Inuit Research Articles

Engaging Respectfully with Indigenous Knowledges

This paper contributes to building respectful relationships between Indigenous (First Nations, Métis, and Inuit) peoples and Canada's cultural memory institutions, such as libraries, archives and museums, and applies to knowledge repositories that hold tangible and intangible traditional knowledge. The central goal of the paper is to advance understandings to allow cultural memory institutions to respect, affirm, and recognize Indigenous ownership of their traditional and living Indigenous knowledges and to respect the protocols for their use. This paper honours the spirit of reconciliation through the joint authorship of people from Indigenous, immigrant, and Canadian heritages. The authors outline the traditional and living importance of Indigenous knowledges; describe the legal framework in Canada, both as it establishes a system of enforceable copyright and as it recognizes Indigenous rights, self-determination, and the constitutional protections accorded to Indigenous peoples; and recommend an approach for cultural memory institutions to adopt and recognize Indigenous ownership of their knowledges, languages, cultures, and histories by developing protocols with each unique Indigenous nation.

Sharing stories: The Saskatchewan Aboriginal Storytelling project

The Saskatchewan Aboriginal Storytelling project is a month-long event in Saskatchewan, Canada, which celebrates the lives, histories, practices and cultures of First Nations, Métis, Inuit and non-Status peoples through storytelling. The Library Services for Saskatchewan Aboriginal Peoples committee oversees the project and employs a coordinator, who applies for grants, coordinates the project’s guidelines, and is the contact for site funding and event reporting. Since its launch in 2004, the Saskatchewan Aboriginal Storytelling project has grown significantly and has effectively promoted traditional storytelling, supported a network of Aboriginal storytellers, and helped to create stronger relationships between Aboriginal peoples and libraries. The Saskatchewan Aboriginal Storytelling project is a dynamic methodological and theoretical model for decolonizing library spaces, programmes and collections through celebrating Aboriginal oral traditions.

Can scientists and knowledge keepers sit comfortably together? An Indigenous physician\u2019s reflections on a decade of participatory research into First Nations nutrition, environment and health

The author, an Indigenous physician, offers his reflections on the history of scientific research with Indigenous People and its past role in ethical breaches and excesses of colonialism, as a backdrop to the relatively recent advances in collaborative, community-based participatory research involving First Nations and Inuit in Canada. The First Nations Food, Nutrition and Environment Study (2008–2018), introduced in this Special Issue, is presented as an example of an ethical space that was sustained for a decade to collaboratively develop new knowledge by First Nations and scientists working together, respectfully and inspired by shared interest. A short overview of twelve articles of the Special Issue is provided and characterized as creating a previously inaccessible picture of the modern diets of First Nations, along with the suite of environmental factors that are present in food and water in and around communities. Ultimately, the author hopes that Canadian society can set the table with Indigenous Peoples and respectfully set opinions onto each other and do this over and over again. With Canada already being a multicultural and pluralistic society, adding Indigenous realities into the mix only respects and honours the Indigenous roots of this country.

Genomic data support management of anadromous Arctic Char fisheries in Nunavik by highlighting neutral and putatively adaptive genetic variation.

Distinguishing neutral and adaptive genetic variation is one of the main challenges in investigating processes shaping population structure in the wild, and landscape genomics can help identify signatures of adaptation to contrasting environments. Arctic Char (Salvelinus alpinus) is an anadromous salmonid and the most harvested fish species by Inuit people, including in Nunavik (Québec, Canada), one of the most recently deglaciated regions in the world. Unlike many other anadromous salmonids, Arctic Char occupy coastal habitats near their natal rivers during their short marine phase restricted to the summer ice‐free period. Our main objective was to document putatively neutral and adaptive genomic variation in anadromous Arctic Char populations from Nunavik and bordering regions to inform local fisheries management. We used genotyping by sequencing (GBS) to genotype 18,112 filtered single nucleotide polymorphisms (SNP) in 650 individuals from 23 sampling locations along >2000 km of coastline. Our results reveal a hierarchical genetic structure, whereby neighboring hydrographic systems harbor distinct populations grouped by major oceanographic basins: Hudson Bay, Hudson Strait, Ungava Bay, and Labrador Sea. We found genetic diversity and differentiation to be consistent both with the expected postglacial recolonization history and with patterns of isolation‐by‐distance reflecting contemporary gene flow. Results from three gene–environment association methods supported the hypothesis of local adaptation to both freshwater and marine environments (strongest associations with sea surface and air temperatures during summer and salinity). Our results support a fisheries management strategy at a regional scale, and other implications for hatchery projects and adaptation to climate change are discussed.

