Using Art as a Medium for First Nations Youth to Express Their Pain: A Two-Eyed Seeing Qualitative Study

Abstract

Abstract BACKGROUND: First Nations (FN) youth in Canada have the highest rates of pain-related conditions (ear, dental, headaches) yet may be least likely to be treated for them. Untreated pain has an arresting impact on growth and development and is detrimental to the achievement of life goals. In recent research conducted by the Aboriginal Children’s Hurt & Healing Initiative (ACHH), community participants reported that First Nation children are stoic and are reluctant to talk about their pain (Latimer & Rudderham, 2013). Clinicians are trained to assess pain based on overt signs of expression (cry, facial grimace, ability to describe) however if you do not present your pain this way it may reduce the chance of proper assessment and treatment. OBJECTIVES: Using a Two-Eyed Seeing qualitative perspective (best of Indigenous and Western knowledge) the purpose of this research was to provide FN youth with the method of art making to determine how they express their pain. DESIGN/METHODS: Youth from four FN communities, in three Maritime Provinces were invited to participate in art workshops facilitated by internationally renowned Mi’kmaq artist Alan Syliboy. The workshop began with a conversation circle about pain experiences and then proceeded to the art making. A FN documentary cinematographer captured the workshops and the results are documented in art and film. Three team members independently themed the data using thematic analysis and the inter-rater reliability was >85%. RESULTS: 39 youth aged 10-18 years participated in 4 community-based conversation and art sessions. The themes for the sessions were themed using the four dimensions of the Medicine Wheel. While the overwhelming theme discussed in the conversation sessions was physical pain, when provided the nonverbal, art mode of expression, the youth painted emotional pain more frequently than physical, spiritual and mental pain. There was overlap between the four themes but 70% of the artwork prominently illustrated emotional pain with 54% overlapping with physical, 30% mental and 31% spiritual. CONCLUSION: These results present a more complicated issue regarding the integration of the different types of pain, intertwined together. The finding that when asked-youth primarily discussed physical pain but given the opportunity, more frequently painted emotional pain may shed new light on the degree to which emotional pain is a factor for these youth. The artwork and accompanying narratives are powerful and have implications for understanding the complexity of assessing the different dimensions of pain in a culturally meaningful manner and for clinician education purposes. A sample of the artwork is attached.