To address concerns about disruptions in the continuity of health care delivered to residents in three remote aboriginal communities in northern Ontario, Canada, the local health authority initiated a study in collaboration with the department of Health Canada responsible for ensuring that aboriginal reserves receive mandatory health services, and an inter-disciplinary team of researchers from two universities. The study focussed on the delivery of oncology, diabetes and mental health care, specifically, as well as systems issues such as recruitment and retention of health human resources and financial costs. The paper discusses the procedures involved, the benefits derived and the challenges encountered in doing this as a community driven participatory action research project. It also summarizes the findings that led to community formulated policy and program recommendations.
This paper examines collaborative arrangements between Aboriginal peoples and the forest sector across Canada. Using a broad definition of collaboration, we identified 1378 arrangements in 474 Aboriginal communities in all Canadian provinces and territories, except Nunavut. We categorize these collaborative arrangements into five broad types: treaties and other formal agreements; planning and management activities; influence on decision-making; forest tenures; and economic roles and partnerships. Consistent data was available for only the first three types, which showed that close to 60% of Aboriginal communities use each approach. However, this masks significant differences between provinces. For example, economic roles and partnerships are in place in all New Brunswick communities and 74% of communities in British Columbia, but only 12% of Manitoban communities. The proportion of communities that have been involved in participatory processes in forest decision-making (such as advisory committees and consultation processes) is particularly high in Quebec with 88% of communities, but only 32% of communities hold forest tenures. We also find that three-quarters of all communities choose to engage in two or more approaches, despite the demands that this can place upon the time and energy of community members. We finally consider how policy environments in different jurisdictions affect the frequency of certain types of collaboration. This empirical study, and the typology that it demonstrates, can inform policy development for Aboriginal involvement in Canadian forestry and help guide future research into broader issues of collaborative governance of natural resources.
This case study of community and university research partnerships utilizes previously developed principles for conducting research in the context of Native American communities to consider how partners understand and apply the principles in developing community-based participatory research partnerships to reduce health disparities. The 7 partnership projects are coordinated through a National Institutes of Health-funded center and involve a variety of tribal members, including both health care professionals and lay persons and native and nonnative university researchers. This article provides detailed examples of how these principles are applied to the projects and discusses the overarching and interrelated emergent themes of sharing power and building trust.
To report on a participatory research process in southwest Alaska focusing on youth involvement as a means to facilitate health promotion. We propose youth-guided community-based participatory research (CBPR) as way to involve young people in health promotion and prevention strategizing as part of translational science practice at the community-level.
We utilized a CBPR approach that allowed youth to contribute at all stages.
Implementation of the CBPR approach involved the advancement of three key strategies including: (a) the local steering committee made up of youth, tribal leaders, and elders, (b) youth-researcher partnerships, and (c) youth action-groups to translate findings.
The addition of a local youth-action and translation group to the CBPR process in the southwest Alaska site represents an innovative strategy for disseminating findings to youth from a research project that focuses on youth resilience and wellbeing. This strategy drew from two community-based action activities: (a) being useful by helping elders and (b) being proud of our village.
In our study, youth informed the research process at every stage, but most significantly youth guided the translation and application of the research findings at the community level. Findings from the research project were translated by youth into serviceable action in the community where they live. The research created an experience for youth to spend time engaged in activities that, from their perspectives, are important and contribute to their wellbeing and healthy living. Youth-guided CBPR meant involving youth in the process of not only understanding the research process but living through it as well.
Cites: Soc Sci Med. 2009 Aug;69(4):565-7019596503
Cites: Am Indian Alsk Native Ment Health Res. 2009;16(1):1-2419340763
Centre for Aboriginal Health Research, Suite 715 Buhler Research Centre, Department of Community Health Sciences, The University of Manitoba, 715 McDermot Avenue, Winnipeg, MB R3E 3P4. firstname.lastname@example.org
Can J Public Health. 2005 Jan-Feb;96 Suppl 1:S9-12
This paper describes the emergence of a formal partnership between Manitoba First Nations and researchers in the Department of Community Health Sciences at the University of Manitoba. This partnership reflects two decades of a working relationship in Manitoba involving university researchers and First Nations communities, as well as new and innovative approaches to developing organizations, training initiatives and projects that strengthen First Nations principles of governance. The emerging trust that has developed between the Manitoba First Nations and the University has made it possible to extend this partnership into building further research capacity and evidence-based decision-making among First Nations. Discussions between the Assembly of Manitoba Chiefs and the Northern Health Research Unit resulted in the development of a Manitoba First Nations Centre for Aboriginal Health Research. Its mission is to initiate, coordinate and support research activities designed to assist First Nations and Aboriginal communities and organizations in their efforts to promote healing, wellness and improved health services in their communities. Much of the health research described in this journal was facilitated through this partnership, which demonstrated the value of partnerships and new funding opportunities to better address the health information needs of First Nations communities, particularly at a time when Aboriginal communities were highly skeptical of the value of academic research.
