This project aims to improve health literacy in Indigenous communities through the development of evidence-based culturally relevant health promotion materials on dementia that bridge the gap between Indigenous and Western perspectives of the illness. The research team worked in partnership with Health Canada's First Nations and Inuit Home and Community Care Program (FNIHCC) and consulted with Indigenous elders to utilize a two-eyed seeing framework that draws upon Indigenous knowledge and Western biomedicine. A consolidated review of materials and research involving Indigenous perspectives of Alzheimer's and age-related dementias led to the development of two culturally appropriate fact sheets. Two Indigenous-specific fact sheets were developed "What is Dementia? Indigenous Perspectives and Cultural Understandings" and "Signs and Symptoms of Dementia: An Indigenous Guide." The fact sheets prioritize Indigenous knowledge and pay particular attention to Indigenous languages, diverse Indigenous cultures, and literacy levels. The content uses phrasing and words from Indigenous people involved in the research to share information. Biomedical concepts and words were included when necessary but language or presentation of these aspects were often modified to reflect Indigenous conceptualizations. This project provides a foundation for evidence-based knowledge translation in relation to cultural safety in dementia care. Specifically, the researchers outline how health care providers can develop culturally appropriate health promotion material, thus increasing Indigenous cultural understandings of dementia and health literacy.
Northern Ontario School of Medicine (NOSM) serves as the Faculty of Medicine of Lakehead and Laurentian Universities, and views the entire geography of Northern Ontario as its campus. This paper explores how community engagement contributes to achieving social accountability in over 90 sites through NOSM's distinctive model, Distributed Community Engaged Learning (DCEL).
Studies involving qualitative and quantitative methods contribute to this paper, which draws on administrative data from NOSM and external sources, as well as surveys and interviews of students, graduates and other informants including the joint NOSM-CRaNHR (Centre for Rural and Northern Health Research) tracking and impact studies.
Community engagement contributes throughout the lifecycle stages of preadmission, admission, and undergraduate medical education. High school students from 70 Northern Ontario communities participate in NOSM's week-long Health Sciences Summer Camps. The MD admissions process involves approximately 128 volunteers assessing written applications and over 100 volunteer interviewers. Thirty-six Indigenous communities host first year students and third-year students learn their core clinical medicine in 15 communities, throughout Northern Ontario. In general, learners and communities report net benefits from participation in NOSM programs.
Community engagement makes a key contribution to the success of NOSM's socially accountable distributed medical education.
Les démences liées à l'âge constituent un problème de santé important au Canada, en particulier chez les communautés autochtones, où les taux de démences surpassent d'environ 34 % ceux retrouvés dans la population canadienne. Cette étude présente une synthèse des données qualitatives tirées des articles traitant de la compréhension culturelle des démences chez les peuples autochtones du Canada. Les résultats principaux suggèrent que peu de recherches ont été effectuées dans ce domaine, en particulier chez les Inuits et les Métis, malgré une progression de l'exploration de ce sujet au Canada. La synthèse de la littérature a révélé que la démence est perçue comme une partie naturelle du cycle de vie par de nombreux Autochtones. Bien que les modèles communautaires et informels de soins soulèvent d'importants défis pour les aidants naturels, ils sont régulièrement appliqués. Cette synthèse sera utile pour les organismes et les prestataires de soins de santé qui recherchent des approches appropriées pour répondre aux besoins des patients et des familles autochtones aux prises avec la démence.
Age-related dementias present a significant health concern in Canada, particularly for Indigenous communities, in which rates of dementia are estimated to be 34 per cent higher than in the general Canadian population. This article reports on a qualitative evidence synthesis of available literature concerning cultural understandings of dementia in Indigenous peoples in Canada. Key findings suggest that although exploration of this topic is on the rise in Canada, there remains a paucity of research on this topic, particularly among the Inuit and Métis. The synthesis of the literature found that dementia is viewed as a natural part of the life cycle by many Indigenous people; and although this presents significant challenges for caregivers, informal and community models of care are routinely practiced. This synthesis will be useful for health care providers and organizations that are searching for appropriate approaches to respond to the needs of Indigenous patients and families experiencing dementia.
