Indigenous Peoples Worldwide Research Articles

Food sovereignty in Kalaallit Nunaat

Kalaallit Nunaat (Greenland), a self-governing country within the Danish Realm with a majority Indigenous population, has one of the most far-reaching self-determination arrangements of all Indigenous peoples worldwide. A close look at the food system in Kalaallit Nunaat, however, reveals a situation in which Indigenous foods are marginalized and imported foods are promoted even when incompatible with the local context. Here, I ask why Danish foods are so prevalent in Kalaallit Nunaat and argue that an unacknowledged factor in dietary transitions, well-known to be the cause of major public health issues, is a biased view of foodways that favors imported foods and questions Indigenous foods. The conclusion is that there is a lack of Indigenous food sovereignty in Kalaallit Nunaat such that Indigenous views of food and health are not prioritized in the public food system. The significance of this conclusion is that without Indigenous food sovereignty, Indigenous health, wellbeing and thriving cannot be achieved.

Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence.

Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities. In this manuscript, we aimed to examine the current evidence on disparities in Indigenous access to services along the lung cancer treatment pathway. A narrative literature review was conducted for all manuscripts and reports published up until July 20, 2022, using Medline, Scopus, Embase, and Web of Science. Following the identification of eligible literature, full-text versions were scanned for relevance for inclusion in this review, and relevant information was extracted. After scanning 1,459 documents for inclusion, our final review included 36 manuscripts and reports that included information on lung cancer service access for Indigenous peoples relative to non-Indigenous peoples. These documents included data from Aotearoa New Zealand, Australia, Canada, and the USA (including Hawai'i). Our review found evidence of disparities in access to, and the journey through, lung cancer care for Indigenous peoples. Disparities were most obvious in access to early detection and surgery, with inconsistent evidence regarding other components of the pathway. These observations are made amid relatively scant data in a global sense, highlighting the need for improved data collection and monitoring of cancer care and outcomes for Indigenous peoples worldwide. Access to early detection and guideline-concordant treatment are essential to addressing enduring disparities in cancer survival experienced by Indigenous peoples globally.

Hopeful, but Worried for the Future: An Analysis of the Lived Consequences of Colonisation as Narrated by Older South Sámi in Norway

Various forms of colonisation and discrimination processes are unfortunately common to Indigenous Peoples worldwide. In this article, the focus is the lived consequences of colonisation in the Norwegian part of Sápmi (the Sámi traditional lands), where systematic state-imposed colonisation officially ended decades ago. Thus, based on a thematic analysis of qualitative in-depth interviews with 12 South Sámi aged 67–84, the aim was to examine how stories about hopes and worries for the future can shed light on how colonisation is experienced among older South Sámi today. The voices of these participants are important, as they can be considered triply muted, due to (a) ageism and (b) continued yet unconscious colonising practices against the Sámi in general and (c) against the South Sámi people in particular, a minority within the minority. Inspired by decolonising perspectives, this article reveals that older South Sámi are worried for the future, not only due to memories from the past but also their experiences with persisting colonial practices such as the ongoing enlargement of windmill parks and cabin areas in the midst of the winter pastures of the South Sámi reindeer herders. Hopefully, the time has come to finally put an end to colonial practices and take collective responsibility for creating a more just future for both coloniser and colonised. Similarly to the participants in this study, the report from the Truth and Reconciliation Commission also stresses issues such as loss of language, experience of racism, and reindeer husbandry being under pressure. This report may therefore be used as an important tool to ameliorate the conditions of the Sámi people if taken into consideration in the time to come.

Climate change, biodiversity loss, and Indigenous Peoples' health and wellbeing: A systematic umbrella review.