To gain preliminary knowledge about issues identified by Native health investigators who would encourage greater community involvement in Indigenous health programs and research in Canada, Pacific Rim, and the United States.
A pilot/feasibility study, August 2001-April 2002.
Indigenous health agencies and institutions in New Zealand, Australia, Canada, and the United States.
Thirty-six health professionals from rural and urban health centers participated, which resulted in 10 group and four individual interviews. Subjects included program managers, clinical physicians, and health researchers. Approximately 58% of the subjects self-identified as Indigenous.
Three overarching themes emerged from the interview data: (i) integration of cultural values of family and community into health provision; (ii) emphasis on health education and prevention programs for Indigenous youth; and (iii) indigenous recognition and self-determination in health delivery and research.
To improve and promote community involvement in primary health programs and services for Indigenous people involves a long-term social and political commitment to health protection on a national and an international level, as well as the understanding that research methodologies and health interventions must explicitly involve culturally appropriate values and behaviors that are implemented by Indigenous people.
Within the past 2 decades, community capacity building and community empowerment have emerged as key strategies for reducing health disparities and promoting public health. As with other strategies and best practices, these concepts have been brought to indigenous (American Indian and Alaska Native) communities primarily by mainstream researchers and practitioners. Mainstream models and their resultant programs, however, often have limited application in meeting the needs and realities of indigenous populations. Tribes are increasingly taking control of their local health care services. It is time for indigenous people not only to develop tribal programs but also to define and integrate the underlying theoretical and cultural frameworks for public health application.
Cites: Scand J Public Health Suppl. 2002;59:72-712227969
Health care services for registered "band" Indians in Ontario are provided primarily by the Canadian Federal Government. Complex management methods preclude the direct involvement of Indian people in the decisions for their health resource allocation. Health indicators, need, and health status indexes are reviewed. The biostatistics of mortality and demography of the Indian and reference populations are aggregated with hospitalization/morbidity experience as the Chen G'1 Index, as an indicator of normative and comparative need. This is weighted by linear measurements of perceived need for preventive medicine programs, as ranked and scaled values of priorities, Zj. These were determined by community survey on 11 Indian reserves using a non-probabilistic psychometric method of "pair comparisons," based upon "Thurstone's Law of Comparative Judgement.," The calculation of the aggregate single unit Indian Health Status Index [Log.G'1].Zj and its potential application in a "zero-base" budget is described.
Democratic or equal participation in decision making is an ideal that community and academic stakeholders engaged in participatory research strive to achieve. This ideal, however, may compete with indigenous peoples' right to self-determination. Study objectives were to assess the perceived influence of multiple community (indigenous) and academic stakeholders engaged in the Kahnawake Schools Diabetes Prevention Project (KSDPP) across six domains of project decision making and to test the hypothesis that KSDPP would be directed by community stakeholders. Self-report surveys were completed by 51 stakeholders comprising the KSDPP Community Advisory Board (CAB), KSDPP staff, academic researchers and supervisory board members. KSDPP staff were perceived to share similar levels of influence with (i) CAB on maintaining partnership ethics and CAB activities and (ii) academic researchers on research and dissemination activities. KSDPP staff were perceived to carry significantly more influence than other stakeholders on decisions related to annual activities, program operations and intervention activities. CAB and staff were the perceived owners of KSDPP. The strong community leadership aligns KSDPP with a model of community-directed research and suggests that equitable participation-distinct from democratic or equal participation-is reflected by indigenous community partners exerting greater influence than academic partners in decision making.
Current human subject research training modules fail to capture ethically relevant cultural aspects of research involving American Indian and Alaska Native (AI/AN) community members. Applying a Community Engaged Research (CEnR) approach, we adapted the Collaborative IRB Training Initiative training module "assessing risk and benefits." In a two-arm randomized controlled trial, followed by debriefing interviews, we evaluated module acceptability and understandability (test scores) among 40 reservation-based community members. Participants who took the adapted module, compared to those who took the standard module, reported higher scores on relevance of the material overall satisfaction, module quiz scores, and a trend toward higher self-efficacy. Implications of the efficacy of this approach for enhancing ethics training and community participation in research within AI/AN and other cultural populations within and outside the United States are discussed.
Cites: JAMA. 2000 May 24-31;283(20):2701-1110819955