Indigenous Community Health Research Articles

"We Need to Live off the Land": An Exploration and Conceptualization of Community-Based Indigenous Food Sovereignty Experiences and Practices.

Although Indigenous food systems are sustainable in nature, many of these systems have been forcibly altered among Indigenous communities within Canada, as a consequence of colonization. Indigenous Food Sovereignty (IFS) movements work to counteract the dismantling of Indigenous food systems as well as the negative health impacts of environmental dispossession experienced by Indigenous communities. Through community-based participatory research methodologies and the utilization of Etuaptmumk, or two-eyed seeing, this research project explored community perspectives of IFS in Western Canada. Reflexive thematic analysis of qualitative data collected during a sharing circle held with community members identified the influence of Indigenous Knowledge and community support on three main aspects of Indigenous food sovereignty, including (1) environmental concerns, (2) sustainable practices and (3) a strong relationship with the land and waters. Through the sharing of stories and memories related to traditional foods and current sovereignty projects, community members identified concerns for their local ecosystem as well as a desire to preserve its natural state for generations to come. The strengthening of IFS movements is critical to the overall wellbeing of Indigenous communities within Canada. Support is needed for movements that honour relationships with traditional foods and recognize traditional lands and waters as necessary for healing and sustaining the health of Indigenous communities.

Barriers and facilitators influencing parent–adolescent communication on sexual and reproductive health in Indigenous communities in Latin American countries: protocol for a scoping review

IntroductionDespite the global efforts to promote adolescent sexual and reproductive health (SRH), many doubts remain on how to ensure universal health access for this population. Many obstacles prevent adolescents from...

Decolonizing Water Discussions: A Look at the Indigenous Water Crisis in Canada from an Anti-Settler Colonialist Perspective

Introduction: Canada is one of the most water-rich countries in the world, so it may be surprising to hear that many Indigenous communities do not have access to clean drinking water. Due to colonial legacies that have been supported in Western society for centuries, Indigenous Peoples have been denied guaranteed access to clean drinking water by the Canadian government. This is a violation of fundamental human rights. Furthermore, research in this area is incredibly important to Indigenous Peoples’ quality of life in Canada. Previous research has shown that drinking tap water filled with parasites, bacteria, and heavy metals can lead to serious health, socio-economic, and cultural issues in Indigenous communities. This research protocol aims to survey members of several Indigenous communities in Canada to gain insight on the state of water quality, chemically analyze the water, and understand settler-colonialism’s role in modern day policy to improve water accessibility in those communities. Methods: This study will focus on determining the accessibility, reliability, and quality of drinking water made available by the Canadian government compared to alternatively sourced water, if applicable. For alternative water sources, biocultural indicators, and the observational indicators used to assess water, utilized by Indigenous community members will be recorded. Samples of water from multiple sources will be collected and analyzed for turbidity, and the presence of pathogens. Results: As a proposed study we have predicted findings based on existing literature. We expect significant reports of water advisories and the usage of alternative sources of water or unsafe drinking water, posing an increased risk for health issues such as higher rates of gastrointestinal diseases, diabetes, and obesity. Discussion: Funding issues serve as one of the key underlying obstacles to drinking water advisories in Canada, both in terms of underfunding and an outdated funding formula for water treatment systems. The means to sustain and employ these systems are crucial to ensure safe drinking water is continually available. Conclusion: It is our hope that through this research, we will contribute data that will better inform policy and awareness to improve the equitable access to clean water in Indigenous communities across Canada.

Community Health Nurses' Spirituality Shapes Their Practice Working With Indigenous Communities in British Columbia, Canada.

