Indigenous Health Promotion Research Articles

Sparks of Light, Sparks of Life

This article examines the critical issue of Indigenous mental health in Canada, focusing on First Nations, Inuit, and Métis. It underscores the urgency in addressing Indigenous mental wellness challenges, particularly the high rates of suicide, amid their rapid population growth. The study centers on the role of frontline responders in managing mental health and suicidal distress in these communities, and their work to promote life and mental wellness. Through a synthesis of psychological, critical, and Indigenous perspectives, the article reviews Canadian literature on Indigenous mental health and suicide prevention. The article then highlights reflexive insights derived from a knowledge-sharing event with 33 Indigenous mental health professionals, focusing on the unique challenges and opportunities in this field and the importance of life-affirming dialogues in suicide prevention. The article aims to integrate these insights into broader discussions on Indigenous mental wellness, health, and life promotion systems, proposing enhanced wellness and suicide prevention strategies and frameworks tailored to the needs and aspirations of Indigenous communities.

Mental health implementation research in Indigenous communities: creating culturally safe space to enhance collective strengths

In this article, we discuss the construct of cultural safety in relation to the ethics, politics, and practice of implementation research in Indigenous communities. We convened a 3-day workshop, bringing together 23 Indigenous and non-Indigenous collaborators from First Nation communities and universities across Canada to reflect on experiences with implementing an Indigenous youth and family mental health promotion program in First Nation communities. Participants identified three dimensions central to achieving culturally safe space in implementation research: (1) interpersonal dynamics of collaboration between Indigenous and non-Indigenous partners; (2) structural and temporal arrangements necessary for collaborative work; and (3) the systematic recognition and incorporation of Indigenous cultural knowledge, values, and practices. Within implementation research, attention to cultural safety can mitigate the epistemic injustice that arise from research frameworks and methodologies that exclude Indigenous perspectives and values. Cultural safety can increase the likelihood that the research process itself contributes to mental health promotion.

Embodied Politics: Indigenous Migrant Activism, Cultural Competency and Health Promotion in California By Rebecca J.Hester, New Brunswick, NJ: Rutgers University Press.2022. 208 pp.

Embodied Politics: Indigenous Migrant Activism, Cultural Competency and Health Promotion in California By Rebecca J.Hester, New Brunswick, NJ: Rutgers University Press.2022. 208 pp.

Dynamic Nature of Positionality: How my Positionality has Changed Through Experience

As an individual of mixed Métis and European descent, growing up and working/studying in a colonial system, I often reflect on how my biases, perspectives, and identity impact my research in Indigenous health promotion. I am aware that my position of privilege may unintentionally marginalize and disempower others. However, I also acknowledge that my connection to my Métis family and community has given me insights into the perceptions and worldview of Indigenous communities in Canada. In this paper, I explore the dual nature of my position and how it is challenged and shaped through my work with the Kahnawà:ke School Diabetes Prevention Program, Indigenous health promotion leaders, and interactions with Indigenous community members. I discuss how my cultural and personal backgrounds, influenced by my Métis and European heritage, are both questioned and reinforced in these experiences, leading to a deeper connection with my family and community. By considering my positionality, I discuss how it both contributes and poses challenges to the research process in Indigenous health promotion contexts.

Waka ama: An exemplar of indigenous health promotion in Aotearoa New Zealand.

The use of old-style, top-down health education and awareness programmes in Aotearoa New Zealand, which adopt a single issue-based approach to health promotion, primarily ignores a broad approach to social determinants of health, as well as indigenous Māori understandings of wellbeing. This paper draws on the indigenous framework Te Pae Māhutonga as a guide for presenting narratives collated from members of a waka ama rōpū (group) who were interviewed about the social, cultural and health benefits of waka ama. This waka ama case study is an exemplar of community-led health promotion within an indigenous context, where Māori values and practices, such as whanaungatanga (the process of forming and maintaining relationships), manaakitanga (generosity and caring for others) and kaitiakitanga (guardianship), are foundational. The findings highlight the multiple benefits of engagement in waka ama and illustrate effective techniques for enhancing wellbeing within local communities. At a time when Aotearoa New Zealand is seeing a decreasing trend in physical activity levels and an increase in mental health challenges, waka ama provides us with an exemplar of ways to increase health and wellbeing within our communities. SO WHAT?: The findings of this research contribute to the evidence base of effective indigenous health promotion, bridging the gap between academia and local community action. To better recognise, comprehend and improve indigenous health and wellbeing, we argue that active participation of people in the community is required to achieve long-term and revolutionary change.