ABSTRACTAge-related dementias present a significant health concern in Canada, particularly for Indigenous communities, in which rates of dementia are estimated to be 34 per cent higher than in the general Canadian population. This article reports on a qualitative evidence synthesis of available literature concerning cultural understandings of dementia in Indigenous peoples in Canada. Key findings suggest that although exploration of this topic is on the rise in Canada, there remains a paucity of research on this topic, particularly among the Inuit and Métis. The synthesis of the literature found that dementia is viewed as a natural part of the life cycle by many Indigenous people; and although this presents significant challenges for caregivers, informal and community models of care are routinely practiced. This synthesis will be useful for health care providers and organizations that are searching for appropriate approaches to respond to the needs of Indigenous patients and families experiencing dementia.
School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; ICES Central (Walker, Shah), Toronto, Ont.; Department of Family Medicine (Slater, Green) and Health Services and Policy Research Institute (Frymire), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; ICES Queen's (Frymire, Khan, Green), Kingston, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn. email@example.com.
Diabetes mellitus is an established health concern in First Nations communities and is associated with complex influences of colonization. This study, a partnership between First Nations and academic researchers, was undertaken to determine patterns of diabetes prevalence, incidence and mortality in Ontario.
Using health services and population data from Ontario for 1995 to 2014, linked with the federal Indian Register, we calculated age- and sex-adjusted annual estimates of diabetes prevalence, incidence and mortality for First Nations people (living within and outside First Nations communities) and other people in Ontario. We also examined age- and sex-specific crude diabetes prevalence.
Between 1995 and 2014, the prevalence of diabetes increased and the incidence decreased somewhat in all populations. Both prevalence and incidence were substantially higher among First Nations people than among other people in Ontario. In particular, First Nations women had higher prevalence than other women (4.2% v. 1.6% for ages 20-34 yr and 17.6% v. 6.0% for ages 35-49 yr). The lifetime risk of diabetes was higher among First Nations people than among other people in Ontario (57.0%, 95% confidence interval [CI] 56.3%-57.6% v. 44.5%, 95% CI 44.4%-44.6%). Over time, all-cause mortality for those with diabetes declined but remained consistently higher for First Nations people than for other people in Ontario.
Diabetes is more common among First Nations people than among other people in Ontario, particularly at younger ages and in women. First Nations-led approaches to address the high prevalence of diabetes in younger First Nations women have the potential to improve metabolic health across generations.
ErratumIn: CMAJ. 2021 Jan 18;193(3):E105 PMID 33462156
This paper analyzes the community health of the Wikwemikong Unceded Indian Reserve (WUIR), Ontario, Canada. Results are reported from fieldwork including participant observation, key informant interviewing and self-reported data measuring health status, risk behaviour, place of residence, self-identity, and personal history extracted from 350 interviews conducted during a community-wide needs assessment. The research aimed to create a health plan for the community; however, subsequent analysis of the needs assessment results indicates that internal diversity exists in health status and needs between the seven villages that comprise WUIR. The analysis suggests variation in health status and risk-taking behaviour among community members may be related to varying colonial histories among the villages. The implications of intra-community variation in health status in First Nations are discussed in relation to influential health policy theories such as the determinants of health and health transfer policy in Canada.
Ce projet en application de connaissances a exploré la pertinence d'une documentation en promotion de la santé élaborée pour une population autochtone nationale en vue de son utilisation dans une communauté autochtone urbaine du nord de l'Ontario. Une approche décolonisée et communautaire de recherche-action participative faisant appel à l'épistémologie tribale a été suivie pour former un groupe consultatif autochtone local et établir un partenariat avec le N'Swakamok Native Friendship Centre. Deux groupes de discussion (n=8) composés d'adultes autochtones et cinq entrevues individuelles avec des aidants autochtones soignant une personne atteinte de démence ont alimenté l'analyse thématique qualitative. Quatre thèmes sont ressortis des données: (1) la nécessité d'une compréhension commune des cultures autochtones et occidentales dans le cadre des soins de santé; (2) l'amélioration de la communication interculturelle dans les discussions sur la santé; (3) l'ancrage du matériel de promotion de la santé dans la culture, et (4) les stratégies autochtones de littératie en matière de santé et la sensibilisation aux maladies neurodégénératives. Considérant que les prestataires de soins de santé cherchent des moyens efficaces pour communiquer avec les peuples autochtones, il est important de fournir de l'information pertinente localement et sur le plan culturel afin d'améliorer l'adoption et l'efficacité chez ces populations.