Common conceptions of spirituality in nursing often concentrate on nurses providing spiritual care, but there is insufficient research indicating how nurses' spirituality impacts their nursing practice. This study examines how Indigenous and non-Indigenous community health nurses' experiences of spirituality, regardless of any religious affiliation, shape their nursing practice with Indigenous communities. Results indicate that spirituality is a pervasive nursing ethic manifesting respect, connectedness, love, acceptance, caring, hope, endurance, and compassion toward clients. Participants' experiences of spirituality promote self-awareness, open-mindedness, and acceptance of others and encourage participants' reflexivity, which grounds their nursing practice. Nurses' spiritual awareness fosters an appreciation for Indigenous community healing, leading to more reciprocal interactions with community members. Significantly, these participants provide care spiritually; they do not provide spiritual care.

Workers' compensation experience in some Indigenous Northern Ontario communities.

There is a dearth of research about occupational health and safety experience in Indigenous communities and compensation applications from Indigenous workers appear limited. This qualitative descriptive study was designed to explore workers' compensation experiences in some Canadian Indigenous communities. A community-based participatory research approach was used to conduct focus groups (n = 25 participants) in three Northeastern Ontario (NEO) Indigenous communities and at one NEO Indigenous employment centre. Semi-structured focus group questions addressed community experience with workers' compensation, the compensation process, and discussion of a training session about the process. Reflexive thematic analysis followed Braun and Clarke procedures. Discussion with study participants resulted in these themes: 1) both lack of knowledge, and knowledge, about compensation demonstrated, 2) impact of lack of compensation coverage and need for universal coverage on reserve, 3) need for community training sessions about workers' compensation, 4) workload and financial impact of workers' compensation on reserve, and 5) requirement for cultural competence training in the compensation board. This qualitative descriptive study revealed the: need for more information about applying for workers' compensation and navigating the process, need for universal workplace insurance coverage in Indigenous communities, demand for community-based compensation process training, community costs of compensation, and the requirement for cultural safety and competence training for compensation organization employees. More education about the workers' compensation process would be of benefit to leadership, health care providers, administrative personnel, employers, and employees on reserves. Nurses in community health centres are well situated to provide further guidance.

Supporting the Health and Well-Being of Indigenous Communities: A Position Paper From the American College of Physicians.

Indigenous peoples in the United States experience many health disparities and barriers to accessing health care services. In addition, Indigenous communities experience poor social drivers of health, including disproportionately high rates of food insecurity, violence, and poverty, among others. These challenges are unsurprising, given historical societal discrimination toward Indigenous peoples and government policies of violence, forced relocation with loss of ancestral home, and erasure of cultures and traditions. Indigenous peoples have displayed resilience that has sustained their communities through these hardships. Through treaties between the federal government and Indigenous nations, the federal government has assumed a trust responsibility to provide for the health and well-being of Indigenous populations through the direct provision of health care services and financial support of tribally operated health systems. However, despite serving a population that has endured substantial historical trauma and subsequent health issues, federal programs serving Indigenous peoples receive inadequate federal funding and substantially fewer resources compared with other federal health care programs. Access to care is further challenged by geographic isolation and health care workforce vacancies. Given the history of Indigenous peoples in the United States and their treatment by the federal government and society, the American College of Physicians (ACP) asserts the federal government must faithfully execute its trust responsibility through increased funding and resources directed toward Indigenous communities and the undertaking of concerted policy efforts to support the health and well-being of Indigenous people. ACP believes that these efforts must be community-driven, Indigenous-led, and culturally appropriate and accepted, and center values of respect and self-determination.

78.2 Impact of Climate Change on the Health and Well-Being of Indigenous Communities in Australia

78.2 Impact of Climate Change on the Health and Well-Being of Indigenous Communities in Australia

Developing Relationships on a Shared Path to Reconciliation: The Core of Health Transformation and Safe Care for Indigenous People.