Culturally appropriate health solutions: Aboriginal men 'thriving' through activities in Men's Sheds/groups.

This study examines social determinants impacting the health and wellbeing of Aboriginal and Torres Strait Islander men in Australia. Social determinants prevent many men from thriving in community environments which also impacts on their social, work and family lives. We examine the impact on men's health and identify how men who participate in Men's Sheds/groups engage in learning about health interventions. Our study extends the work of Percival et al. and their Indigenous health promotion model. A qualitative case study approach conducted 'gatherings' and 'yarning circles' (focus groups) with men from urban, regional and remote areas of the country. We argue that men's groups can serve as a central intervention to support men to build their confidence to learn about health and wellbeing and how to thrive through activities in community life. Findings support health interventions delivered through training and mentoring around various health and other services, healthy eating, sport and fathering programmes (to name a few) to enhance awareness and men's vitality for learning. There are implications for our healthcare system to better understand the conditions of Aboriginal men's health and support these vulnerable groups. Our study proposes men's groups as culturally safe environments to promote and deliver central health promotion interventions that support men to thrive in all facets of their lives.

One Size Does not Fit All – A Realist Review of Screening Asymptomatic Atrial Fibrillation in Indigenous Communities in Australia, Canada, New Zealand, and the USA

The true prevalence of atrial fibrillation (AF) is underestimated because asymptomatic AF is underdetected. Adverse consequences of AF such as stroke may occur before AF is diagnosed. Current guidelines recommend opportunistic screening of AF in the general population for patients 65 years and older; however, this might not be suitable for Indigenous people. Screening for AF meets the World Health Organization criteria for successful routine screening, yet little is known about successful implementation of AF screening in Indigenous communities. This study uses a realist review methodology and framework to identify what works, how, for whom, and under what circumstances for AF screening in Indigenous communities. Eight databases and gray literature were searched for studies targeted at AF screening in Indigenous communities. Realist analysis was used to identify context-mechanism-outcome configurations across 11 included records. Some mechanisms that improve AF screening in Indigenous communities were identified. Salient enablers of AF screening in Indigenous communities include opportunistic nonclinical settings, portable electrocardiogram devices, and increasing training in Indigenous health-care workers. Tailoring follow-up protocols that are geographically and culturally appropriate to the settings is important. Prominent barriers included lack of cultural safety, fear of abnormal results, and time-poor environments. A middle-range theory is proposed in combination with the Indigenous health promotion tool model. Indigenous populations require earlier screening and culturally safe approaches for AF detection and pathways to treatment. A novel AF screening strategy is required. This realist review provides lessons learned for the successful implementation of AF screening and treatment programs for Indigenous communities.

Climate change impacts on indigenous health promotion: the case study of Dikgale community in Limpopo Province, South Africa

The most important determinants of indigenous health promotion are availability and accessibility of water, food and traditional medicine. It is for this reason that the 1986 Ottawa Charter for Health Promotion proposed the inclusion of food, water and ecosystems in any health promotion strategies. The present study describes the extent to which climate change in the form of rainfall scarcity and increased temperatures impacts the availability and accessibility of quality water, food and traditional medicine as basic determinants of indigenous health promotion. In-depth interviews were conducted with 240 participants purposely selected from Dikgale community in Limpopo Province, South Africa. The study results show that availability and accessibility of water, food and traditional medicine are negatively impacted by increased temperature and scarcity of rainfall. These resources are scarcely encountered, and where they exist, they are of poor quality. However, community members resorted to modern technological practices such as sourcing water from the municipal water reticulation system, buying foodstuffs from retail outlets and immunization against disease via modern health care facilities. It can be deduced from the study that the prerequisites of indigenous health promotion are climate-sensitive. They become available and accessible under favourable climate conditions, and are scarce under unfavourable climate conditions, a situation that compromises the practice of indigenous health promotion.