The Case for a Greenpeace Apology to Newfoundland and Labrador

Greenpeace’s early work in the anti-sealing movement in the 1970s–1980s is a complex legacy for the organization to navigate. While Greenpeace Canada withdrew from the anti-sealing movement in 1986 and expressed regret for the impact of its actions on Inuit, the extent of the long-term damage caused by the anti-sealing movement, and Greenpeace’s controversial track record in it, motivated Greenpeace Canada to articulate a more robust public apology to Canadian Inuit in 2014. This commentary outlines a case for Greenpeace to continue its path of reconciliation for activities undertaken during the anti-sealing movement and to apologize to the people of Newfoundland and Labrador. Particularly, the commentary calls for an apology to sealers, their families, and their communities, and to First Nations and Inuit people from the province, for Greenpeace’s role in inflicting and promoting forms of violence, stigma, and cultural hatred, and in undermining Indigenous rights in the province.

A HUMAN RIGHTS APPROACH TO FOOD INSECURITY IN INUIT NUNANGAT

The Inuit Tapiriit Kanatami, the national organization for Inuit in Canada, has voiced serious concern about the food insecurity crisis in Inuit Nunangat, the Inuit homeland comprising Nunavut, Nunavik, Nunatsiavut, and the Northwest Territories (Inuit Tapiriit Kanatami, 2019). The widespread and disproportionate experiences of food insecurity in Inuit Nunangat requires critical examination, especially when access to adequate food has been identified as a human right (OHCHR, 2010). My research paper aims to explore this topic of food insecurity as a human rights concern in Inuit Nunangat. A human rights approach acts as both a pathway to investigate, and a tool to inform, policy development. Such an investigation is especially relevant given Canada’s international reputation and constitutional mandate to grant equal protection of rights to all citizens. In this essay, I review international and domestic human rights frameworks that intersect with Inuit food insecurity, in addition to evaluating Canada’s current interventions. I ultimately argue that, based on Canada’s commitments to uphold rights to food, health, and Indigenous self-determination, the government must increase the enforceability of food rights in domestic policy and, second, there must be strengthened collaboration between the government and Inuit partners to more appropriately conceptualize, and respond to, food needs in Inuit Nunangat.

Against settler colonial iatrogenesis: Inuit resistance to treatment in Indian Hospitals in Canada

Canada’s program to examine, transfer and treat Indigenous and Inuit peoples with tuberculosis in Indian Hospitals (ca. 1936 and 1969) has generally been framed by official narratives of population health, benevolence, and care. However, letters written by Inuit patients in Indian hospitals and their kin, and which were addressed to government officials and translated by government employees, challenge this assumption. By focusing on the harmful effects of the segregation and long-term detainment of Inuit peoples away from their communities, the letters theorize TB treatment as multiply harmful and iatrogenic. The letters also showcase how Inuit peoples resisted Indian Hospital treatment and articulated the need for care and treatment to occur within a network of intimate relations, rather than in distant sanatoriums.