This article describes the experience of a pan-Canadian health organization that led a quality improvement collaborative focused on suicide prevention and life promotion with Indigenous communities in northern and remote regions of Canada. Working in partnership with a Guidance Group, it became clear that working in a relational way that is culturally safe and acknowledges "two-eyed seeing" helps to create an ethical space in which open dialogue and collaboration can occur. Relational work enabled the improvement teams in the Promoting Life Together Collaborative to co-develop life promotion activities within their communities. The primacy of building relationships is at the core of reconciliation with Indigenous peoples and is a key enabler of system transformation required to support the health and wellness of Indigenous communities across Canada.

Impact on mental health and wellbeing in Indigenous communities due to land loss resulting from industrial resource development: protocol for a systematic review

BackgroundIndigenous Peoples are impacted by industrial resource development that takes place on, or near, their communities. Existing literature on impacts of industrial resource development on Indigenous Peoples primarily focus on physical health outcomes and rarely focus on the mental health impacts. To understand the full range of long-term and anticipated health impacts of industrial resource development on Indigenous communities, mental health impacts must be examined. It is well-established that there is a connection between the environment and Indigenous wellbeing, across interrelated dimensions of mental, physical, emotional, and spiritual health.MethodsThis paper identifies how the Community Advisory Team and a team of Indigenous and settler scholars will conduct the review. The literature search will use the OVID interface to search Medline, Embase, PsycINFO, and Global Health databases. Non-indexed peer-reviewed journals related to Indigenous health or research will be scanned. Books and book chapters will be identified in the Scopus and PsycINFO databases. The grey literature search will also include Google and be limited to reports published by government, academic, and non-profit organizations. Reference lists of key publications will be checked for additional relevant publications, including theses, dissertations, reports, and other articles not retrieved in the online searches. Additional sources may be recommended by team members. Included documents will focus on Indigenous Peoples in North America, South America, Australia, Aotearoa New Zealand, and Circumpolar regions, research that reports on mental health, and research that is based on land loss connected to dams, mines, agriculture, or petroleum development. Literature that meets the inclusion criteria will be screened at the title/abstract and full-text stages by two team members in Covidence. The included literature will be rated with a quality appraisal tool and information will be extracted by two team members; a consensus of information will be reached and be submitted for analysis.DiscussionThe synthesized evidence from this review is relevant for land use policy, health impact assessments, economic development, mental health service planning, and communities engaging in development projects.Systematic review registrationRegistered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration number CRD42021253720)

Indigenous Peoples and International Law in the Ecuadorian Amazon

The adoption and ratification of new conventions and treaties under international law designed to protect both Indigenous peoples and the rights of nature have resulted in successful rulings by local, federal, and regional courts in favor of Indigenous groups engaged in class-action suits against their governments. In 2012 and 2019, respectively, the Sarayaku Kichwa and the Huaorani and Cofán peoples of the Ecuadorian Amazon won cases against the Ecuadorian government for its lack of consultation on planned oil exploration. Such cases upholding the correct application of the right to Free, Prior, and Informed Consent (FPIC) under international treaties are rare; more often, Western judicial systems and environmental impact assessments have been used to serve corporate interests, as exemplified by the Aguinda v. Texaco case initiated in 1993 and the planned operations of Andes Petroleum in Orellana province 2019–2020, respectively. Indigenous and non-Western epistemologies tend to be incompatible with state-driven liberal secular capitalism—hence Indigenous efforts to prevent land seizures and the expansion of the extractive frontier into Indigenous territories in the Amazon rainforest have been undermined by the imperatives of modernization/developmentalism. These same forces have stimulated demand for gold, the legal and illegal mining of which, along the Napo river, have caused the contamination of the waters of the Amazon, threatening the health of Indigenous and non-indigenous riverine communities.

