non-Indigenous Populations Research Articles

Indigenous and Non-Indigenous Unemployment, Employment, and Participation Rates Through 2023: Education Remains Critical

Employment, unemployment, participation, and wage rates have been more favourable for the non-Indigenous population than for the Indigenous population. With one exception, this has been the case in every year since 2007, when the data first became available. While wages were higher in 2022 than they were in 2021 for both Indigenous and non-Indigenous populations, the overall employment picture for the Indigenous population was worse in 2023 than in 2022. Their unemployment rate was higher, while their employment and participation rates were lower. In comparison, all three rates were higher for non-Indigenous people in 2023. A critical factor related to each of these three rates is the education level achieved. Higher completed educational levels are directly related to lower unemployment rates and higher employment and participation rates as well as to higher wage levels.

COVID-19 and protection measures adopted in rural amazon communities during the first months of the pandemic.

Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics. To analyze the evolution of COVID-19 in rural populations of Loreto and Ucayali in the early stage of the pandemic. A community-level longitudinal observational study was conducted and based on two rounds of telephone surveys with local authorities of more than 400 indigenous and non-indigenous rural communities in Loreto and Ucayali, in July and August 2020. We collected information on cases and deaths by COVID-19 in their communities, protective measures adopted and if state assistance was received in the early stage of the pandemic. Descriptive statistics allowed us to evaluate the evolution of the pandemic after the initial outbreak and compare the trends of the two regions, as well as between indigenous and non-indigenous populations. In July 2020, COVID-19 had reached 91.5% of the communities, although deaths from COVID-19 were reported in 13.0% of the communities, with rural mortality being higher in Ucayali (0.111%) than in Loreto (0.047%) and in non-indigenous communities. By August, prevalence decreased from 44.0% to 32.0% of communities, but became more frequent in indigenous communities, and those in Ucayali. Traveling to the city to receive state bonuses and difficulties maintaining social distancing contributed to the spread. Our findings show the evolution of COVID-19 in rural communities and point to important areas of attention in future public policies, for the adoption of protective measures and reconsidering strategies for the distribution of assistance in the face of future pandemics. Motivation for the study. To document the evolution of COVID-19 in rural Amazonian populations, which are still little known. Main findings. COVID-19 spread rapidly through rural communities, initially spreading to mestizo hamlets and later affecting indigenous communities. Rural mortality varied by region and ethnicity. Social distancing was difficult, and travel to receive government vouchers contributed to contagion. Implications. Identifying the factors that contributed to contagion and the barriers to the adoption of protective measures in rural Amazonian populations will help to face future pandemics.

The interaction between Indigenous identity and rural residency in dementia prevalence among Ecuadorian older adults.

While recognizing the acknowledged difference in dementia prevalence between Indigenous and non-Indigenous populations, most previous studies were conducted in the Global North. This study aims to examine the relationship between Indigenous ethnic identity and dementia status with a special focus on urban-rural differences among older adults in Ecuador. Data came from Ecuador's Survey of Health, Welfare, and Aging (SABE), derived from a probability sample of households in Ecuador. The final sample comprised 4,984 adults aged 60 or older. Dementia status was assessed through three indicators: low scores on a cognitive assessment, the number of difficulties in instrumental activities of daily living (IADL), and self-reported dementia diagnosis. Logistic regression and multivariate decomposition analyses were utilized. Indigenous participants, even after adjusting for sociodemographic and health-related factors, exhibited a higher likelihood of having dementia compared to their non-Indigenous counterparts. Among Indigenous participants, those residing in rural areas had higher likelihood of having dementia status, while there was no significant urban-rural difference observed among non-Indigenous participants. Rural residency and covariates explain 91.0% of the observed difference in dementia prevalence between Indigenous and non-Indigenous older adults. Indigenous older adults who are living in rural areas are at particularly high risk of having dementia largely because they have presently recognized modifiable risk factors. These findings underscore the urgent need to prioritize provisions of appropriate and equitable service related to dementia for Indigenous People living in rural areas outside high-income countries.

Survival Experiences of Mapuche Parents in Multilevel Schools in La Araucanía

ABSTRACT This article examines how colonial legacies shape parents’ schooling experiences in multilevel schools within the Mapuche context of La Araucanía, Chile, also known as WallMapu. Authorities built schools to evangelize Indigenous people into Christianity. Researchers used biographical narratives to reflect the importance of orality for the Mapuche. The findings show that the physical and psychological violence endured by Mapuche children has widened the educational gap between Indigenous and non-Indigenous populations. The study concludes that recognizing the harm caused by the school system is essential to rebuild trust and improve educational outcomes for Indigenous children.