Health Promotion Strategies to Address Gambling-Related Harm in Indigenous Communities: A Review of Reviews

The evolution of commercial gambling and its expansion into digital arenas has increased opportunities for people all over the world—including Indigenous people—to gamble. While there is considerable evidence for the suitability of a health promotion approach to improving the health and well-being of Indigenous communities worldwide, the evidence-base does not extend to the field of gambling research. A systematic review of reviews was conducted to identify relevant reviews in crossover areas of interest: interventions to address gambling-related harm in Indigenous populations and/or health promotion interventions on related health or behavioural outcomes. The quality of reviews was critically assessed—13 fit the inclusion criteria. Principal themes were characterised as being either related to ‘cultural,’ ‘structural,’ or ‘methodological’ factors. Findings indicate that an appropriate model of health promotion to address Indigenous gambling would necessarily involve careful consideration of all three elements. Applying a health promotion approach to the context of Indigenous gambling harms is increasingly relevant considering recent conceptual shifts in key areas, but there is currently limited evidence to guide the implementation and evaluation of such strategies. This review highlights what published evidence is available to strengthen future research in this area.

From controlling to connecting: M'Wikwedong as a place of urban Indigenous health promotion in Canada.

In recent years, health promotion has come under critique for being framed according to the contexts and priorities of Western communities, with the notion of 'control' underpinning much of its theoretical and practical development. Ceding space to Indigenous voices and knowledge is one way forward to overcoming this limitation and decolonizing the field. This paper reports on insights gained from a participatory digital storytelling project focused on Indigenous health promotion that took place at M'Wikwedong Indigenous Friendship Centre in the city of Owen Sound, Canada. The research team was formed by M'Wikwedong's Executive Director, five Indigenous youth and two university researchers. We co-created data through an 8-month digital storytelling process that involved 13 weekly research meetings, the creation of 4 digital stories and video screenings. We analysed data from seven group interview transcriptions, field notes and video transcripts through qualitative coding and theme building. The four themes we identified speak to the ways M'Wikwedong reinforced connections to youth, their sense of self, place in the city and Indigenous cultures. From our findings, we theorize that egalitarianism of knowledge, restoring balance in relationships and Indigenous leadership are core components of an 'ethos of connection' that underlies Indigenous health promotion. The 'ethos of connection' challenges Western notions of 'control' and brings attention to the unique expertise and practices of urban Indigenous communities and organizations as a primary basis for health promotion.

Integrating pharmacists into care teams: a qualitative systematic review protocol.

This review will systematically examine the qualitative literature reporting on strategies that have been used (or could be developed) by health care services to integrate pharmacists into a multidisciplinary health care team. Delivery models of pharmaceutical care have been developed, trialed and refined since this concept was first defined more than 30 years ago. Delivery models that integrate pharmacists within a multidisciplinary team allow pharmacists to play a pivotal role in improving health outcomes for patients and contributing to patient self-management. Systematic reviews clearly demonstrate the effectiveness of these models; however, the attitudes, beliefs, expectations, understandings, perceptions and experiences of these multidisciplinary teams is less clear. The populations of interest in this review are health care providers, including hospital specialists, general practitioners, nurses, health workers, pharmacists, allied health workers, aged care workers, Indigenous health workers and health promotion workers. The phenomena of interest are attitudes, beliefs, expectations, understandings, perceptions and experiences of the populations of interest arising from experiencing, developing or implementing strategies that have or could support the integration of pharmacists into multidisciplinary health care teams. The databases to be searched include PubMed, Cochrane, EBSCO (CINAHL), Embase, MedNar, Trove and Australian Indigenous Health Infonet. Studies published from 2011 onwards and in English will be considered for inclusion. Selected studies will be assessed for methodological quality by two independent reviewers, using standardized critical appraisal instruments. Where possible, qualitative research findings will be pooled. Where textual pooling is not possible, the findings will be presented in narrative form.

Climate change and Indigenous Health Promotion.