Experiences of Inuit in Canada who travel from remote settings for cancer care and impacts on decision making

BackgroundInuit experience the highest cancer mortality rates from lung cancer in the world with increasing rates of other cancers in addition to other significant health burdens. Inuit who live in remote areas must often travel thousands of kilometers to large urban centres in southern Canada and negotiate complex and sometimes unwelcoming health care systems. There is an urgent need to improve Inuit access to and use of health care. Our study objective was to understand the experiences of Inuit in Canada who travel from a remote to an urban setting for cancer care, and the impacts on their opportunities to participate in decisions during their journey to receive cancer care.MethodsWe are an interdisciplinary team of Steering Committee and researcher partners (“the team”) from Inuit-led and/or -specific organizations that span Nunavut and the Ontario cancer health systems. Guided by Inuit societal values, we used an integrated knowledge translation (KT) approach with qualitative methods. We conducted semi-structured interviews with Inuit participants and used process mapping and thematic analysis.ResultsWe mapped the journey to receive cancer care and related the findings of client (n = 8) and medical escort (n = 6) (“participant”) interviews in four themes: 1) It is hard to take part in decisions about getting health care; 2) No one explains the decisions you will need to make; 3) There is a duty to make decisions that support family and community; 4) The lack of knowledge impacts opportunities to engage in decision making. Participants described themselves as directed, with little or no support, and seeking opportunities to collaborate with others on the journey to receive cancer care.ConclusionsWe describe the journey to receive cancer care as a “decision chain” which can be described as a series of events that lead to receiving cancer care. We identify points in the decision chain that could better prepare Inuit to participate in decisions related to their cancer care. We propose that there are opportunities to build further health care system capacity to support Inuit and enable their participation in decisions related to their cancer care while upholding and incorporating Inuit knowledge.

Narratives of Displacement and Trauma

The Inuit of Canada have suffered from a plethora of governmental interventions including relocations, residential schooling, and forced hospitalisation due to the tuberculosis epidemic. The hospitalisation of Inuit had a detrimental effect on individuals through physical abuse, disconnection from language and culture, and being removed from their families and communities. These government interventions are examples of structural violence that potentially cause both individual and collective trauma and are recounted through the personal narratives of Inuit Elders. In addition, the ethical concerns of conducting anthropological fieldwork on trauma and memory are investigated.

PL03.06 Improving Outcomes with Immunotherapy: Lessons from Other Diseases

The Ottawa Hospital (TOH) in Canada’s capital city is the tertiary cancer care center for the Baffin Island area of Nunavut- a Territory located in Canada’s north accessed by a 3-hour flight. The Inuit of Canada’s north have dramatically higher social and economic inequities compared to mainstream Canada (ITK, 2018). [GB1] [CR2] [CR3] For example, 70% of Nunavut Inuit households experience food insecurities compared to 8% of the remainder of Canada. 63% of adult Inuit smoke compared to 16% of mainstream Canada. Approximately 30% of Inuit living in Nunavut diagnosed with cancer between 2000 and 2010 did not access any cancer services (Asmis, 2016). Building productive relationships is one of the key pillars of our organization’s cancer strategy. This is demonstrated by the efforts that have taken place among key partners including: 1) TOH’s interdisciplinary teams; 2) the Indigenous Cancer Control Unit of Cancer Care Ontario (CCO), a provincial agency responsible for addressing the cancer burden of First Nations, Inuit and Metis (FNIM) peoples; 3) the Qikiqtani General Hospital (QGH) in Nunavut, providing inpatient and ambulatory care in the Baffin Island and 4) Ottawa-based Inuit service provider organizations. The collaborative relationship developed among the multiple partners resulted in the following positive outcomes: The establishment of a ‘Relationship Table’ where Inuit service provider stakeholders in Ottawa and Nunavut meet quarterly to review cancer related issues and to provide advice on service delivery challenges. The Table is grounded in a formalized relationship protocol with the Inuit community and organizational leaders. Significant increase in the number of patients and family members supported by the Indigenous Cancer Program at TOH. Many cases present with very complex physical and psychosocial issues and require extensive and long-term intervention. TOH is involved in several research initiatives related to Inuit and cancer care, with the goals of 1) better understanding barriers to accessing cancer care: 2) developing tools to support the patients’ understanding of their illness and prognosis, and 3) encouraging FNIM involvement in shared decision making. Over the past year, TOH experts in cancer care have delivered introductory education to health care providers in Nunavut. This initial education event led to TOH hosting nine physicians and nurses for a week of onsite training in the Cancer Care environment, thereby solidifying relationships with oncology staff, and enhanced their ability to provide care closer to home for their patients. A significant milestone was achieved in September 2020 when the first dose of trastuzumab was delivered in Nunavut. This was the first cancer-related medication administered in the Territory, and required education of the QGH Team in the areas of HER2 positive breast cancer assessment, clinical monitoring for toxicity, and administration of sc trastuzumab including relevant symptom/self-management strategies and resources. A policy and standard operating procedure for administration, order set, and confirmation of administration documents were finalized and distributed to support the care process. These were a collaboration between nursing and pharmacy (both TOH and in the QGH Medical Day Unit) and were vetted by other key stakeholders in Ottawa (breast disease site lead and medical oncology division head) as well as in Nunavut. The collaborative effort to provide breast cancer therapy in Nunavut was groundbreaking and lays the foundation to provide treatment for other cancers, such as lung cancer. In May 2020, The Ottawa Hospital took the lead in organizing the first ever Oncology conference in Nunavut. It was anticipated that approximately 100 health care providers from across Canada and other international locations would be meeting in Iqaluit, Nunavut to discuss models of care and strategies to improve access to care, health outcomes, and overall patient experience with cancer care. The outcome of this conference was planned to be shared at the WCLC but due to Covid-19, the conference has been postponed.