How Indigenous Scholarship Changes the Field: Pluriversal Appreciation, Decolonial Aspirations, and Comparative Indigenous Education

As a project of state political and economic agendas, the schooling of Indigenous peoples has historically tended to reflect everyone else’s values, standards, and objectives but our own. However, for Indigenous communities, education is part of an array of long-term self-determination strategies that serve Indigenous autonomy, which is undergirded by Indigenous knowledge systems that encompass the political, economic, environmental, health, social, and cultural lives of Indigenous communities. Accordingly, Indigenous education in its many designs is founded in Indigenous struggles for interlinking forms and realizations of justice that recognize environmental dignity as indivisible from human life. Furthermore, the philosophies and enactments that sustain Indigenous autonomy in one place are never removed from other Indigenous places and the efforts of their people. This bridging across Indigenous worlds and our distinct and collective decolonial and interepistemic meanings of education constitute comparative Indigenous education, which is the focus of this themed issue.

Legal Regime for the Protection of Genetic Information of Indigenous Peoples and Local Communities in International Law

The present study aims at providing an idea that the protection of genetic and genomic information of indigenous peoples and local communities should be legally established at universal and regional levels. There is a trend in many countries towards the disappearance of rare nations and peoples representing genetic diversity. In the case of the collection, processing, storage, transmission of data in the application of artificial intelligence take further action to ensure cybersecurity, develop ethical guidelines and confidentiality requirements for collection and processing genomic and genetic information on the health of indigenous peoples and local communities bearing in mind the provisions of the United Nations Declaration on the Rights of Indigenous Peoples (2007) and the International Convention on the Elimination of All Forms of Racial Discrimination (1965). Although human genes are not covered by the Convention on Biodiversity (1992), it should be applied by analogy in the case of the protection of the “genetic” heritage of mankind. The research uses general scientific and special cognitive techniques wherein legal analysis and synthesis, systemic, formal-legal, comparative-legal, historical-legal and dialectical methods are applied. The author calls on the international community to recognize indigenous genetic information from medical research as the common heritage of mankind and to establish special legal responsibility of present generations for the future of mankind at the universal level. The author of the article notes the importance of prevention the development of racial and ethnic weapons against a certain population group and to prevent the commission of the crime of “genomocide” against indigenous peoples and local communities and to comply with biosafety measures in conducting scientific research and obtaining certain genetic information, to preserve the uniqueness of the biocode of the nations and peoples inhabiting our planet.

Cultural efficacy as a novel component of understanding linkages between culture and mental health in Indigenous communities.

We used a novel measure of cultural efficacy to examine empirical pathways between enculturation, efficacy, and two wellbeing outcomes. Cultural factors are not consistently linked to better wellbeing in the academic literature despite widespread understanding of these processes in Indigenous communities. Healing pathways is a community‐based participatory study with eight reservations/reserves in the upper Midwest and Canada. This study uses data collected in 2017–2018 (n = 453, 58.1% women, mean age = 26.3 years) and structural equation modeling to test the relationships between enculturation, cultural efficacy, and mental health. The direct effect of enculturation on anxiety was positive. The indirect effect of enculturation via cultural efficacy was negatively associated with anxiety and positively associated with positive mental health. Cultural efficacy is an important linking variable through which the protective effects of culture manifest. The complex nature of culture must be met with innovative measures and deep understanding of Indigenous peoples to fully capture the protective role of culture.

Combining Conceptual Frameworks on Maternal Health in Indigenous Communities—Fuzzy Cognitive Mapping Using Participant and Operator-independent Weighting

A recurring issue in intercultural research is whose knowledge informs conceptualization and design of projects or interventions. Fuzzy cognitive mapping uses arrows and weights to represent stakeholder knowledge on causal relationships and can generate composite theories to inform research and action. Cognitive mapping is accessible across different cultures, but participant weighting is not always straightforward. We describe a procedure to combine and condense maps from different stakeholders and an alternative operator-independent weighting procedure adapted from Harris’s discourse analysis.