Climate change poses a serious threat to the health and well-being of Indigenous peoples around the world. Despite living in diverse contexts, Indigenous peoples face a number of common challenges. Disproportionate threats from climate change exist due to a range of factors including unique relationships with the natural environment, socioeconomic deprivation, a greater existing burden of disease, poorer access to and quality of health care, and political marginalization. Responses to climate change at global, national, and local levels also threaten Indigenous people's rights. While climate action presents many opportunities to improve health and reduce inequities, there is also significant potential for climate mitigation and adaptation policies to inflict harm on Indigenous peoples. An important aspect of this is the impact on traditional lands, which are acknowledged as a fundamental determinant of Indigenous health and well-being. This article seeks to elucidate the relationships between climate change and Indigenous health and to inform health promotion solutions to achieve climate justice for Indigenous peoples. The underpinning analysis is founded on a Kaupapa Māori positioning, which seeks transformative change and involves critiquing Western knowledges and structures that undermine Indigenous rights. A central theme is that anthropogenic climate change is intimately connected to the ideologies, systems and practices of colonialism, and that the impacts on Indigenous peoples can be conceptualized as an intensification of the process of colonization. It is not possible to understand and address climate-related health impacts for Indigenous peoples without examining this broader context of colonial oppression, marginalization and dispossession. The challenge for health promotion is to engage in a process of decolonization. This involves deconstructing its own systems and practices to avoid reinforcing colonialism and perpetuating inequities. It also requires health promotion practitioners to support Indigenous self-determination and recognize Indigenous knowledges as a critical foundation for climate change and health solutions.

Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities.

Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts "from the ground up." Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.

Advancing Indigenous primary health care policy in Alberta, Canada

For Indigenous people worldwide, accessing Primary Health Care (PHC) services responsive to socio-cultural realities is challenging, with institutional inequities in healthcare and jurisdictional barriers encumbering patients, providers, and decision-makers. In the Canadian province of Alberta, appropriate Indigenous health promotion, disease prevention, and primary care health services are needed, though policy reform is hindered by complex networks and competing interests between: federal/provincial funders; reserve/urban contexts; medical/allied health professional priorities; and three Treaty territories each structuring fiduciary responsibilities of the Canadian government.In 2015, the Truth and Reconciliation Commission (TRC) of Canada released a final report from over six years spent considering impacts of the country's history of Indian residential schools, which for more than a century forcibly removed thousands of children from their families and communities. The TRC directed 94 calls to action to all levels of society, including health systems, to address an historical legacy of cultural assimilationism against Indigenous peoples. To address TRC calls that Indigenous health disparities be recognized as resulting from previous government policies, and to integrate Indigenous leadership and perspectives into health systems, PHC decision-makers, practitioners, and scholars in the province of Alberta brought together stakeholders from across Canada. The gathering detailed here explored Indigenous PHC models from other Canadian provinces to collaboratively build relationships for policy reform and identify opportunities for PHC innovations within Alberta.

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.

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.

Deadly Choices empowering Indigenous Australians through social networking sites.

The potential for health promotion through social networking sites (SNSs) is widely recognized. However, while health promotion prides itself in focusing on the social determinants of health, its partiality for persuading individuals to comply with health behaviours dominates the way health promotion utilizes SNSs. This paper contributes to an understanding of collaborative ways SNSs can work for health promotion agendas of self-determination and empowerment in an Indigenous Australia context. An ethnographic study was undertaken with Deadly Choices, an Indigenous-led health promotion initiative. The study involved participant observation of interactions on Deadly Choices SNSs between Deadly Choices and its online community members. Deadly Choices provides an example of SNSs providing a powerful tool to create a safe, inclusive and positive space for Indigenous people and communities to profile their healthy choices, according to Indigenous notions of health and identity. The study found five principles that underpin Deadly Choices' use of SNSs for health promotion. These are: create a dialogue; build community online and offline; incentivise healthy online engagement; celebrate Indigenous identity and culture; and prioritize partnerships. Deadly Choices SNSs empowers Indigenous people and communities to be health promoters themselves, which represents a power shift from health promotion practitioner to Indigenous people and communities and more broadly, an enactment of Indigenous self-determination on SNSs. Mainstream health promotion can learn from Indigenous health promotion practice regarding the use of SNSs for health promotion agendas.

Enhancing Indigenous Health Promotion Research Through Two-Eyed Seeing: A Hermeneutic Relational Process.