An early dog from southeast Alaska supports a coastal route for the first dog migration into the Americas.

The oldest confirmed remains of domestic dogs in North America are from mid-continent archaeological sites dated approximately 9900 calibrated years before present (cal BP). Although this date suggests that dogs may not have arrived alongside the first Native Americans, the timing and routes for the entrance of New World dogs remain uncertain. Here, we present a complete mitochondrial genome of a dog from southeast Alaska, dated to 10 150 ± 260 cal BP. We compared this high-coverage genome with data from modern dog breeds, historical Arctic dogs and American precontact dogs (PCDs) from before European arrival. Our analyses demonstrate that the ancient dog belongs to the PCD lineage, which diverged from Siberian dogs around 16 700 years ago. This timing roughly coincides with the minimum suggested date for the opening of the North Pacific coastal (NPC) route along the Cordilleran Ice Sheet and genetic evidence for the initial peopling of the Americas. This ancient southeast Alaskan dog occupies an early branching position within the PCD clade, indicating it represents a close relative of the earliest PCDs that were brought alongside people migrating from eastern Beringia southward along the NPC to the rest of the Americas. The stable isotope δ13C value of this early dog indicates a marine diet, different from the younger mid-continent PCDs' terrestrial diet. Although PCDs were largely replaced by modern European dog breeds, our results indicate that their population decline started approximately 2000 years BP, coinciding with the expansion of Inuit peoples, who are associated with traditional sled-dog culture. Our findings suggest that dogs formed part of the initial human habitation of the New World, and provide insights into their replacement by both Arctic and European lineages.

Equitable Allocations in Northern Fisheries: Bridging the Divide for Labrador Inuit

Canada has undertaken commitments to recognize the rights of Indigenous Peoples in fisheries through policies and agreements, including Integrated Fishery Management Plans, the Reconciliation Strategy, and Land Claim Agreements (LCAs). In addition to recognizing rights, these commitments were intended to respect geographic adjacency principles, to enhance the economic viability of Indigenous communities, and to be reflective of community dependence on marine resources. We examined the determinants of quota allocations in commercial fisheries involving Nunatsiavut, Northern Labrador, the first self-governing region for the Inuit peoples in Canada. It has been argued that current fishery allocations for Nunatsiavut Inuit have not satisfied federal commitments to recognize Indigenous rights. Indicators that measure equity in commercial allocations for the turbot or Greenland halibut (Reinhardtius hippoglossoides) and northern shrimp (Pandalus borealis)fisheries were identified and assessed. In these two cases, historical allocations continue to predominate for allocations based upon equity or other social or economic considerations. We illustrate equity-enhancing changes in the quota distribution under scenarios of different levels of inequality aversion, and we make qualitative assessments of the effects of these allocations to Nunatsiavut for socioeconomic welfare. This approach could benefit fisheries governance in Northern Labrador, where federal commitments to equity objectives continue to be endorsed but have not yet been integrated fully into quota allocations.