Indigenous Peoples worldwide are experiencing a cascade of impacts on their health and wellbeing as a result of climate change and biodiversity loss. Existing literature at the interface of climate change, biodiversity loss, and Indigenous health tells us that Indigenous Peoples are among those most disproportionately and acutely affected by these impacts. Yet, a gap exists with respect to comprehensively and critically synthesizing the impacts reported across this literature and identifying Indigenous-led responses. Guided by an Indigenous advisory group, we employed a systematic umbrella review methodology, following PRISMA guidelines, to characterize the global secondary literature (PROSPERO registration #: CRD42023417060). In so doing, we identified the proximal, intermediate, distal, and gendered impacts of climate change and biodiversity loss on Indigenous health and wellbeing as well as Indigenous-led responses. Five databases were searched for published reviews, along with a grey literature search that focused on underrepresented geographic regions in the academic literature. Two independent reviewers conducted two-stage screening, data extraction, and quality assessment of retrieved records. Basic descriptive statistics were calculated. Qualitative data were analyzed thematically, using a constant comparative approach. A total of 38 review articles met the eligibility criteria and 37 grey literature records were retrieved and included in the review. Reviews were published between 2010-2023 and geographically clustered in the Circumpolar North. Intersecting proximal, intermediate, and distal impacts were characterized as place-based and specific, and linked to colonialism as an antecedent to and driver of these impacts. Gendered impacts were underexplored within reviews. Reviewed literature underscored the value of engaging diverse knowledge systems; platforming localized, community-led adaptation to climate change and biodiversity loss, while addressing sociopolitical constraints to these efforts; and applying a broader conceptualization of health that aligns with Indigenous frameworks. Going forward, we must foreground equity- and rights-based considerations within integrated responses to climate and biodiversity crises.

Increased community engagement of Indigenous Peoples in dementia research leads to higher context relevance of results.

Health research that focuses on Indigenous Peoples must ensure that the community in question is actively engaged, and that the results have context relevance for Indigenous Peoples. Context relevance is "the benefits, usability, and respectful conduct of research from the perspective of Indigenous communities." The purpose of this study was to apply two tools within an already-published scoping review of 76 articles featuring research on cognitive impairment and dementia among Indigenous Peoples worldwide. One tool assessed levels of community engagement reported in the corpus, and the other tool assessed the context relevance of recommendations in the corpus. We hypothesized that research with higher levels of reported community engagement would produce recommendations with greater context relevance for Indigenous Peoples. We employed semi-structured deductive coding using two novel tools assessing levels of reported community engagement and context relevance of recommendations based on studies included in the existing scoping review. Application of the two tools revealed a positive relationship between increasing community engagement and greater context relevance. Community engagement primarily occurred in studies conducted with First Nations, Inuit, and Métis populations in Canada and with Australian Aboriginal and/or Torres Strait Islander Peoples. Research with Alaska Native, American Indian, and Native Hawaiian Peoples in the USA stood out for its comparative lack of meaningful community engagement. There is opportunity to utilize these tools, and the results of this assessment, to enhance training and mentorship for researchers who work with Indigenous populations. There is a need to increase investigator capacity to involve communities throughout all phases of research, particularly in the pre-research stages.

Access to and Timeliness of Lung Cancer Surgery, Radiation Therapy, and Systemic Therapy in New Zealand: A Universal Health Care Context.

Lung cancer is the biggest cancer killer of indigenous peoples worldwide, including Māori people in New Zealand. There is some evidence of disparities in access to lung cancer treatment between Māori and non-Māori patients, but an examination of the depth and breadth of these disparities is needed. Here, we use national-level data to examine disparities in access to surgery, radiation therapy and systemic therapy between Māori and European patients, as well as timing of treatment relative to diagnosis. We included all lung cancer registrations across New Zealand from 2007 to 2019 (N = 27,869) and compared access with treatment and the timing of treatment using national-level inpatient, outpatient, and pharmaceutical records. Māori patients with lung cancer appeared less likely to access surgery than European patients (Māori, 14%; European, 20%; adjusted odds ratio [adj OR], 0.82 [95% CI, 0.73 to 0.92]), including curative surgery (Māori, 10%; European, 16%; adj OR, 0.72 [95% CI, 0.62 to 0.84]). These differences were only partially explained by stage and comorbidity. There were no differences in access to radiation therapy or systemic therapy once adjusted for confounding by age. Although it appeared that there was a longer time from diagnosis to radiation therapy for Māori patients compared with European patients, this difference was small and requires further investigation. Our observation of differences in surgery rates between Māori and European patients with lung cancer who were not explained by stage of disease, tumor type, or comorbidity suggests that Māori patients who may be good candidates for surgery are missing out on this treatment to a greater extent than their European counterparts.

