Indigenous Health Research Research Articles

Indigenous communities, collectives and organizations advancing decolonizing methodologies: perspectives from British Columbia Network Environment for Indigenous Health Research in Canada

PurposeThe British Columbia Network Environment for Indigenous Health Research (BC NEIHR) aims to support and advance research leadership among Indigenous communities, collectives and organizations (ICCOs) within British Columbia, Canada. The BC NEIHR provides support and funding to ICCOs for research development and knowledge sharing. This funding model supports ICCOs' self-determined health research by providing funds that are fully controlled by ICCOs, without the requirement of a non-Indigenous host organization.Design/methodology/approachWe conducted a critical analysis of 35 ICCO research development and knowledge-sharing grant applications to identify how ICCOs are decolonizing research and methodologies.FindingsSix themes were identified from ICCO decolonizing methodologies: (1) identified, driven, and led by Indigenous Peoples and community; (2) guidance from advisors, ethical guidelines, and local protocols; (3) follow traditional and cultural practices; (4) determine what is knowledge and ways to share knowledge; (5) celebrating the sharing and returning of knowledge and (6) advancing relationality: building and strengthening relationships.Originality/valueThis paper highlights the impact of how the BC NEIHR and ICCOs are advancing decolonizing methodologies to support self-determined Indigenous health research led by, and grounded in, Indigenous communities. It reflects on the work of Maori scholar Linda Tuhiwai Smith’s Decolonizing Methodologies: Research and Indigenous Peoples and contributes to the literature of decolonizing methodologies.

An overview of outputs of Aboriginal- and Torres Strait Islander-related publications from University Departments of Rural Health in Australia; 2010-2021.

Disparities in the health of Indigenous people and in the health of rural populations are well described. University Departments of Rural Health (UDRHs) in Australia are federally funded under a program to address ongoing challenges with health workforce distribution for rural and remote areas. They have a significant role in research in regional, rural and remote areas, including research related to Indigenous health. However, a comprehensive analysis of their contributions to original Indigenous health related to Indigenous health is lacking. This study examines the contributions of UDRHs to Indigenous issues through analysis of publications of UDRHs focused on Indigenous health during the period 2010-2021. This paper examines a database of UDRH Indigenous-related publications from 2010 to 2021. A total of 493 publications to which UDRHs contributed were analysed, including 354 original research articles. Health services research was the most common category, followed by epidemiology and papers exploring Indigenous culture and health. While health services research substantially increased over the period, the numbers of original research papers specifically focused on Indigenous workforce issues, whether related to Indigenous people, students or existing workforce was relatively small. This broad overview shows the nature and trends in Indigenous health research by UDRHs and makes evident a substantial contribution to Indigenous health research, reflecting their commitment to improving the health and well-being of Indigenous communities. The analysis can help direct future efforts, and future analyses should delve deeper into the impact of this research and further engage Indigenous researchers.

Holistic Education and Pedagogy from the Inuit Worldview

This article delves into the intricate fabric of Inuit holistic pedagogical practice, balancing the narrative and the historical dominance of Western colonial education frameworks within Inuit Nunangat. For decades, Inuit knowledge and learning methodologies have been marginalized, leading to a disconnect between education and the cultural fabric of the Inuit community. Recognizing the urgent need for revitalization and elevation of Inuit pedagogical models, this paper draws upon the invaluable insights of Elders, existing research, and narratives from two Inuit learners actively engaged in the Nunavut Network Environment for Indigenous Health Research. The study intertwines the wisdom of Elders, scholarly literature, and the lived experiences of Inuit learners to articulate learning models and specific components that are key in practice, such as experiential learning and relationship-building. By synthesizing diverse perspectives, the article offers an emerging multi-faceted understanding of Inuit pedagogical practice, highlighting its intrinsic connection to cultural identity, community well-being, and lifelong learning. Through the narratives of Inuit learners, the paper provides tangible examples of the transformative power of Inuit pedagogy in action, emphasizing the positive impact on individual empowerment and community resilience. By amplifying the voices of Elders and learners, this article contributes to the ongoing discourse on culturally responsive education and underscores the significance of reclaiming and reinstating Inuit holistic pedagogy as a cornerstone for education in the region.

