbeing from their perspectives and set their own wellbeing priorities. In keeping with this viewpoint, the aims of the present study were to conceptualize wellbeing and determine what was (and is) important for wellbeing from Canadian Indigenous peoples' perspectives. In this paper, we take a partnership approach based on the elements of respect, equity, and empowerment. One primary data source and two existing data sources were examined and analyzed thematically utilizing a combination approach of deductive and inductive coding. Indigenous leadership and organizations viewed wellbeing holistically and conceptualized wellbeing multidimensionally. From across Canada, wellbeing was communicated as physical, economic, political, social, and cultural. The scaling of wellbeing represented a collectivist perspective, and land was the connecting thread between all types of wellbeing, being a place to practice cultural traditions, reassert one's Indigenous identity, find solace, and pass on Indigenous knowledge and languages. Although wellbeing was discussed in the context of the individual, family, community, and nation, wellbeing was most often discussed at the cultural level by regional and national Indigenous leadership and organizations. Even in acknowledging the great cultural diversity among Canadian Indigenous nations, four concordant themes were identified regionally and nationally, with respect to what was important for cultural wellbeing: land and water, sustainability, and inherent obligations; being on the land, and indigenous languages and knowledge systems; sustainable development; and meaningful involvement in decision-making, and free, prior, and informed consent. Taking into account these themes is foundational for any interaction with Indigenous peoples, especially in the context of land, culture, and development. There needs to be a new beginning on the journey to reconciliation with land and cultural wellbeing at the forefront.

The determinants of dietary diversity and nutrition: ethnonutrition knowledge of local people in the East Usambara Mountains, Tanzania

BACKGROUND

Diet and nutrition-related behaviours are embedded in cultural and environmental contexts: adoption of new knowledge depends on how easily it can be integrated into existing knowledge systems. As dietary diversity promotion becomes an increasingly common component of nutrition education, understanding local nutrition knowledge systems and local concepts about dietary diversity is essential to formulate efficient messages.

METHODS

This paper draws on in-depth qualitative ethnographic research conducted in small-scale agricultural communities in Tanzania. Data were collected using interviews, focus group discussions and participant observation in the East Usambara Mountains, an area that is home primarily to the Shambaa and Bondei ethnic groups, but has a long history of ethnic diversity and ethnic intermixing.

RESULTS

The data showed a high degree of consensus among participants who reported that dietary diversity is important because it maintains and enhances appetite across days, months and seasons. Local people reported that sufficient cash resources, agrobiodiversity, heterogeneity within the landscape, and livelihood diversity all supported their ability to consume a varied diet and achieve good nutritional status. Other variables affecting diet and dietary diversity included seasonality, household size, and gender.

CONCLUSIONS

The results suggest that dietary diversity was perceived as something all people, both rich and poor, could achieve. There was significant overlap between local and scientific understandings of dietary diversity, suggesting that novel information on the importance of dietary diversity promoted through education will likely be easily integrated into the existing knowledge systems.

Maintaining Research Integrity While Balancing Cultural Sensitivity: A Case Study and Lessons From the Field

Contemporary emphasis on creating culturally relevant and context specific knowledge increasingly drives researchers to conduct their work in settings outside their home country. This often requires researchers to build relationships with various stakeholders who may have a vested interest in the research. This case study examines the tension between relationship development with stakeholders and maintaining study integrity, in the context of potential harms, data credibility and cultural sensitivity. We describe an ethical breach in the conduct of global health research by a arising from the ad-hoc participation of a community stakeholder external to the visiting research group. A framework for reflection is developed from a careful examination of underlying factors and presented with a discussion of consequences and mitigation measures. This framework aims to present lessons learned for researchers working abroad who might face similar situations in their work.

