Indigenous Youth Peer-Led Health Promotion in Canada, New Zealand, Australia, and the United States: A Systematic Review of the Approaches, Study Designs, and Effectiveness.

Daniel Vujcich,James Ward,Jessica Thomas,Katy Crawford

doi:10.3389/fpubh.2018.00031

Abstract

Youth peer-led interventions have become a popular way of sharing health information with young people and appear well suited to Indigenous community contexts. However, no systematic reviews focusing on Indigenous youth have been published. We conducted a systematic review to understand the range and characteristics of Indigenous youth-led health promotion projects implemented and their effectiveness. A systematic search of Medline, Embase, and ProQuest Social Sciences databases was conducted, supplemented by gray literature searches. Included studies focused on interventions where young Indigenous people delivered health information to age-matched peers. Twenty-four studies were identified for inclusion, based on 20 interventions (9 Australian, 4 Canadian, and 7 from the United States of America). Only one intervention was evaluated using a randomized controlled study design. The majority of evaluations took the form of pre-post studies. Methodological limitations were identified in a majority of studies. Study outcomes included improved knowledge, attitude, and behaviors. Currently, there is limited high quality evidence for the effectiveness of peer-led health interventions with Indigenous young people, and the literature is dominated by Australian-based sexual health interventions. More systematic research investigating the effectiveness of peer-led inventions is required, specifically with Indigenous populations. To improve health outcomes for Indigenous youth, greater knowledge of the mechanisms and context under which peer-delivered health promotion is effective in comparison to other methods of health promotion is needed.

Highlights

Improving the health status of Indigenous young people remains a longstanding aspiration in the colonized western countries of Australia, New Zealand, Canada, and the United States of America
To be included in the systematic review, studies needed to relate to a health promotion intervention that was both aimed at, and delivered by, young people aged 13–29 years who were Indigenous to New Zealand, Australia, Canada, or the United States of America
Seven interventions focused on sexual health in combination with another topic area, two focused

Summary

Introduction

Improving the health status of Indigenous young people remains a longstanding aspiration in the colonized western countries of Australia, New Zealand, Canada, and the United States of America. Indigenous Youth Peer-Led Health Promotion infections and unplanned, high-risk pregnancies; this is related to both historical and contemporary trauma including intergenerational trauma [1]. Government strategies to improve the health outcomes of Indigenous youth often promote the use of peer-led interventions [2,3,4,5]. The perceived advantages of the approach derive from the fact that peers have a high level of interaction with one another, and the ability to impart health information in relatable ways [7]. Youth peer-led interventions have become a popular way of sharing health information with young people and appear well suited to Indigenous community contexts. We conducted a systematic review to understand the range and characteristics of Indigenous youth-led health promotion projects implemented and their effectiveness. Included studies focused on interventions where young Indigenous people delivered health information to age-matched peers

Methods

Results

Discussion

Conclusion