Advancing Indigenous primary health care research and education capacity: a qualitative study in Alberta, Canada

Background/Purpose The study explores the perspectives of family physicians in Alberta regarding Indigenous health research education within the framework of primary health care (PHC). Recognizing the key role of PHC in healthcare system, the research identified the preferences and needs of family physicians for relevant and accessible research skills education. To design effective research education, it is critical to understand the skills, content, and delivery methods desired by family physicians engaged in Indigenous health research. The Indigenous Primary Health Care and Policy Research (IPHCPR) Network is examined as a potential transformative platform aligned with Truth and Reconciliation Commission principles and Calls to Action. Methods Through purposive sampling, 12 family physicians practicing in Alberta were recruited to participate in semi-structured qualitative interviews . The study utilized a thematic content approach for data analysis. Results Four key themes emerged from the analysis: 1) Indigenous role modeling; 2) cohort-based learning; 3) relational learning; and 4) the epistemic importance of Indigenous perspectives on learning. Participants emphasized the need for mentorship, collaborative learning settings, and meaningful connections within a research network. Discussion The IPHCPR Network stands out as a pivotal platform for transformative change in healthcare research education, offering opportunities for family physicians, researchers, trainees, and communities to collaboratively improve Indigenous health outcomes. Through its inclusive practices, the network aligns with TRC principles to advance Indigenous health equity and addressing critical gaps in Indigenous primary health research and practice.

Supporting Indigenous Graduate Student Health Research Capacity: Mentorship through a Provincial Health Research Network Environment in British Columbia,

The British Columbia Network Environment for Indigenous Health Research (BC NEIHR), funded by the Canadian Institute of Health Research, is an Indigenous-led network that supports the research development and knowledge sharing of Indigenous communities, collectives and organizations and Indigenous graduate students in BC. To understand how we impacted the health research journey of Indigenous graduate students, we conducted a critical analysis of our annual evaluation reports and offer a reflective narrative of our operations. In this article, we share our Indigenous mentorship model and describe how we supported and enhanced Indigenous-led research among Indigenous graduate students in BC by: addressing common challenges related to financial costs of pursuing health research; prioritizing cultural and land-based learning opportunities; providing exceptional academic and professional development opportunities; and promoting Indigenous cultural safety, equity, and self-determination by creating systems-level change through partnerships. We conclude that as we work toward systems change, the BC NEIHR offers a promising approach towards enhancing Indigenous health research capacity through mentorship.

Place-Based Indigenous Student Mentorship: Storying the Process of the Atlantic Indigenous Mentorship Network

Introduction. Indigenous post-secondary education students bring unique insights, knowledges, and expertise into post-secondary education spaces. Yet, post-secondary education in Canada is often a site of marginalization for Indigenous students given its’ colonial underpinnings. Targeted mentorship initiatives can be a way to support Indigenous learners through their post-secondary education journeys. Purpose. This manuscript chronicles the creation and ongoing work of the Atlantic Indigenous Mentorship Network and shares insights, challenges, and goals for the network as it continues to support Indigenous students in the Atlantic region. Implications. Our network utilizes a multi-pronged mentorship approach through offering financial, learning, and mentorship opportunities guided by the voices of Indigenous students in the region. Notably, our ability to build relationships with and amongst Indigenous students is strengthened through having an Indigenous graduate student coordinating the network over more than four years. Given the diversity of Indigenous Peoples in the Atlantic, our network has and continues to capture and engage with diverse Indigenous learners in a way that pays respect to their unique knowledges and challenges through continuous consultation and engagement. Our success is demonstrated through the increase in funded students conducting Indigenous health research in the region and through feedback gathered directly from students engaged with the network. Conclusion. By sharing the story of the Atlantic Indigenous Mentorship Network, we hope that learnings and insight can be gleamed to create and continue to strengthen other mentorship initiatives directed towards supporting Indigenous students.