Predicting Mental Health Hospitalizations Among First Nations Adults in Residential Treatment

Indigenous peoples in Canada experience disproportionately higher rates of hospitalization for mental health and substance use concerns than non-Indigenous populations. Ambulatory care sensitive conditions are community-level markers of mental illness which can theoretically be managed through community-based health services, and therefore should not require urgent care services. Previous mental health related ambulatory sensitive conditions have included psychotic and mood disorders; however, limited research has explored these relationships of increased hospitalization among specific health disorders with Indigenous populations. This study analyzed predictors of prior mental health hospitalizations among a predominately First Nations population seeking residential treatment for substance use. We hypothesized that increased co-morbid mental health concerns would predict increased hospitalizations for mental health concerns, and this relationship would be moderated by higher Adverse Childhood Experience (ACE) scores. Logistic regression showed that for every increase in each reported mental health concern, the odds of prior hospitalization was 1.6 times higher among this sample, although ACEs did not moderate this relationship. Participants with depressive, anxiety-related, psychotic, and personality-related disorders reported proportionally more hospitalization. Although study results suggest ACEs are not a useful predictor of hospitalization, their presence has previously shown to exacerbate co-morbid concerns, and thus, may influence prior hospitalization history indirectly. Further research can explore relationships between exposure to childhood trauma and hospitalization, particularly in consideration of access to tertiary mental health services.

Interpersonal Violence Against Indigenous Sámi and Non-Sámi Populations in Arctic Sweden and the Mediating Effect of Historical Losses and Discrimination.

The prevalence of interpersonal violence has been reported at higher levels among Indigenous than non-Indigenous populations worldwide, but has not been thoroughly investigated among the Sámi population in Sweden. The aims of this study were to investigate: (1) the prevalence of emotional, physical, and sexual violence and violence by intimate partners, family members, acquaintances, and strangers among participants identifying as Sámi or Swedish, (2) whether reporting experiences of historical losses and discrimination mediated the anticipated association between identifying as Sámi and reporting experiences of violence, and (3) whether background characteristics were associated with reporting experiences of violence. Cross-sectional questionnaire data collected in 2021 for the "Health and Living conditions in Sápmi" study were used. All adults in an arctic region in Sweden were invited to participate (response rate: 41%). Respondents self-identifying as Sámi (n = 375; 24.7%) or Swedish (n = 1,144; 75.3%) were included in this study. Sámi respondents of both sexes more often reported violence by an acquaintance or stranger. Likewise, more Sámi than Swedish women reported family violence (16.4% vs. 9.2%), but there was no difference concerning intimate partner violence (13.3% vs. 15.4%). Mediation analyses revealed strong positive indirect effects of historical losses and discrimination on the different types of violence. Being female was the strongest predictor of reporting intimate partner violence, and younger age was associated with violence by all perpetrators except family members. In conclusion, interpersonal violence was more often reported by Sámi respondents, but the association was explained in full by experiences of historical losses and discrimination. The results underline the importance of a life-course and even intergenerational and historical perspectives when investigating interpersonal violence.

Comparative analysis of COVID-19 diagnoses and mortality among hospitalized indigenous and non-indigenous populations in Chile: 2020–2021