Social and behavioral risk reduction strategies for tuberculosis prevention in Canadian Inuit communities: a cost-effectiveness analysis

BackgroundTuberculosis (TB) is an important public health problem in Inuit communities across Canada, with an annual incidence rate in 2017 that was nearly 300 times higher than in Canadian-born non-Indigenous individuals. Social and behavioral factors that are prevalent in the North, such as commercial tobacco use, excessive alcohol use, food insecurity and overcrowded housing put individuals at higher risk for TB morbidity and mortality. We examined the potential impact of mitigation strategies for these risk factors, in reducing TB burden in this setting.MethodsWe created a transmission model to simulate the epidemiology of TB in Nunavut, Canada. We then used a decision analysis model to assess the potential impact of several evidence-based strategies targeting tobacco use, excessive alcohol use, food insecurity and overcrowded housing. We predicted TB incidence, TB-related deaths, quality adjusted life years (QALYs), and associated costs and cost-effectiveness over 20 years. All costs were expressed in 2018 Canadian dollars.ResultsCompared to a status quo scenario with no new interventions for these risk factors, the reduction strategy for tobacco use was most effective and cost-effective, reducing TB incidence by 5.5% (95% uncertainty range: 2.7–11%) over 20 years, with an estimated cost of $95,835 per TB case prevented and $49,671 per QALY gained. The addition of the food insecurity reduction strategy reduced incidence by a further 2% (0.5–3%) compared to the tobacco cessation strategy alone, but at significant cost.ConclusionsStrategies that aim to reduce commercial tobacco use and improve food security will likely lead to modest reductions in TB morbidity and mortality. Although important for the communities, strategies that address excess alcohol use and overcrowding will likely have a more limited impact on TB-related outcomes at current scale, and are associated with much higher cost. Their benefits will be more substantial with scale up, which will also likely have important downstream impacts such as improved mental health, educational attainment and food security.

SOS! Summer of Smoke: a retrospective cohort study examining the cardiorespiratory impacts of a severe and prolonged wildfire season in Canada’s high subarctic

ObjectivesTo determine healthcare service utilisation for cardiorespiratory presentations and outpatient salbutamol dispensation associated with 2.5 months of severe, unabating wildfire smoke in Canada’s high subarctic.DesignA retrospective cohort study using hospital,...

Adapting Evidence-Based Tobacco Addiction Treatment for Inuit Living in Ontario: A Qualitative Study of Collaboration and Co-creation to Move From Pan-Indigenous to Inuit-Specific Programming


 
 
 Settler introduction of tobacco to Inuit Nunangat (homeland of Inuit in Canada) has led to high tobacco use prevalence among Inuit. Inuit are moving from traditional territories to the province of Ontario to access resources, including health services. Indigenous-specific tobacco cessation approaches in Ontario lack cultural relevance among Inuit, as they often reflect First Nations and Métis worldviews. To improve effectiveness of tobacco cessation services for Inuit living in Ontario, materials reflective of Inuit culture and worldviews were developed through a community-based participatory approach. The Centre for Addiction and Mental Health collaborated with Tungasuvvingat Inuit and members of an Engagement Circle who work with Inuit or identify as Inuk (n = 25) to initiate a knowledge translation project aimed at co-creating a toolkit of Inuit-specific cessation resources. Development was guided by Two-Eyed Seeing, whereby Inuit and Western worldviews come together to support a strengths-based approach. The toolkit was evaluated through a pilot session and focus group with Inuit living in Ottawa who use tobacco (n = 13) and an online survey administered with a group of helpers who work with Inuit (n = 11). Analysis of qualitative data from the focus group and online survey highlighted five themes: choice, cultural relevance and safety, capacity-building, access, and impact. Focus group participants reported they learned quitting was possible and identified new strategies to quit through the session. Our findings emphasize the importance of engagement and co-creation with Indigenous Peoples to ensure cultural relevance and appropriateness of healthcare interventions.
 