Heart work: Indigenous doulas responding to challenges of western systems and revitalizing Indigenous birthing care in Canada

BackgroundIn Canada, there has been a significant increase in the training of Indigenous doulas, who provide continuous, culturally appropriate support to Indigenous birthing people during pregnancy, birth, and the postpartum period. The purpose of our project was to interview Indigenous doulas across Canada in order to document how they worked through the logistics of providing doula care and to discern their main challenges and innovations.Population/settingOur paper analyzes interviews conducted with members of five Indigenous doula collectives across Canada, from the provinces of British Columbia, Manitoba, Ontario, Quebec and Nova Scotia.MethodsSemi-structured interviews were conducted with members of the five Indigenous doula collectives across Canada in 2020 as part of the project, “She Walks With Me: Supporting Urban Indigenous Expectant Mothers Through Culturally Based Doulas.” Interview transcripts were approved by participants and subsequently coded by the entire research team to identify key themes.ResultsOur paper examines two themes that emerged in interviews: the main challenges Indigenous doulas describe confronting when working within western systems, and how they navigate and overcome these obstacles. Specifically, interview participants described tensions with the biomedical approach to maternal healthcare and conflicts with the practice of Indigenous infant apprehension. In response to these challenges, Indigenous doulas are working to develop Indigenous-specific doula training curricula, engaging in collective problem-solving, and advocating for the reformation of a grant program in order to fund more Indigenous doulas.ConclusionsBoth the biomedical model of maternal healthcare and the crisis of Indigenous infant apprehension renders Canadian hospitals unsafe and uncomfortable spaces for many Indigenous birthing people and their families. Indigenous doulas are continually navigating these challenges and creatively and concertedly working towards the revitalization of Indigenous birthing care. Indigenous doula care is critical to counter systemic, colonial barriers and issues that disproportionately impact Indigenous families, as well as recentering birth as the foundation of Indigenous sovereignty and community health.

Twenty Important Research Questions in Microbial Exposure and Social Equity.

ABSTRACTSocial and political policy, human activities, and environmental change affect the ways in which microbial communities assemble and interact with people. These factors determine how different social groups are exposed to beneficial and/or harmful microorganisms, meaning microbial exposure has an important socioecological justice context. Therefore, greater consideration of microbial exposure and social equity in research, planning, and policy is imperative. Here, we identify 20 research questions considered fundamentally important to promoting equitable exposure to beneficial microorganisms, along with safeguarding resilient societies and ecosystems. The 20 research questions we identified span seven broad themes, including the following: (i) sociocultural interactions; (ii) Indigenous community health and well-being; (iii) humans, urban ecosystems, and environmental processes; (iv) human psychology and mental health; (v) microbiomes and infectious diseases; (vi) human health and food security; and (vii) microbiome-related planning, policy, and outreach. Our goal was to summarize this growing field and to stimulate impactful research avenues while providing focus for funders and policymakers.

Building evidence to reduce inequities in management of pain for Indigenous Australian people.

Pain is a universal experience which each person encounters differently, guided by the psycho-socio-environmental context in which it occurs. Although more research is underway yet very little is known about pain from Indigenous Australian perspective. Therefore, this study aims to examine, experience of pain and coping, and utility of three measures: Brief Pain Inventory short form, McGill Pain Questionnaire and Numerical rating scale, from Indigenous South Australian people perspective. Thirteen in-person interviews were conducted which lasted around 90min and were audio-recorded. The transcripts were coded and analysed thematically with NVivo. Six key themes were identified; 1: Spiritual conceptualisation of pain; 2: Frequent experience of trauma and injury; 3: Influence of familial history of pain; 4: Acceptance of pain as normal; 5: Outlook on biomedical management of pain; 6: Preference for non-pharmacological management of pain. Also, the three measures did not fully capture pain from an Indigenous Australian perspective which is more deeply rooted in a bio-psycho-socio-spiritual context which is cardinal to conceptualization of health and wellbeing in Indigenous Australian communities. Findings highlight some commonalities as well as unique differences between Indigenous experiences of pain as compared to non-Indigenous. Factors such as spiritual connection with pain, grief and loss, history of trauma and injury, fear of addiction to pain medication and exposure to pain from early childhood had important implications for how participants viewed pain.