BackgroundCurrent literature presents mixed effects of the COVID-19 pandemic on Indigenous communities. We aim to highlight potential disparities and temporal shifts in both the impact of COVID-19 and vaccine uptake among hospitalized Indigenous populations in Chile.MethodsWe conducted an observational analysis utilizing 1,598,492 hospitalization records from 2020 to 2021 based on publicly accessible hospital discharge data spanning 65 healthcare facilities of medium and high complexity funded through the Diagnosis-Related Groups (DRG) mechanism in Chile, representing roughly 70% of the country’s total hospitalizations. This was supplemented with publicly available municipal data on COVID-19 vaccinations and socio-demographic variables. We performed logistic regression analysis at 0.05 level of significance to assess the bivariate and multivariable association of Indigenous status with COVID-19 diagnosis and COVID-19 deaths among hospitalized populations. We also performed univariate and multiple linear regression to assess the association of COVID-19 vaccination rate and Indigenous status at the municipality level. In addition, we report the distribution of top 10 secondary diagnoses among hospitalized COVID-19 cases and deaths separately for Indigenous and non-Indigenous populations.ResultsIndigenous populations displayed lower adjusted odds for both COVID-19 diagnosis (OR: 0.76, 95% CI: 0.74, 0.77) and death (OR: 0.91, 95% CI: 0.85, 0.97) when compared to non-Indigenous groups. Notably, the adjusted odds ratio for COVID-19 diagnosis in Indigenous populations rose from 0.59 (95% CI: 0.57, 0.61) in 2020 to 1.17 (95% CI: 1.13, 1.21) in 2021. Factors such as the significantly higher median age and greater number of comorbidities in the non-Indigenous hospitalized groups could account for their increased odds of COVID-19 diagnosis and mortality. Additionally, our data indicates a significantly negative adjusted association between COVID-19 vaccination rates and the proportion of Indigenous individuals.ConclusionAlthough Indigenous populations initially showed lower odds of COVID-19 diagnosis and mortality, a marked rise in diagnosis odds among these groups in 2021 underscores the urgency of targeted interventions. The observed negative association between the proportion of Indigenous populations and vaccination rates further underscores the necessity to tackle vaccine access barriers and work towards equitable distribution.

Navigating the cultural adaptation of a US-based online mental health and social support program for use with young Aboriginal and Torres Strait Islander males in the Northern Territory, Australia: Processes, outcomes, and lessons

BackgroundDespite disproportionate rates of mental ill-health compared with non-Indigenous populations, few programs have been tailored to the unique health, social, and cultural needs and preferences of young Aboriginal and Torres Strait Islander males. This paper describes the process of culturally adapting the US-based Young Black Men, Masculinities, and Mental Health (YBMen) Project to suit the needs, preferences, culture, and circumstances of Aboriginal and Torres Strait Islander males aged 16–25 years in the Northern Territory, Australia. YBMen is an evidence-based social media-based education and support program designed to promote mental health, expand understandings of gender and cultural identities, and enhance social support in college-aged Black men.MethodsOur adaptation followed an Extended Stages of Cultural Adaptation model. First, we established a rationale for adaptation that included assessing the appropriateness of YBMen’s core components for the target population. We then investigated important and appropriate models to underpin the adapted program and conducted a non-linear, iterative process of gathering information from key sources, including young Aboriginal and Torres Strait Islander males, to inform program curriculum and delivery.ResultsTo maintain program fidelity, we retained the core curriculum components of mental health, healthy masculinities, and social connection and kept the small cohort, private social media group delivery but developed two models: ‘online only’ (the original online delivery format) and ‘hybrid in-person/online’ (combining online delivery with weekly in-person group sessions). Adaptations made included using an overarching Aboriginal and Torres Strait Islander social and emotional wellbeing framework and socio-cultural strengths-based approach; inclusion of modules on health and wellbeing, positive Indigenous masculinities, and respectful relationships; use of Indigenous designs and colours; and prominent placement of images of Aboriginal and Torres Strait Islander male sportspeople, musicians, activists, and local role models.ConclusionsThis process resulted in a culturally responsive mental health, masculinities, and social support health promotion program for young Aboriginal and Torres Strait Islander males. Next steps will involve pilot testing to investigate the adapted program’s acceptability and feasibility and inform further refinement. Keywords: Aboriginal, Torres Strait Islander, Indigenous, Australia, male, cultural adaptation, social media, mental health, masculinities, social support.

Bridges between two medical realities: Perspectives of Indigenous medical and nursing students on snakebite care in the Brazilian Amazon.

In the Brazilian Amazon, snakebite envenomations (SBEs) disproportionately affect Indigenous populations, and have a significantly higher incidence and lethality than in non-Indigenous populations. This qualitative study describes the Indigenous and biomedical healthcare domains for SBE care from the perspective of the Indigenous medical and nursing students in Manaus, Western Brazilian Amazon. In-depth interviews were conducted with five Indigenous students from the Amazonas State University, between January and December 2021. The interviews were analyzed using inductive content analysis. We organized an explanatory model with five themes: (1) participants' identities; (2) causality levels in Indigenous and biomedical systems; (3) therapeutic itineraries in Indigenous and biomedical systems; (4) ideological implications of adding biomedical devices to Indigenous healing systems; and (5) therapeutic failure in and efficacy of Indigenous and biomedical systems. From a noncolonial perspective and seeking to increase the quality and acceptability of health care for the Indigenous populations of the Brazilian Amazon, the training of Indigenous health professionals presents itself as a promising strategy. For this goal, universities should serve as empowering settings for Indigenous health students that support them in their growth and development, raise their awareness of injustice, and catalyze change toward a culturally adapted and effective service for the users.