Challenging structural racism through the development of equity-driven core Māori hauora ā iwi/public health competencies for university hauora ā iwi/public health teaching

ABSTRACT In Aotearoa New Zealand, significant health inequities persist between Māori (the Indigenous people) and non-Māori. These ethnic-based inequities are intrinsically linked to Aotearoa New Zealand’s colonial and colonising racist history. Decolonising health systems imbued with racist ideology, and mitigating inequities, is foundational to improving the health outcomes of Māori and Indigenous peoples worldwide. Social justice and equity are internationally recognised core values and functions of the discipline of hauora ā iwi/public health and, more recently, recognised as acting against racism. Tertiary institutions in Aotearoa New Zealand that offer hauora ā iwi/public health as a programme of study have an obligation to improve Māori health and reduce inequities through their teaching. This project aimed to provide a set of core Māori hauora ā iwi/public health competencies, which can be used to support Indigenous equity-focused, anti-racist hauora ā iwi/public health curricula for tertiary institutions, locally and internationally. This paper reports the process of developing a novel set of core Māori hauora ā iwi/public health competencies (as a framework that can be delivered by both Māori and non-Māori/non-Indigenous health academics), designed and set within their international context of educating for Indigenous health equity as well as the Aotearoa New Zealand hauora ā iwi/public health context.

The Multiple Roles of Socio-Anthropological Expert Evidence in Indigenous Land Claims: The Xukuru People Case

ABSTRACT In 2018, the Inter-American Court delivered the first – and so far, only – judgment against Brazil on Indigenous land rights. This leading decision upheld the state’s failure to comply with human rights obligations due to the non-removal of non-Indigenous individuals from the territory of the Xukuru people. Such an issue, namely, insecure land tenure affects Indigenous peoples worldwide. The decision’s outcome consolidated a critical trend in international law concerning the concept of Indigenous lands: a place where Indigenous peoples have their residence and holistically develop their life, which states must actively protect, according to Article 21 of the American Convention read in conjunction with Article 1.1 and 2 thereof. By analyzing secondary sources (inter alia, ethnographies and court documents), this paper addresses the role of social (or cultural) anthropology regarding expert evidence in the Xukuru land claims. It articulates the Brazilian and Inter-American legal framework on expert evidence and Indigenous land rights with the literature on ‘anthropological expertise’ and ‘cultural expertise’, which includes the branches of forensic social anthropology and expert social anthropology. This analysis underscores the evolving challenges concerning expert evidence in legal-administrative procedures on the national and international levels. It argues that cultural anthropologists acting as experts on these levels need different sets of skills, which should be developed through special training. Thus, this paper amplifies the interdisciplinary dialogue between law and social anthropology on the topical issue of human rights adjudication.

Indigenous determinants of health: a unified call for progress

The UN General Assembly formally declared 1993 as the International Year of the World's Indigenous People, with a “view to strengthening international cooperation for the solution of problems faced by Indigenous communities in areas such as human rights, the environment, development, education, and health”. 1 UN General AssemblyInternational Year for the World's Indigenous People, 1993: resolution / adopted by the General Assembly. https://www.refworld.org/docid/3b00f08ab.htmlDate: Dec 14, 1992 Date accessed: June 2, 2023 Google Scholar In 2000, the UN Permanent Forum on Indigenous Issues (UNPFII) was formally established with health as one of its six mandated areas of focus. The UNPFII supported the work to ensure the 2007 adoption of the UN Declaration on the Rights of Indigenous Peoples (UNDRIP), a human rights instrument specifying the rights of Indigenous Peoples worldwide, including the right to health and social security. 2 Redvers N Celidwen Y Cloud QY Jensen A Githaiga C Indigenous solutions to the climate and biodiversity crises: a reflection on UNDRIP. PLOS Glob Public Health. 2023; 3e0002060 Crossref PubMed Google Scholar Yet, globally, substantial challenges remain for Indigenous Peoples.