How Etuaptmumk/Two-Eyed Seeing is used in indigenous health research: A scoping review

Our scoping review sought to describe how Etuaptmumk or Two-Eyed Seeing is used and reported on in Indigenous health research. Using the JBI scoping review methodology, we extracted uses of Etuaptmumk/Two-Eyed Seeing from 83 articles and then categorized the reported uses of Etuaptmumk/Two-Eyed Seeing according to Huria et al.’s eight CONSIDER statement domains (governance, prioritization, relationships, methodologies, participation, capacity, analysis and interpretation, and dissemination). We found that while authors used Etuaptmumk/Two-Eyed Seeing in varied ways and at different stages of their research projects, characterizations of the guiding principle were often insufficiently described or overly simplified. This scoping review intends to contribute to a greater dialogue about how Etuaptmumk/Two-Eyed Seeing is conceptualized and used in Indigenous health research with the goal of encouraging more intentional reporting of the guiding principle.

Reflecting on the quality of a methodologically pluralist evaluation of a large-scale Indigenous health research collaboration in Australia

BackgroundIndigenous communities worldwide lead calls for all evaluations of research, programmes and policies affecting their communities to reflect the values, priorities and perspectives of the Indigenous peoples and communities involved....

Knowledge translation in Indigenous health research: voices from the field.

To better understand what knowledge translation activities are effective and meaningful to Indigenous communities and what is required to advance knowledge translation in health research with, for, and by Indigenous communities. Workshop and collaborative yarning. Lowitja Institute International Indigenous Health Conference, Cairns, June 2023. About 70 conference delegates, predominantly Indigenous people involved in research and Indigenous health researchers who shared their knowledge, experiences, and recommendations for knowledge translation through yarning and knowledge sharing. Four key themes were developed using thematic analysis: knowledge translation is fundamental to research and upholding community rights; knowledge translation approaches must be relevant to local community needs and ways of mobilising knowledge; researchers and research institutions must be accountable for ensuring knowledge translation is embedded, respected and implemented in ways that address community priorities; and knowledge translation must be planned and evaluated in ways that reflect Indigenous community measures of success. Knowledge translation is fundamental to making research matter, and critical to ethical research. It must be embedded in all stages of research practice. Effective knowledge translation approaches are Indigenous-led and move beyond Euro-Western academic metrics. Institutions, funding bodies, and academics should embed structures required to uphold Indigenous knowledge translation. We join calls for reimaging health and medical research to embed Indigenous knowledge translation as a prerequisite for generative knowledge production that makes research matter.

Progress towards cultural safety in Indigenous cardiovascular health care and research

Progress towards cultural safety in Indigenous cardiovascular health care and research

Indigenous community engagement requirements for academic journals

This commentary emerged from an Indigenous research ethics and governance gathering and a scoping review completed by a diverse team of Indigenous and non-Indigenous scholars, which includes some of the co-authors of this article. A lack of detail regarding whether and how community engagement was carried out and reported in the context of published Indigenous health research in the Atlantic region of Canada were identified. This commentary builds on this work as well as other published works that emphasize the need to further ensure that Indigenous research is community based if not community led. Moreover, this commentary lends support to important changes to journal submission requirements regarding Indigenous health research submissions recently made at the Canadian Journal of Public Health through the work of Senior Editor Dr Janet Smylie and colleagues.

Indigenous methodologies walking together in a good way: urban Indigenous collective governance in health research

Indigenous methodology is a living methodology of doing research in a good way that honours respectful relationships with Indigenous Peoples and communities in which knowledge is co-created and ownership is shared. Guided by Indigenous methodologies, the Urban Indigenous Collective Governance Circle was co-developed for urban Indigenous health research. The Collective Governance uses approaches that stay true to the connectedness of Traditional Knowledges, Indigenous protocols, and relational processes. Relationality ensures guidance from knowledge, experiences, and wisdom of community members participating in, leading, and benefitted by the research. The Governance Circle ensures that self-determination and self-governance is realized through Indigenous health research; research responsive to community-identified priorities, leadership, control, approval, and community ownership. The Collective Governance embraces ethical, respectful, and reciprocal research through a shared process to address health equity for urban Indigenous Peoples. We share insights and recommendations on how to support meaningful urban Indigenous-led community health research.