The intention of this article is to demonstrate how Indigenous and allied health promotion researchers learned to work together through a process of Two-Eyed Seeing. This process was first introduced as a philosophical hermeneutic research project on diabetes prevention within an Indigenous community in Quebec Canada. We, as a research team, became aware that hermeneutics and the principles of Haudenosaunee decision making were characteristic of Two-Eyed Seeing. This article describes our experiences while working with each other. Our learning from these interactions emphasized the relational aspects needed to ensure that we became a highly functional research team while working together and becoming Two-Eyed Seeing partners.

Implementing health promotion tools in Australian Indigenous primary health care.

In Australia, significant resources have been invested in producing health promotion best practice guidelines, frameworks and tools (herein referred to as health promotion tools) as a strategy to improve Indigenous health promotion programmes. Yet, there has been very little rigorous implementation research about whether or how health promotion tools are implemented. This paper theorizes the complex processes of health promotion tool implementation in Indigenous comprehensive primary healthcare services. Data were derived from published and grey literature about the development and the implementation of four Indigenous health promotion tools. Tools were theoretically sampled to account for the key implementation types described in the literature. Data were analysed using the grounded-theory methods of coding and constant comparison with construct a theoretical implementation model. An Indigenous Health Promotion Tool Implementation Model was developed. Implementation is a social process, whereby researchers, practitioners and community members collectively interacted in creating culturally responsive health promotion to the common purpose of facilitating empowerment. The implementation of health promotion tools was influenced by the presence of change agents; a commitment to reciprocity and organizational governance and resourcing. The Indigenous Health Promotion Tool Implementation Model assists in explaining how health promotion tools are implemented and the conditions that influence these actions. Rather than simply developing more health promotion tools, our study suggests that continuous investment in developing conditions that support empowering implementation processes are required to maximize the beneficial impacts and effectiveness of health promotion tools.

Creating a Community of Practice to Prevent Suicide Through Multiple Channels: Describing the Theoretical Foundations and Structured Learning of PC CARES.

It is critical to develop practical, effective, ecological, and decolonizing approaches to indigenous suicide prevention and health promotion for the North American communities. The youth suicide rates in predominantly indigenous small, rural, and remote Northern communities are unacceptably high. This health disparity, however, is fairly recent, occurring over the last 50 to 100 years as communities experienced forced social, economic, and political change and intergenerational trauma. These conditions increase suicide risk and can reduce people's access to shared protective factors and processes. In this context, it is imperative that suicide prevention includes--at its heart--decolonization, while also utilizing the "best practices" from research to effectively address the issue from multiple levels. This article describes such an approach: Promoting Community Conversations About Research to End Suicide (PC CARES). PC CARES uses popular education strategies to build a "community of practice" among local and regional service providers, friends, and families that fosters personal and collective learning about suicide prevention in order to spur practical action on multiple levels to prevent suicide and promote health. This article will discuss the theoretical underpinnings of the community intervention and describe the form that PC CARES takes to structure ongoing dialogue, learning, solidarity, and multilevel mobilization for suicide prevention.

'We don't tell people what to do': ethical practice and Indigenous health promotion.

Health promotion aspires to work in empowering, participatory ways, with the goal of supporting people to increase control over their health. However, buried in this goal is an ethical tension: while increasing people's autonomy, health promotion also imposes a particular, health promotion-sanctioned version of what is good. This tension positions practitioners precariously, where the ethos of empowerment risks increasing health promotion's paternalistic control over people, rather than people's control over their own health. Herein we argue that this ethical tension is amplified in Indigenous Australia, where colonial processes of control over Indigenous lands, lives and cultures are indistinguishable from contemporary health promotion 'interventions'. Moreover, the potential stigmatisation produced in any paternalistic acts 'done for their own good' cannot be assumed to have evaporated within the self-proclaimed 'empowering' narratives of health promotion. This issue's guest editor's call for health promotion to engage 'with politics and with philosophical ideas about the state and the citizen' is particularly relevant in an Indigenous Australian context. Indigenous Australians continue to experience health promotion as a moral project of control through intervention, which contradicts health promotion's central goal of empowerment. Therefore, Indigenous health promotion is an invaluable site for discussion and analysis of health promotion's broader ethical tensions. Given the persistent and alarming Indigenous health inequalities, this paper calls for systematic ethical reflection in order to redress health promotion's general failure to reduce health inequalities experienced by Indigenous Australians.