Building Bridges of Communication: Seeking Conversation between Indigenous and Western Cultures through Magical Consciousness

My aim in this article is to further work on building bridges of communication between Indigenous and Western worldviews through 'magical consciousness', a pan-human participatory and analogical orientation of mind. In a bid to overcome the many cultural differences that have justified the discrimination and genocide of Indigenous peoples worldwide, and the near hegemony of a science based solely on logical knowledge, I seek by comparison a common ground for mutual understanding. Searching out similarities and differences between the world of the Dreaming of Paddy Compass Namadbara, an Australian 'clever man' of north-west Arnhem Land, and the prophetic mythologies of English eighteenth-century artist and poet William Blake, I suggest that it might be possible to find points of conversation and acceptance through stories and mythologies that could aid the healing of differences.

Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review

BackgroundVirtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities.MethodsWe conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities?ResultsWe discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. Discussion: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity.ConclusionThese findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.

Acknowledging colonialism in the room: Barriers to culturally safe care for Indigenous Peoples

Indigenous peoples worldwide continue to face health inequities compared to non-Indigenous populations. Frameworks like cultural safety can be used to mitigate these inequities; however, this is not widely implemented in healthcare settings. Thus, additional research into barriers to providing culturally safe care are critical. To address this need, we examined the existing barriers to culturally safe care for Indigenous peoples in Canada, and Māori in Aotearoa New Zealand, through the perspectives of key informants. Major issues identified by key informants included systemic racism, lack of organisational accountability and/or buy-in, ineffective health-provider education, funding, health system structure, undervaluing Indigenous knowledge, negative framing, terminology, and changes to the concept of cultural safety over time. When examined closely, systemic racism and ongoing settler colonialism are the key driving forces underpinning many of the barriers identified. Findings from this research point to barriers at every level and require a system-wide, intersectoral approach in order to provide culturally safe care for Indigenous peoples and advance Indigenous health equity.

Repatriation of Indigenous Peoples’ Cultural Property: Could Alternative Dispute Resolution Be a Solution? Lessons Learned from the G’psgolox Totem Pole and the Maaso Kova Case

Considering that the vast majority of the objects constituting Indigenous Peoples’ cultural heritage are now located outside their source communities, the restitution of cultural property has become a pressing issue among Indigenous Peoples worldwide and should be understood as part of Indigenous Peoples’ historical (as well as current) encounter with colonization and its consequences. As such, this article investigates whether international cultural heritage law offers any possibilities for successful repatriation and to what extent the shortcomings of the framework in place could be complemented by alternative dispute resolution (ADR) mechanisms and the new mandate of the Expert Mechanism on the Rights of Indigenous Peoples (Expert Mechanism). First, crucial concepts in the repatriation debates are explained. Next the factual background of the case studies of the G’psgolox Totem Pole and Maaso Kova are presented. This is followed by a discussion of the most pertinent mechanisms of international cultural heritage law and the place of Indigenous Peoples’ rights within such a framework. Subsequently, the concept of ADR is introduced, and the details of the negotiation processes between the Haisla First Nation (Canada) and the Yaqui People (Mexico, the United States) – both with the Museum of Ethnography in Stockholm (Sweden) – are presented. Finally, the article evaluates to what extent ADR could be an appropriate mechanism for the settlement of disputes concerningIndigenous Peoples’ cultural property, andwhether the Expert Mechanism is a well-suited body for facilitating the process of repatriating Indigenous Peoples’ cultural heritage.

Indigenous Cultural Identity of Research Authors Standard: research and reconciliation with Indigenous Peoples in rural health journals.

The Indigenous Cultural Identity of Research Authors Standard (ICIRAS) is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously recognised in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination. Reflecting on these broader movements, the editorial teams of three rural health journals - Rural and Remote Health, the Australian Journal of Rural Health, and the Canadian Journal of Rural Medicine - adopted a policy of 'Nothing about Indigenous Peoples, without Indigenous Peoples'. This meant changing practices so that Indigenous Peoples' identity could be embedded in authorship credentials - such as in the byline. An environmental scan of literature about the inclusion of Indigenous Peoples in research revealed many ways in which editorial boards of journals could improve their process to signal to readers that Indigenous voices are included in rural health research publication governance. Improving the health and wellbeing of Indigenous peoples worldwide requires high-quality research evidence. This quality benchmark needs to explicitly signal the inclusion of Indigenous authors. The ICIRAS is a call to action for research journals and institutions to rigorously improve research governance and leadership to amplify the cultural identity of Indigenous peoples in rural health research.