Honoring our teachings: children's storybooks as indigenous public health practice.

American Indian and Alaska Native (AIAN) communities continue to flourish and innovate in the face of the COVID-19 pandemic. Storytelling is an important tradition for AIAN communities that can function as an intervention modality. To support the needs of AIAN children and caregivers, we (a collaborative workgroup of Indigenous health researchers) developed a culturally grounded storybook that provides pandemic-related public health guidance and mental health coping strategies woven with Inter-Tribal values and teachings. A collaborative workgroup, representing diverse tribal affiliations, met via four virtual meetings in early 2021 to discuss evolving COVID-19 pandemic public health guidance, community experiences and responses to emerging challenges, and how to ground the story in shared AIAN cultural strengths. We developed and distributed a brief survey for caregivers to evaluate the resulting book. The workgroup iteratively reviewed versions of the storyline until reaching a consensus on the final text. An AI artist from the workgroup created illustrations to accompany the text. The resulting book, titled Our Smallest Warriors, Our Strongest Medicine: Honoring Our Teachings during COVID-19 contains 46 pages of text and full-color illustrations. An online toolkit including coloring pages, traditional language activities, and caregiver resources accompanies the book. We printed and distributed 50,024 physical copies of the book and a free online version remains available. An online survey completed by N = 34 caregivers who read the book with their child(ren) showed strong satisfaction with the book and interest in future books. The development of this storybook provides insights for creative dissemination of future public health initiatives, especially those geared toward AIAN communities. The positive reception and widespread interest in the storybook illustrate how braiding AIAN cultural teachings with public health guidance can be an effective way to disseminate health information. This storybook highlights the importance of storytelling as an immersive learning experience through which caregivers and children connect to family, community, culture, and public health guidance. Culturally grounded public health interventions can be effective and powerful in uplifting AIAN cultural values and promoting health and well-being for present and future generations.

Moving Beyond Ignorance and Epistemic Violence: Indigenous Health Nurses' Response to Systems Transformation.

Health inequity among Indigenous populations continues to widen despite advances in Indigenous health research. Under Canada's esteemed universal healthcare system, Indigenous populations continue to experience much poorer health outcomes due to the intersectional legacies of colonialism and racism. In this commentary, we reflect on structural, systemic and service delivery racism at all levels of care, which are deeply embedded in historical, political, institutional and socioeconomic policies and practices that continue to perpetuate harm and genocide of Indigenous Peoples. We call for immediate action to re-establishing epistemic justice and reframing Indigenous knowledge systems in nursing practices, policies, research and education as the starting point in counteracting systemic racism.

Royal Society of Canada working group on health research system recovery: strengthening Canada’s health research system after the COVID-19 pandemic

The Royal Society of Canada Working Group on Health Research System Recovery developed actionable recommendations for organizations to implement to strengthen Canada’s health research system. Recommendations were based on input from participants from G7 countries and Australia and New Zealand. Participants included health research funding agency leaders; research institute leaders; health, public health, and social care policy-makers; researchers; and members of the public. The recommendations were categorized using the World Health Organization’s framework for health research systems and include governance/stewardship: (1) Outline research logistics as part of emergency preparedness to streamline research in future pandemics. (2) Embed equity and inclusion in all research processes. (3) Facilitate streamlined, inclusive, and rigorous processes for grant application preparation and review. (4) Create knowledge mobilization infrastructure to support the generation and use of evidence. (5) Coordinate research efforts across local, provincial, national, and international entities. Financing: (6) Reimagine the funding of health research. Capacity building: (7) Invest in formative training opportunities rooted in equity, diversity, and anti-racism. (8) Support researchers’ career development throughout their career span. (9) Support early career researchers to establish themselves. Producing and using research: (10) Strengthen Indigenous health research and break down systemic barriers to its conduct. (11) Develop mechanisms to produce novel research. (12) Enhance research use across the health research ecosystem.