This knowledge translation project explored the appropriateness of utilizing health promotion materials developed for a national Indigenous population with Indigenous people living in a northern Ontario urban community. A de-colonized, community-based participatory action research approach using tribal epistemology assisted in establishing a local Indigenous advisory group and a partnership with the N’Swakamok Native Friendship Centre. Two focus groups (n = 8) with Indigenous adults and five one-on-one interviews with Indigenous caregivers of a person with dementia informed a qualitative thematic analysis. Four themes emerged from the data: (1) the need for shared understandings of Indigenous and Western cultures in health care; (2) improving cross-cultural communication within health-related encounters; (3) grounding health promotion materials in culture; and (4) Indigenous health literacy strategies for dementia awareness. As health care providers search for effective ways to communicate with Indigenous people, it is important to deliver locally and culturally relevant information to improve uptake and effectiveness by Indigenous people.
Department of Family Medicine (Slater, Green) and ICES Queen's (Slater, Green, Khan), Queen's University, Kingston, Ont.; Department of Medicine (Shah), University of Toronto; ICES (Shah, Walker); Chiefs of Ontario (Jones, Sutherland), Toronto, Ont.; Memory Keepers Medical Discovery Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.
To improve diabetes care, First Nations leaders and others need access to population-level health data. We provide details of the collaborative methods we used to describe the prevalence and incidence of diabetes in First Nations people in Ontario and present demographic data for this population compared to the rest of the Ontario population.
To identify the population of First Nations people and other people in Ontario, we created annual cohorts of the Ontario population for each year between Apr. 1, 1995, and Mar. 31, 2015. Through a partnership between First Nations and academic researchers, we linked provincial population-based health administrative data stored at ICES with the Indian Register, which identifies all Status First Nations people. Our collaborative process was guided by the First Nations principles of ownership, control, access and possession (OCAP).
Demographic characteristics for the 2014/15 cohort (n = 13 406 684) are presented here. The cohort includes 158 241 Status First Nations people and 13 248 443 other people living in Ontario. Using postal codes, we were able to identify virtually all (99.9%) First Nations people in Ontario as living in (n = 55 311) or outside (n =102 889) a First Nations community. First Nations people were younger and more likely to live in semiurban or rural areas than the rest of Ontario's population.
The collaborative methodology used in this study is applicable to many jurisdictions working with Indigenous groups who have access to similar data. The Ontario cohort defined here is being used to conduct analyses of health outcomes and use of health care services among First Nations people with diabetes in Ontario.
CommentIn: CMAJ Open. 2019 Dec 10;7(4):E700-E705 PMID 31822500
CommentIn: CMAJ Open. 2019 Dec 10;7(4):E706-E712 PMID 31822501
Dr. Crowshoe: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Han: Department of Family Medicine, Queen's University, Kingston, Ontario, Canada. Dr. Calam: Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Henderson: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Jacklin: University of Minnesota Medical School, Duluth, Minnesota. Ms. Walker: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Green: Departments of Family Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada.
J Contin Educ Health Prof. 2018 Winter; 38(1):49-59
Health education about Indigenous populations in Canada (First Nations, Inuit, and Métis people) is one approach to enable health services to mitigate health disparities faced by Indigenous peoples related to a history of colonization and ongoing social inequities. This evaluation of a continuing medical education workshop, to enhance family physicians' clinical approach by including social and cultural dimensions within diabetes management, was conducted to determine whether participation in the workshop improved self-reported knowledge, skills, and confidence in working with Indigenous patients with type 2 diabetes.
The workshop, developed from rigorous national research with Indigenous patients, diabetes care physicians, and Indigenous health medical educators, was attended by 32 family physicians serving Indigenous populations on three sites in Northern Ontario. A same-day evaluation survey assessed participants' satisfaction with workshop content and delivery. Preworkshop and postworkshop surveys consisting of 5-point Likert and open-ended questions were administered 1 week before and 3 month after the workshop. Descriptive statistics and t test were performed to analyze Likert scale questions; thematic analysis was used to elicit and cluster themes from open-ended responses.
Participants reported high satisfaction with all aspects of the workshop. Reporting improved understanding of socioeconomic (P = .002), psychosocial, and cultural factors (P = .001), participants also described adapting their clinical approach to more actively incorporating social and cultural factors and focusing on patient-centered care.
The workshop was effective in shifting physician's self-reported knowledge, attitudes, and skills resulting in clinical approach modifications within social, psychosocial, and cultural domains for their Indigenous patients with diabetes.