ICIRAS: Research and reconciliation with indigenous peoples in rural health journals.

AimWe aim to promote discussion about an Indigenous Cultural Identity of Research Authors Standard (ICIRAS) for academic journal publications.ContextThis is based on a gap in research publishing practice where Indigenous peoples' identity is not systematically and rigorously flagged in rural health research publications. There are widespread reforms, in different research areas, to counter the reputation of scientific research as a vehicle of racism and discrimination against the world's Indigenous peoples. Reflecting on these broader movements, the editorial teams of three rural health journals—the Australian Journal of Rural Health, the Canadian Journal of Rural Medicine, and Rural and Remote Health—recognised that Indigenous peoples' identity could be embedded in authorship details.ApproachAn environmental scan (through a cultural safety lens where Indigenous cultural authority is respected, valued, and empowered) of literature was undertaken to detect the signs of inclusion of Indigenous peoples in research. This revealed many ways in which editorial boards of Journals could systematically improve their process so that there is ‘nothing about Indigenous people, without Indigenous people’ in rural health research publications.ConclusionImproving the health and wellbeing of Indigenous peoples worldwide requires high quality research evidence. The philosophy of cultural safety supports the purposeful positioning of Indigenous peoples within the kaleidoscope of cultural knowledges as identified contributors and authors of research evidence. The ICIRAS is a call‐to‐action for research journals and institutions to rigorously improve publication governance that signals “Editing with IndigenUs and for IndigenUs”.

A Critique of Philosophical Shamanism

A Critique of Philosophical Shamanism

Addressing inequities in access to care among Indigenous peoples with chronic hepatitis C in Alberta, Canada

Indigenous peoples worldwide continue to suffer disproportionate health inequities resulting from ongoing and intergenerational colonial trauma, including psychological, social, physical, and spiritual effects. 1 Mitchell TL Maracle DT Post-traumatic stress and the health status of Aboriginal populations in Canada. Int J Indig Health. 2005; 2: 14-23 Google Scholar In Canada, contemporary colonial traumas include, but are not limited to, the displacement of Indigenous peoples (First Nations, Inuit, and Métis) from their land and resources, historical banning of cultural ceremony and language, forced removal and abuse of children via the residential school and child welfare systems, and the federal Indian Act (a paternalistic and racist imposition of colonial systems controlling access to food, land, resources, naming, health care, education, and even status as an Indigenous person). Although Canada is considered a wealthy nation, the continued impact of these abuses result in impoverished socioeconomic status and disruption of wellness for many Indigenous peoples. The compounding effect over successive generations has contributed to disproportionately higher rates of substance abuse, suicide, and many diseases, including liver disease resulting from chronic hepatitis C virus (HCV) infection, in these populations. 2 Mitchell T Arseneau C Colonial Trauma: Complex, continuous, collective, cumulative and compounding effects on the health of Indigenous peoples in Canada and beyond. Int J Indig Health. 2019; 14: 74-94 Crossref Google Scholar Health inequities in Indigenous peoples are often highlighted in health research without sufficient explanation of the role of systemic drivers, which further victimises or stigmatises Indigenous populations. 3 Fayed ST King A King M et al. In the eyes of Indigenous people in Canada: exposing the underlying colonial etiology of hepatitis C and the imperative for trauma-informed care. Can Liv J. 2018; 1: 115-129 Crossref Google Scholar In this Comment, we describe the creation and implementation of a co-design approach centred on respectful relationships with Indigenous communities in the province of Alberta, Canada, to address systemic and longstanding inequities regarding access to HCV care.