Collaboration with Indigenous communities in an integrated care learning health system in Ontario, Canada: a case study of the Frontenac, Lennox & Addington Ontario Health Team

Context: Health systems in the province of Ontario in Canada have been restructured into Ontario Health Teams (OHTs). OHTs seek to provide integrated care through improving patient experience, improving care provider experience, improving population health outcomes, reducing costs, and addressing health equity - per the Quintuple Aim framework. The Frontenac, Lennox & Addington (FLA) OHT was created in bringing together numerous clinical and community partners, including local Indigenous health groups. Indigenous peoples face health inequities driven by colonization and systematic racism; improving accessibility, cultural appropriateness, and cultural safety of health systems are essential. To ensure that unique needs of Indigenous peoples are met, there should be a collaborative, participatory approach to planning and executing Indigenous-specific evaluation activities, with Indigenous-specific performance indicators.
 Objectives: 1) To co-design, implement, and evaluate a governance process for collaboration with Indigenous communities, for Indigenous-focussed evaluation of FLA OHT activities. 2) To nest the above into a case study of the FLA OHT, examining processes for centering Indigenous perspectives and priorities in systems evaluation. 
 Study Design: Case study method involving community-based participatory research (CBPR), and using principles of Ownership, Control, Access, Possession (OCAP) in ethical Indigenous health research. The research team involves Indigenous members of FLA OHT working groups and tables, other partners and stakeholders from the broader Indigenous communities of the region, Queen’s University (Kingston, Ontario) researchers on the FLA OHT’s evaluation support structure, and other FLA OHT team members. Data used for the case study include focus groups and interviews with Indigenous members, analysis of meeting minutes and other relevant organizational documents, and surveys on team function and Indigenous-specific evaluation activities. Indigenous-specific indicators have been identified through rapid literature reviews and are being incorporated into logic models for evaluation of FLA OHT projects.
 Expected Outcomes: 1) A framework to operationalize collaboration between Indigenous stakeholders and mainstream health systems, in the co-design and co-execution of health system evaluation approaches that reflect Indigenous perspectives and priorities. 2) Incorporation of Indigenous-specific evaluation activities for FLA OHT projects.
 Results: Work in progress at time of abstract submission.
 Conclusions: The framework produced will serve as a practical, operationalized guide to other mainstream health systems and Indigenous groups seeking to collaborate together. The Indigenous-specific evaluation activities will enable thoughtful and rigorous consideration of whether the needs of Indigenous patients and communities are met, and allow for modification of programs and services – per the “learning health system” goal of iterative knowledge production and action to drive continuous improvement. Additionally, this project will strengthen relationships between the region’s mainstream service organizations, policymakers, Queen’s University academic researchers, and local Indigenous peoples. Strengthened relationships will facilitate current and future collaborative work to improve systems, as a step towards addressing health inequities facing Indigenous peoples.

The Benefits of Cooperative Inquiry in Health Services Research: Lessons from an Australian Aboriginal and Torres Strait Islander Health Study.

Health services research is underpinned by partnerships between researchers and health services. Partnership-based research is increasingly needed to deal with the uncertainty of global pandemics, climate change induced severe weather events, and other disruptions. To date there is very little data on what has happened to health services research during the COVID-19 pandemic. This paper describes the establishment of an Australian multistate Decolonising Practice research project and charts its adaptation in the face of disruptions. The project used cooperative inquiry method, where partner health services contribute as coresearchers. When the COVID-19 pandemic hit, data collection needed to be immediately paused, and when restrictions started to lift, all research plans had to be renegotiated with services. Adapting the research surfaced health service, university, and staffing considerations. Our experience suggests that cooperative inquiry was invaluable in successfully navigating this uncertainty and negotiating the continuance of the research. Flexible, participatory methods such as cooperative inquiry will continue to be vital for successful health services research predicated on partnerships between researchers and health services into the future. They are also crucial for understanding local context and health services priorities and ways of working, and for decolonising Indigenous health research.