Pharmacotherapeutic Impact of Computed Tomography Coronary Angiography Findings in Indigenous and Non-Indigenous Population in the Northern Territory, Australia

Pharmacotherapeutic Impact of Computed Tomography Coronary Angiography Findings in Indigenous and Non-Indigenous Population in the Northern Territory, Australia

Diagnostic and Prognostic Utility of Computed Tomography Coronary Angiography in Top End Australia's Indigenous and Non-Indigenous Population: A Retrospective Analysis

Diagnostic and Prognostic Utility of Computed Tomography Coronary Angiography in Top End Australia's Indigenous and Non-Indigenous Population: A Retrospective Analysis

Outcomes of Indigenous Australians undergoing isolated coronary artery bypass graft surgery at a single institution.

The 'gap' continues to exist between the Indigenous and non-Indigenous populations within Australia, with Indigenous Australians continuing to experience poorer health outcomes, and a reduced life expectancy of 10.6 years for males and 9.5 for females. Indigenous Australians are far more likely to suffer from ischaemic heart disease. We sought to investigate the outcomes of Indigenous Australians undergoing isolated coronary artery bypass graft surgery (CABG) at a single institution. A retrospective cohort study comparing Indigenous with non-Indigenous Australians from prospectively collected data were performed for all patients who underwent isolated CABG at a single centre between 2015 and 2018. The primary endpoint was 30-day mortality with secondary endpoints including deep sternal wound infection, new renal failure, length of stay, stroke and rate of readmission. A total of 905 patients were included in the study. The Indigenous cohort had 130 patients and the non-Indigenous cohort contained 775 patients. The baseline preoperative characteristics were significantly different between the two cohorts, with Indigenous patients younger (55.7 vs. 64.6 years), more likely to be female (33.1% vs. 16.4%) and to be dialysis-dependent (10% vs. 1.2%). The primary outcome was more likely in Indigenous Australians, with a 30-day mortality rate of 3.1% compared with 0.8%. There was a higher incidence of new renal failure (12.3% vs. 5.9%), red blood cell transfusion (30% vs. 20.8%). Indigenous patients undergoing CABG at our institution have significantly more co-morbidities as well as worse post-operative outcomes and strategies to address this are urgently required.

Unveiling a Health Disparity: Comparative Analysis of Head and Neck Cancer Trends between First Nations People and Non-Indigenous Australians (1998-2015).

We aim to assess and compare the HNC trends between the First Nations and non-Indigenous population. HNC incidence (1998-2013) and mortality (1998-2015) data in First Nations people and non-Indigenous Australians were utilised from the Australian Cancer Database. The age-standardised incidence and mortality trends along with annual percentage changes were analysed using Joinpoint models. Age-standardised incidence and mortality rates according to remoteness, states, and five-year survival rates among First Nations people and non-Indigenous Australians were presented as graphs. First Nations people had over twice the age-standardised incidence (2013; 29.8/100,000 vs. 14.7/100,000) and over 3.5 times the age-standardised mortality rates (2015; 14.2/100,000 vs. 4.1/100,000) than their non-Indigenous counterparts. Both populations saw a decline in mortality, but the decline was only statistically significant in non-Indigenous Australians (17.1% decline, 1998: 4.8/100,000, 2015: 4.1/100,000; p < 0.05). Across all remoteness levels and states, First Nations people consistently had higher age-standardised incidence and mortality rates. Furthermore, the five-year survival rate was lower by 25% in First Nations people. First Nations people continue to shoulder a disproportionate HNC burden compared to non-Indigenous Australians.