Assessment and rehabilitation of acquired communication disorders in Aboriginal and Torres Strait Islander adults with stroke or traumatic brain injury: a retrospective chart review

Purpose Speech-language pathologists’ (SLP) management practices for Aboriginal and Torres Strait Islander adults with acquired communication disorder (ACD), following stroke or traumatic brain injury (TBI), are not well understood. This study explores SLPs’ management approaches for ACDs for Aboriginal and Torres Strait Islander adults post-stroke or TBI. Materials and methods SLPs’ documented notes were analysed from a two-year retrospective medical record review of Aboriginal and Torres Strait Islander adults (≥18 years), admitted to a regional Queensland hospital with principal diagnoses of stroke or TBI. Results SLPs frequently used informal approaches to assess ACDs. English-language formal assessment tools were also used in conjunction with the informal approaches. ACD diagnosis was more common in stroke than TBI patients. One-third of patients with ACD received inpatient rehabilitation at the study site. SLPs infrequently documented cultural or linguistic adaptions to assessment or interventions. Conclusions Informal approaches to assess ACDs were commonly employed which may be because they are perceived to be more culturally appropriate. Clinical guidelines for stroke and TBI should accommodate the diversity of cultures and languages. Better consideration of Aboriginal and Torres Strait Islander communication styles and incorporation of these into SLP ACD management approaches may facilitate accurate diagnosis and culturally safe rehabilitation services. Implications for Rehabilitation Informal approaches for assessment and intervention of ACDs, that incorporate yarning and salient tasks, are likely to be more culturally appropriate and safe for Aboriginal and Torres Strait Islander peoples. More flexibility and guidance in the use of culturally and linguistically appropriate alternative assessment approaches are required in the National stroke guidelines for Aboriginal and Torres Strait Islander peoples. The adoption of enhanced models of culturally secure ACD service provision, that incorporate frequent SLP engagement with an Aboriginal or Torres Strait Islander support person during assessment and rehabilitation, are needed. There is an imperative for health professionals to actively account for culture and language difference in rehabilitation practices to ensure Indigenous peoples worldwide receive equitable and culturally-responsive services.

Occupational Justice-Colonial Business as Usual? Indigenous Observations From Aotearoa New Zealand: La justice occupationnelle : sous régime colonial comme d'habitude? Observations d'autochtones d'Aotearoa en Nouvelle-Zélande.

Western ideologies and systems of occupation and justice are implicated in the colonization of indigenous peoples worldwide. Yet, colonialism, racism, and privilege are minimally acknowledged and examined within occupational therapy and occupational science literature, as evidenced in uncritical development of notions of "occupational justice." First, to open a discussion of how and why theories and approaches to justice have developed as they have in Aotearoa New Zealand. Second, to further a burgeoning field of Indigenous perspectives and critiques of colonial theorizing within the profession, while highlighting local Indigenous justice frameworks including Te Tiriti o Waitangi and Matike Mai Aotearoa. Colonialism is minimally examined in occupational justice approaches and promotion. Honest examination of colonialism alongside Indigenous justice frameworks can advance critical praxes of decolonising occupation and re-connect occupation with justice and equity.

A Delphi yarn: applying Indigenous knowledges to enhance the cultural utility of SMART Recovery Australia

BackgroundMutual support groups are a popular treatment for substance use and other addictive behaviours. However, little is known about the cultural utility of these programmes for Indigenous peoples.MethodsA three-round Delphi study, utilising Indigenous research yarning methods was conducted to: (1) Obtain expert opinion regarding the cultural utility of an Indigenous SMART Recovery handbook; (2) Gain consensus on areas within the SMART Recovery programme that require cultural modification and; (3) Seek advice on how modifications could be implemented in future programme design and delivery. The panellists were 11 culturally, geographically, and professionally diverse Indigenous Australian health and wellbeing experts. A group consensus level of 80% was set prior to each survey round.ResultsThere was 100% participant retention across all three Delphi rounds. The panel reached consensus on five key programme modifications (composition of a separate facilitator and group member handbook; culturally appropriate language, terminology, and literacy level; culturally meaningful programme activities; supplementary storytelling resources; and customisation for diverse community contexts). The panel also developed a series of practical implementation strategies to guide SMART Recovery through a modification process.ConclusionThe findings highlight the importance of involving Indigenous peoples in the design, delivery and validation of mainstream mutual support programmes. Indigenous-led programme modifications could help improve accessibility and usefulness of mutual support groups for Indigenous peoples worldwide. This study is an example of how Indigenous research methods can be used alongside the Delphi technique. This approach demonstrated a way that Indigenous peoples from culturally and geographically diverse locations can participate in research anonymously, autonomously and without added burden on personal, community or professional obligations.