Responding to COVID‐19: How group model building can assist the health and well‐being of urban Indigenous communities in Australia

AbstractIn this paper, we discuss a rapid‐fire study involving Indigenous and non‐Indigenous stakeholders from the urban Indigenous health sector who collaborated to produce an “Urban COVID‐19 Systems Map.” The map outlines the behaviours, actions and responses that stakeholders identified as mitigating or exacerbating COVID‐19 risks in urban Indigenous communities. Data were collected and analysed during the height of the pandemic in 2021. We begin by introducing the characteristics of system thinking—the methodology that informed our research—and consider its use in Indigenous health research more broadly. We then outline our utilisation of system thinking and discuss how it was applied to the three workshops. System thinking contributes to collaboration and collective debate amongst stakeholders and aims to produce holistic understandings of complex problems, such as pandemics. This article provides a reflective overview of the benefits and challenges of applying system thinking in Indigenous health research whilst also sharing some of the research findings. We argue that centralising the voices of stakeholders, particularly Indigenous stakeholders, is critical to developing and implementing effective and culturally appropriate responses to pandemics and is equally as important to the preparedness for future pandemics.

Generations of gardeners regenerating the soil of sovereignty in Moose Cree First Nation: An account of community and research collaboration

The challenges northern remote communities in Canada face acquiring regular access to affordable and healthy food have been well documented. Our Indigenous Health Research Group, made up of an informal network of researchers from universities across Canada, has partnered with northern communities, Tribal Councils, and Political organizations (Assembly of First Nations, Nishnawbe Aski Nation) in Yukon, Northwest Territories, British Columbia, and Ontario since 2004 to document and support local land-based food strategies to increase local food capacity. While much of this work has focused on supporting traditional food harvesting efforts, many community partners are seeking to develop small-scale gardening to increase access to fresh fruit and vegetables. As part of a five-year project supporting local food initiatives in four communities in northern Canada (Northwest Territories and northern Ontario), we worked with the Moose Cree First Nation in Moose Factory, Ontario and their local Food Developer to support food sustainability planning. The research presented in this article describes collaborative efforts between Moose Cree First Nation Band Council leadership, community members, and our research group in support of local garden development as part of their local food sustainability strategy. With the guidance and engagement of community, we worked with families in Moose Factory to build and plant family-centered gardens. The article focuses on start-up engagement strategies, garden uptake, garden construction and planting activities, garden yields, and individual feedback from gardeners describing their experiences with the project.

Indigenous Health Research Mentorship within Post-Secondary Institutions in Canada, the United States, Australia, and New Zealand: A Scoping Review

Indigenous peoples have been engaged in research since time immemorial, and have always acknowledged the power of their own knowledge systems, ways of being, and approaches. However, Indigenous peoples continue to be underrepresented in health research within academic institutions. There is an increased need for Indigenous leadership in health research, including greater Indigenous autonomy, mentorship, and self-determination in health research. This scoping review aims to explore Indigenous mentorship within Indigenous health research in post-secondary institutions in Canada, the US, New Zealand, and Australia. A review of empirical studies, case studies, reviews, commentaries, and grey literature was conducted. Four databases were used: Web of Science, PubMed, Native Health, and Google Scholar. Out of 1594 articles, 11 articles met the inclusion criteria. Four overarching themes were identified: (1) reciprocity: giving back to community; (2) supporting the development of research skills to build research capacity; (3) fostering a sense of belonging; and (4) building student ownership and confidence. The findings suggest that Indigenous mentorship is vital to creating supportive research environments for Indigenous students in the area of health sciences. Indigenous mentorship holds promise to address challenges faced by Indigenous scholars within post-secondary institutions, including intellectual, social, and cultural isolation, and can help to foster greater integration of Indigenous worldviews in Western-dominated academic settings and research systems. Future research should examine place-based mentorship opportunities for Indigenous students in community-based health research environments. Fostering Indigenous mentorship in health sciences is essential for advancing the health and wellbeing of Indigenous peoples and communities.