Decomposing the gaps in healthy and unhealthy life expectancies between Indigenous and non-Indigenous Australians: a burden of disease and injury study

BackgroundThe gaps in healthy life expectancy (HLE) between Indigenous and non-Indigenous Australians are significant. Detailed and accurate information is required to develop strategies that will close these health disparities. This paper aims to quantify and compare the causes and their relative contributions to the life expectancy (LE) gaps between the Indigenous and non-Indigenous population in the Northern Territory (NT), Australia.MethodsThe age-cause decomposition was used to analyse the differences in HLE and unhealthy life expectancy (ULE), where LE = HLE + ULE. The data was sourced from the burden of disease and injury study in the NT between 2014 and 2018.ResultsIn 2014–2018, the HLE at birth in the NT Indigenous population was estimated at 43.3 years in males and 41.4 years in females, 26.5 and 33.5 years shorter than the non-Indigenous population. This gap approximately doubled the LE gap (14.0 years in males, 16.6 years in females) at birth. In contrast to LE and HLE, ULE at birth was longer in the Indigenous than non-Indigenous population. The leading causes of the ULE gap at birth were endocrine conditions (explaining 2.9–4.4 years, 23–26%), followed by mental conditions in males and musculoskeletal conditions in females (1.92 and 1.94 years, 15% and 12% respectively), markedly different from the causes of the LE gap (cardiovascular disease, cancers and unintentional injury).ConclusionsThe ULE estimates offer valuable insights into the patterns of morbidity particularly useful in terms of primary and secondary prevention.

New Zealand's world-first smokefree legislation 'goes up in smoke': A setback in ending the tobacco epidemic

For several decades, Aotearoa New Zealand has maintained a relatively strict regulatory approach towards tobacco. In response to the significant impact of tobacco-related illnesses, many countries worldwide have worked to enhance tobacco control measures. These efforts include introducing plain tobacco packaging with graphic health warnings, improving access to smoking cessation services and offering supportive treatments for tobacco dependence. In December 2022, New Zealand enacted world-leading tobacco control legislation aimed at leading the nation towards a 'smokefree' future by 2025, a future where the smoking prevalence falls below 5 percent across all population groups. To achieve this goal, revolutionary measures were needed. These measures included denicotinising cigarettes, reducing the number of tobacco retail outlets, and implementing a generational ban on smoked products. Despite receiving support from academics, clinicians, leaders of local indigenous communities, and the general public, the sixth National-led coalition government remained resolute in repealing the law and did so through parliamentary urgency on 27 February 2024. The reversal of this health policy is anticipated to result in thousands of lives lost and widen life expectancy gaps between indigenous and non-indigenous populations. This decision, driven by political agenda objectives and interference from the tobacco industry, has not only impeded New Zealand's progress but also weakened global efforts in tobacco control.

Salt Mining and Salt Miners at Talkherud–Douzlākh, Northwestern Iran: From Landscape to Resource-Scape

The Douzlākh salt deposit (region: Māhneshān, Zanjān Province, Iran) is unique for its pure and crystal rock salt and was an important supplier of culinary (‘table’) salt in Achaemenid, Sassanid and Middle Islamic times. At the same time, the site was of central importance to the economic life of the rural populations in the Talkherud Basin. This article focuses on the question of which strategies were decisive for the exploitation of the salt mountain and how a potential supra-regional interest in the culinary salt was perhaps reciprocally connected with a rural hinterland. This hinterland was recently investigated in greater detail by our ongoing research. Did a resource-scape based on salt develop with specific economic and social strategies and practices around the Douzlākh? And was this development triggered by state or imperial control and demand? These questions are being pursued from a perspective utilising a variety of subjects and methods in archaeology, archaeobiology, archaeometry and geoarchaeology. In addition to a detailed on-site artefact study, several on- and off-site datasets have been collected and analysed within a multidisciplinary framework. This article synthesises the results of a major 12-year project to identify the organisational principles and daily practices within this specific salt-scape. The sensational finds of the Douzlākh salt mummies, along with the generally outstanding preservation of organic ecofacts and artefacts, allow insights into antique lifeworlds that are otherwise hard to come by. The multidisciplinary study of on- and off-site data allows far-reaching insights into interdisciplinary topics, such as the social system, supply and logistics, or the presence of non-local or non-indigenous populations.

Collective fishing with representatives of indigenous peoples of the North as a legalization of fishing for non-indigenous rural residents in the Primorsky Krai