Maternal health and Indigenous traditional midwives in southern Mexico: contextualisation of a scoping review.

ObjectivesCollate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero.DesignScoping review and stakeholder fuzzy cognitive mapping.Inclusion and exclusionThe scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico.ResultsThe initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature’s map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases.ConclusionsThe literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.

Wak\u021f\xe1\u014bye\u017ea (Little Holy One) - an intergenerational intervention for Native American parents and children: a protocol for a\xa0randomized controlled trial with embedded\xa0single-case experimental design\xa0

BackgroundTrauma within Native American communities compromises parents’ parenting capacity; thus, increasing childrens’ risk for substance use and suicide over the lifespan. The objective of this manuscript is to describe the Wakȟáŋyeža (Little Holy One) intervention and evaluation protocol, that is designed to break cycles of intergenerational trauma, suicide, and substance use among Fort Peck Assiniboine and Sioux parents and their children.MethodsA randomized controlled trial with an embedded single-case experimental design will be used to determine effectiveness of the modular prevention intervention on parent-child outcomes and the added impact of unique cultural lesson-components. Participants include 1) Fort Peck Assiniboine and Sioux parents who have had adverse childhood experiences, and 2) their children (3–5 years). Parent-child dyads are randomized (1:1) to Little Holy One or a control group that consists of 12 lessons taught by Indigenous community health workers. Lessons were developed from elements of 1) the Common Elements Treatment Approach and Family Spirit, both evidence-based interventions, and 2) newly created cultural (intervention) and nutrition (control group only) lessons. Primary outcomes are parent (primary caregiver) trauma symptoms and stress. Secondary outcomes include: Parent depression symptoms, parenting practices, parental control, family routines, substance use, historical loss, communal mastery, tribal identity, historical trauma. Child outcomes include, externalizing and internalizing behavior and school attendance. Primary analysis will follow an intent-to-treat approach, and secondary analysis will include examination of change trajectories to determine impact of cultural lessons and exploration of overall effect moderation by age and gender of child and type of caregiver (e.g., parent, grandparent).DiscussionMany Native American parents have endured adverse childhood experiences and traumas that can negatively impact capacity for positive parenting. Study results will provide insights about the potential of a culturally-based intervention to reduce parental distress – an upstream approach to reducing risk for childrens’ later substance misuse and suicidality. Intervention design features, including use of community health workers, cultural grounding, and administration in Head Start settings lend potential for feasibility, acceptability, sustainability, and scalability.Trial registrationClinicalTrials.gov: NCT04201184. Registered 11 December 2019.

2. Cascading Collective Trauma and COVID-19 Pandemic: The Impact on African Americans and Communities of Color

The COVID-19 pandemic led to collective trauma or long-term psychological effects that are shared by a large group of people who all experience an event. Collective trauma is defined as an entire group’s psychological reaction to a traumatic event that affects an entire society. Collective trauma can be caused by events such as pandemics, wars, natural disasters, mass shootings, genocides, systematic and historical oppression, recessions, and famine or severe poverty. This paper is a brief report of the impact of cascading collective trauma during the COVID-19 pandemic on African Americans and other communities of color. Cascading collective traumas are defined as a series of compounding catastrophes that may be both historic and concurrent and results have stronger emotional responses with each new exposure. COVID-19 pandemic was almost immediately followed by another trauma, such as the racial unrest and reports of African Americans being beaten ferociously with no apparent causes. Collective trauma is not always equal in populations. African Americans and other communities of color in the United States are suffering disproportionately from COVID-19, compounded by historical trauma, structural racism, and persistent poverty. Policy changes are needed to address the structural racism and health inequities that negatively impact the physical and mental health of Blacks, Latinx, and other indigenous communities in the United States. More research is needed to examine cascading collective trauma and increased violence.