Enacting research ethics in partnerships with indigenous communities in Canada: "Do it in a good way"

Two studies conducted through community-campus partnerships demonstrated emerging frameworks for ethical conduct of research involving Indigenous peoples in Canada. Both projects involved multiple Indigenous community partners whose interests in promoting children's development and fathers' involvement motivated the projects. The Indigenous projects were conceived within a broader social agenda of restorative justice and self-determination of Indigenous peoples in Canada following centuries of colonial government interventions. Guiding principles included community relevance, community participation, mutual capacity building, and benefit to Indigenous communities. Memoranda of Understanding negotiated with each community partner specified the roles of community and university partners and research team members in each phase of the research. Testimonials obtained from community representatives before and after the research projects indicated the success of the projects in yielding benefits to the communities in the form of substantive knowledge and strengthened capacities to engage in collaborative research through community-campus partnerships. The larger collaborative research projects in which these two Indigenous projects were embedded created challenges and opportunities due to varying recognition within these networks of the primacy of relationships as a foundation for research and the indeterminacy of outcomes when ownership of data and control over dissemination is in the hands of community partners.

Cultivating the power of partnerships in feminist participatory action research in women's health

Feminist participatory action research integrates feminist theories and participatory action research methods, often with the explicit intention of building community-academic partnerships to create new forms of knowledge to inform women's health. Despite the current pro-partnership agenda in health research and policy settings, a lack of attention has been paid to how to cultivate effective partnerships given limited resources, competing agendas, and inherent power differences. Based on our 10+ years individually and collectively conducting women's health and feminist participatory action research, we suggest that it is imperative to intentionally develop power-with strategies in order to avoid replicating the power imbalances that such projects seek to redress. By drawing on examples from three of our recent feminist participatory action projects we reflect on some of the tensions and complexities of attempting to cultivate power-with research partnerships. We then offer skills and resources needed by academic researchers to effectively harness the collective resources, agendas, and knowledge that each partner brings to the table. We suggest that investing in the process of cultivating power-with research partnerships ultimately improves our collective ability to understand and address women's health issues.

Addressing HIV/AIDS among Aboriginal People using a Health Status, Health Determinants and Health Care Framework: A Literature Review and Conceptual Analysis

OBJECTIVES

(1) To describe the Human Immunodeficiency Virus (HIV) infection among Aboriginal populations using a mixed methods approach (i.e. quantitative and qualitative methods); (2) to examine the individual-level and community-level relationships between HIV/AIDS, health determinants, and health care (e.g. diagnosis, access to treatment and health services planning); and (3) to explore innovative solutions to address HIV/AIDS among Aboriginal populations based upon research and infrastructure (e.g. partnerships, data sources and management, health indicators and culture) and policy (i.e. self-determination of Aboriginal Peoples).

METHODS

Literature review and conceptual analysis using a health status, health determinants and health care framework.

RESULTS

In comparison to non-Aboriginal persons, HIV infection is higher among Aboriginal persons, is more directly attributable to unique risk factors and socio-demographic characteristics, and yields more adverse health outcomes. Culture, poverty and self-determination are determinants of health for Aboriginal populations. Aboriginal people have inadequate primary care and, in particular, specialist care. It is necessary to include traditional Aboriginal approaches and culture when addressing Aboriginal health while understanding competing paradigms between modern medicine and Aboriginal traditions.

CONCLUSION

There is a need for self-determination of Aboriginal Peoples in order to improve the health of Aboriginal communities and those living with HIV/AIDS. Research and policy affecting Aboriginal people should be of the highest quality and based upon Aboriginal community relevance and involvement.

Indigenous fathers' involvement in reconstituting "circles of care"

This qualitative study, part of a Canadian national study of fathers' involvement, opened up First Nations and Métis fathering as a new area of inquiry. Conversational interviews with 80 Indigenous fathers illuminated the socio-historical conditions that have shaped Indigenous men's experiences of learning to be a father and becoming a man in the context of changing gender relationships and the regeneration of circles of care. Indigenous fathers' experiences unfold in a socio-historical context fraught with difficulties. However, the study findings suggest cultural strengths and sources of resilience unseen in research and community programs driven by Euro-western perspectives. This research can inform efforts to reduce systemic barriers and reconstitute positive father involvement following disrupted intergenerational transmission of fathering in Canada and elsewhere.