 

Karen Routledge. Do You See Ice? Inuit and Americans at Home and Away.

K<scp>aren</scp> R<scp>outledge</scp>. <i>Do You See Ice? Inuit and Americans at Home and Away</i>.

Indigenous Peoples Experiences with Aging

&#x0D; &#x0D; &#x0D; Indigenous Peoples in Canada are a non-homogenous group consisting of First Nations, Metis, and Inuit Peoples representing the original settlers of a given land or a geographical area (Parrott, 2018). Based on geographical location, there are unique names used to describe a given subset or group of Indigenous Peoples around the world. Despite their proximity, they originate from different nations, tribes, and communities and remain distinct in their spoken language, history, and way of life. Although there has been a notable growth in the literature on Indigenous Peoples, relatively little is published about their understanding of healthy aging. Similarly, there is a dearth of literature about the specific needs and wishes of Indigenous Peoples in Canada to facilitate a healthy aging process.&#x0D; &#x0D; &#x0D;

Geospatial patterns of comorbidity prevalence among people with osteoarthritis in Alberta Canada

BackgroundKnowledge of geospatial pattern in comorbidities prevalence is critical to an understanding of the local health needs among people with osteoarthritis (OA). It provides valuable information for targeting optimal OA treatment and management at the local level. However, there is, at present, limited evidence about the geospatial pattern of comorbidity prevalence in Alberta, Canada.MethodsFive administrative health datasets were linked to identify OA cases and comorbidities using validated case definitions. We explored the geospatial pattern in comorbidity prevalence at two standard geographic areas levels defined by the Alberta Health Services: descriptive analysis at rural-urban continuum level; spatial analysis (global Moran’s I, hot spot analysis, cluster and outlier analysis) at the local geographic area (LGA) level. We compared area-level indicators in comorbidities hotspots to those in the rest of Alberta (non-hotspots).ResultsAmong 359,638 OA cases in 2013, approximately 60% of people resided in Metro and Urban areas, compared to 2% in Rural Remote areas. All comorbidity groups exhibited statistically significant spatial autocorrelation (hypertension: Moran’s I index 0.24, z score 4.61). Comorbidity hotspots, except depression, were located primarily in Rural and Rural Remote areas. Depression was more prevalent in Metro (Edmonton-Abbottsfield: 194 cases per 1000 population, 95%CI 192–195) and Urban LGAs (Lethbridge-North: 169, 95%CI 168–171) compared to Rural areas (Fox Creek: 65, 95%CI 63–68). Comorbidities hotspots included a higher percentage of First Nations or Inuit people. People with OA living in hotspots had lower socioeconomic status and less access to care compared to non-hotspots.ConclusionsThe findings highlight notable rural-urban disparities in comorbidities prevalence among people with OA in Alberta, Canada. Our study provides valuable evidence for policy and decision makers to design programs that ensure patients with OA receive optimal health management tailored to their local needs and a reduction in current OA health disparities.