Rural population who lives in the same natural and cultural landscape, and sometimes within the same vil-lage, are differentiated in their rights to access natural resources. People classified as indigenous population of the North, Siberia and the Far East (KMNS), unlike officially non-indigenous population, receive legal access to various biological resources. Positive discrimination of particular groups, for various reasons attributed to ‘more’ indigenous, has been causing controversy among anthropologists and sociologists for several decades, espe-cially regarding the situation of non-indigenous residents of multi-ethnic rural areas who do not have the right of access to natural resources, while living in the same environment. In Russia, this problem is specifically relevant for the coastal regions of the Far East, where fish and salmon roe have been historically the most important re-source of self-sustainment for both indigenous residents and resettlers. Using the example of one of the coastal areas of Primorsky Krai, where representatives of indigenous and non-indigenous peoples live alongside each other, we show how unequal distribution of rights to extract natural resources affects communication between them. Based on semi-structured interviews, informal conversations and observations collected during the field research, we have found that individual salmon fishing quotas are becoming a way to partially legalize informal fishing. Villagers go out fishing with their fellow villagers, and in case of the appearance of law enforcement agen-cies, fishermen from among KMNS take full responsibility for the catch and fishing gear on themselves. Regard-less of nationality, rural residents consider it unfair that non-indigenous peoples, who live in the same natural and climatic conditions, and have similar to KMNS economy, have no rights to catch salmonids. Thus, against the background of allocation of quotas for salmonid catching only to indigenous fishermen, new practices of reproduc-tion of solidarity and reciprocity are emerging in multiethnic rural communities.

Outcomes of Valve Replacements in North Queensland, Comparing Aboriginal/Torres Strait Islander Population and Non-Indigenous Population—A Retrospective Single Centre Study

Outcomes of Valve Replacements in North Queensland, Comparing Aboriginal/Torres Strait Islander Population and Non-Indigenous Population—A Retrospective Single Centre Study

The concentration of tuberculosis within Paraguay's incarcerated and Indigenous populations, 2018-2022.

While incidence of tuberculosis (TB) has decreased globally, in Paraguay, considered a medium-incidence country by the WHO, TB incidence has increased slightly from 42 per 100,000 in 2010 to 46 per 100,000 in 2022. We conducted a retrospective study of TB cases notified to the Paraguay National Program for Tuberculosis Control (NPTC) from 2018 to 2022 and quantified trends in specific populations identified as vulnerable. Of the 13,725 TB cases notified in Paraguay from 2018 to 2022, 2,331 (17%) occurred among incarcerated individuals and 1,743 (12.7%) occurred among self-identified Indigenous individuals. In 2022, the relative risk of TB was 87 and 6.4 among the incarcerated and Indigenous populations, compared with the non-incarcerated and non-Indigenous populations respectively. We found significant heterogeneity in TB incidence across Paraguay's 17 departments. Our findings highlight the urgency of expanding access to TB diagnosis, treatment, and prevention in populations at heightened risk of TB in Paraguay.

Modifications of the readiness assessment for pragmatic trials tool for appropriate use with Indigenous populations

BackgroundInequities in health access and outcomes exist between Indigenous and non-Indigenous populations. Embedded pragmatic randomized, controlled trials (ePCTs) can test the real-world effectiveness of health care interventions. Assessing readiness for ePCT, with tools such as the Readiness Assessment for Pragmatic Trials (RAPT) model, is an important component. Although equity must be explicitly incorporated in the design, testing, and widespread implementation of any health care intervention to achieve equity, RAPT does not explicitly consider equity. This study aimed to identify adaptions necessary for the application of the ‘Readiness Assessment for Pragmatic Trials’ (RAPT) tool in embedded pragmatic randomized, controlled trials (ePCTs) with Indigenous communities.MethodsWe surveyed and interviewed participants (researchers with experience in research involving Indigenous communities) over three phases (July-December 2022) in this mixed-methods study to explore the appropriateness and recommended adaptions of current RAPT domains and to identify new domains that would be appropriate to include. We thematically analyzed responses and used an iterative process to modify RAPT.ResultsThe 21 participants identified that RAPT needed to be modified to strengthen readiness assessment in Indigenous research. In addition, five new domains were proposed to support Indigenous communities’ power within the research processes: Indigenous Data Sovereignty; Acceptability – Indigenous Communities; Risk of Research; Research Team Experience; Established Partnership). We propose a modified tool, RAPT-Indigenous (RAPT-I) for use in research with Indigenous communities to increase the robustness and cultural appropriateness of readiness assessment for ePCT. In addition to producing a tool for use, it outlines a methodological approach to adopting research tools for use in and with Indigenous communities by drawing on the experience of researchers who are part of, and/or working with, Indigenous communities to undertake interventional research, as well as those with expertise in health equity, implementation science, and public health.ConclusionRAPT-I has the potential to provide a useful framework for readiness assessment prior to ePCT in Indigenous communities. RAPT-I also has potential use by bodies charged with critically reviewing proposed pragmatic research including funding and ethics review boards.