Struggling to survive: the difficult reality of Aboriginal women living with HIV/AIDS

The increasingly high rates of mortality and morbidity among Canadian Aboriginal women who are living with HIV/ AIDS indicate that there is a need to address deficiencies in the delivery of supportive services and health care. The purpose of this qualitative study was to develop a greater understanding of the barriers, challenges, and successes experienced when accessing health and related support services from the perspective of Aboriginal women living with HIV/AIDS. The findings are organized around four themes reflected in the interview data: fear of rejection when seeking services, finding strength in adversity, struggles with symptoms, and HIV as just one of many competing problems. It is anticipated that the findings from the study will be used to inform decision making regarding the development and delivery of appropriate, responsive, and accessible policies and programs that will support Aboriginal women who are living with HIV/AIDS.

Global health ethics for students

As a result of increased interest in global health, more and more medical students and trainees from the 'developed world' are working and studying in the 'developing world'. However, while opportunities to do this important work increase, there has been insufficient development of ethical guidelines for students. It is often assumed that ethics training in developed world situations is applicable to health experiences globally. However, fundamental differences in both clinical and research settings necessitate an alternative paradigm of analysis. This article is intended for teachers who are responsible for preparing students prior to such experiences. A review of major ethical issues is presented, how they pertain to students, and a framework is outlined to help guide students in their work.

Can the democratic ideal of participatory research be achieved? An inside look at an academic-indigenous community partnership

Democratic or equal participation in decision making is an ideal that community and academic stakeholders engaged in participatory research strive to achieve. This ideal, however, may compete with indigenous peoples' right to self-determination. Study objectives were to assess the perceived influence of multiple community (indigenous) and academic stakeholders engaged in the Kahnawake Schools Diabetes Prevention Project (KSDPP) across six domains of project decision making and to test the hypothesis that KSDPP would be directed by community stakeholders. Self-report surveys were completed by 51 stakeholders comprising the KSDPP Community Advisory Board (CAB), KSDPP staff, academic researchers and supervisory board members. KSDPP staff were perceived to share similar levels of influence with (i) CAB on maintaining partnership ethics and CAB activities and (ii) academic researchers on research and dissemination activities. KSDPP staff were perceived to carry significantly more influence than other stakeholders on decisions related to annual activities, program operations and intervention activities. CAB and staff were the perceived owners of KSDPP. The strong community leadership aligns KSDPP with a model of community-directed research and suggests that equitable participation-distinct from democratic or equal participation-is reflected by indigenous community partners exerting greater influence than academic partners in decision making.

The role played by a former federal government residential school in a First Nation community's alcohol abuse and impaired driving: results of a talking circle

OBJECTIVES

The study's objective was to better understand alcohol abuse and impaired driving behaviors in a First Nations community as it reflects systemic issues linked to historical, family and community experiences.

STUDY DESIGN AND METHODS

Fifteen 18- to 29-year-old drivers participated in an exploratory eight-hour Talking Circle held according to traditional cultural practice. Four First Nations researchers, trained in Talking Circle protocol, and a Band Elder facilitated the data collection, data analysis according to emerging themes, and data verification.

RESULTS

Federal government residential schools contribute to intergenerational effects which impact impaired driving in a northern First Nations community. Traditional parental role modeling has changed dramatically. Rather than guide children through a communally shared development process, many parents now expect their children to assume adult roles by expecting them to take care of their guardians when they drink excessive amounts of alcohol. Because a wall of silence exists between the young and old, many young people seek refuge with friends and peers, who subsequently influence them to abuse alcohol and engage in impaired driving. Many older Band members no longer serve as leaders for young people. Instead, they behave like peers and engage in activities that facilitate alcohol abuse and impaired driving.

CONCLUSIONS

Historical institutions like federal government residential schools have contributed to systemic socio cultural problems which influence alcohol abuse and impaired driving. Hence there is a need for community-based intervention strategies that promote cultural healing. The healing journey can start with First Nations communities providing their people opportunities to share their stresses and traumas in supporting and nurturing environments.

Indigenous peoples' food systems for health: finding interventions that work

This is a short report of a ‘safari’ held in conjunction with the International Congress of Nutrition in September 2005, in Futululu, St. Lucia, South Africa. Participants were several members of the International Union of Nutritional Sciences Task Force on Indigenous Peoples' Food Systems and Nutrition, other interested scientists and members of the Kwa Zulu indigenous community. The paper describes the rationale for and contributions towards understanding what might be successful interventions that would resonate among indigenous communities in many areas of the world. A summary of possible evaluation strategies of such interventions is also given.