95 Child Health Promotion Through Community Educational Sessions in an Urban Inuit Community: A Needs Assessment

Abstract Introduction/Background Canadian Inuit children experience significant health disparities compared to their non-Inuit counterparts. Despite almost one-fifth of Canadian Inuit living in urban centres, few studies have explored their health needs. Current literature surveying Indigenous leaders identifies the need for improved access to child health and parenting knowledge. Community-based initiatives have been shown to improve Indigenous maternal and child health outcomes. Our study aimed to describe urban Inuit parents’ perspectives on accessing child health knowledge to guide development of Inuit-specific health knowledge-sharing initiatives. Objectives Design/Methods In conjunction with community partners, we conducted a qualitative needs assessment through focus groups at an urban-situated organization that provides cultural, educational, and social services to Inuit children and families. Participants were parents and caregivers of Inuit children. All focus groups were recorded, transcribed, and imported into NVivo software. Inductive coding was used to identify themes related to participants’ sources of health knowledge, barriers and facilitators to accessing health knowledge, and health topics that participants hoped to learn more about. Results Twenty-four individuals participated in four focus groups, of which twenty-one (88%) identified as Inuit. While participants represented a range of ages (19-40 years), most participants (42%) were 31-40 years old. The majority of participants (88%) identified as female. Participants had lived a median of 15 years in an urban setting (interquartile range 10-23). Seventeen participants (71%) cared for children aged 5 or younger. The main sources of health knowledge reported were Indigenous-focused services, online resources, telehealth and social networks (e.g. family and peers). The most notable barrier to accessing child health information was cultural differences (i.e. lifestyle and parenting practices). Discrimination and challenges with systems navigation also emerged as themes. Key health topics of interest included common childhood complaints (e.g. infections and immunizations), infant care, nutrition, parenting and development, mental health, and sexual education for adolescents. Preferred modes of child health information delivery were in-person sessions, pamphlets, and online videos with preferences for both health care providers and Inuit Elders as facilitators. Key access factors included Inuit language/translation, convenience of location, transportation, scheduling, and presence of food and childcare. Conclusion Our results reveal important factors affecting access to child health knowledge among Inuit families in a large urban setting, as well as key child health topics of interest to this population. Informed by these findings and with help from our community partners, we are co-developing child health knowledge-sharing initiatives specific to the needs of the Inuit community in our region.

Valuing All Voices: refining a trauma-informed, intersectional and critical reflexive framework for patient engagement in health research using a qualitative descriptive approach

BackgroundCritical stakeholder-identified gaps in current health research engagement strategies include the exclusion of voices traditionally less heard and a lack of consideration for the role of trauma in lived experience. Previous work has advocated for a trauma-informed, intersectional, and critical reflexive approach to patient and public involvement in health research. The Valuing All Voices Framework embodies these theoretical concepts through four key components: trust, self-awareness, empathy, and relationship building. The goal of this framework is to provide the context for research teams to conduct patient engagement through the use of a social justice and health equity lens, to improve safety and inclusivity in health research. The aim of this study was to revise the proposed Valuing All Voices Framework with members of groups whose voices are traditionally less heard in health research.MethodsA qualitative descriptive approach was used to conduct a thematic analysis of participant input on the proposed framework. Methods were co-developed with a patient co-researcher and community organizations.ResultsGroup and individual interviews were held with 18 participants identifying as Inuit; refugee, immigrant, and/or newcomer; and/or as a person with lived experience of a mental health condition. Participants supported the proposed framework and underlying theory. Participant definitions of framework components included characterizations, behaviours, feelings, motivations, and ways to put components into action during engagement. Emphasis was placed on the need for a holistic approach to engagement; focusing on open and honest communication; building trusting relationships that extend beyond the research process; and capacity development for both researchers and patient partners. Participants suggested changes that incorporated some of their definitions; simplified and contextualized proposed component definitions; added a component of “education and communication”; and added a ‘how to’ section for each component. The framework was revised according to participant suggestions and validated through member checking.ConclusionsThe revised Valuing All Voices Framework provides guidance for teams looking to employ trauma-informed approaches, intersectional analysis, and critical reflexive practice in the co-development of meaningful, inclusive, and safe engagement strategies.Plain English SummaryPatient engagement in health research continues to exclude many people who face challenges in accessing healthcare, including (but not limited to) First Nations, Inuit, and Metis people; immigrants, refugees, and newcomers; and people with lived experience of a mental health condition. We proposed a new guide to help researchers engage with patients and members of the public in research decision-making in a meaningful, inclusive, and safe way. We called this the Valuing All Voices Framework, and met with people who identify as members of some of these groups to help define the key parts of the framework (trust; self-awareness; empathy; and relationship building), to tell us what they liked and disliked about the proposed framework, and what needed to be changed. Input from participants was used to change the framework, including clarifying definitions of the key parts, adding another key part called “education and communication”, and providing action items so teams can put these key parts into practice.