Indigenous Health Research Monitoring, June 2021

In this issue:

Just Published

 New scientific publications and articles

Article Summaries

Social inequalities in health

Social and emotional wellbeing of indigenous gender and sexuality diverse youth: Mapping the evidence

Soldatic, K., Briskman, L., Trewlynn, W., Leha, J., et Spurway, K. (2021). Social and emotional wellbeing of indigenous gender and sexuality diverse youth: mapping the evidence. Culture, Health & Sexuality, 1-117.

Context

Few studies have explored the social and emotional wellbeing of Indigenous youth self-identifying as gender and sexuality diverse (including lesbian/gay, bisexual, trans, queer, non-binary, intersex, asexual and two-spirit). However, Indigenous gender and sexuality diverse youth present different experiences, vulnerabilities and needs than other Indigenous young people. These characteristics are set in the context of historical trauma linked to colonialism and the imposition of religious and heteronormative values to the detriment of values that respect gender and sexuality diversity found in many Indigenous populations around the world.

Objectives

This scoping review aimed to:

  • Describe existing data on the social and emotional wellbeing of Indigenous gender and sexuality diverse youth aged 14 to 25 around the world.
  • Determine the strengths, weaknesses, gaps and trends in the literature on this subject.

Methodology and data

A search of the literature using four search engines recognized in the social sciences—ProQuest, InformIT, JSTOR and Scopus—resulted in the selection of 12 evidence-based scientific articles. The studies came mainly from Canada, the United States and Australia, with a majority (9 of 12) published after 2010. An analysis of the results using a narrative approach served to identify the main themes covered by the studies.

What was learned?

  • Several studies point out that colonial systems produced environments characterized by the marginalization of Indigenous gender and sexuality diverse youth. Those young people report experiences of violence more often than do heterosexual and cisgender (someone whose gender identity corresponds to the sex assigned at birth) young people.
  • The high prevalence of social and emotional trauma has negative repercussions, including substance use, socioeconomic hardships and mental health problems. Indigenous gender and sexuality diverse youth more often report feeling depressed and were introduced to substance use at a younger age than their heterosexual and cisgender peers.
  • A connection with their culture and community, as well as the presence of support systems comprising peers who are Indigenous and/or members of the gender and sexuality diverse community, act as resilience factors in dealing with trauma according to several of the studies reviewed. Feeling accepted, respected and connected enables these young people to grow and develop.

Limitations

The authors point out that scoping reviews do not provide an exhaustive portrait of the existing body of evidence and that the small number of publications looking at Indigenous gender and sexuality diverse youth makes it difficult to reach conclusions based on the data collected. The authors looked exclusively at articles published in English, which is a limitation given that many articles may have been published in other languages.

Traditional knowledge of health and wellbeing

Indigenous resilience in Australia: A scoping review using a reflective decolonizing collective dialogue

Usher, K., Jackson, D., Walker, R., Durkin, J., Smallwood, R., Robinson, M., Sampson, U. N., Adams, I., Porter, C., & Marriott, R. (2021). Indigenous Resilience in Australia: A Scoping Review Using a Reflective Decolonizing Collective Dialogue. Frontiers in Public Health, 9.
Open access: PDF.

Context

Indigenous resilience is a complex phenomenon that has been studied in several publications, especially those concerning young people. The concept of resilience, however, tends to be structured around Western definitions and rarely seems to be called into question, as is the case with other related concepts such as adversity and risk.

Objective

This scoping review aimed to produce a more culturally inclusive understanding of resilience by incorporating Australian Indigenous ways of knowing, being and doing.

Methodology and data

The scoping review began with a search for keywords in the selected databases. This research strategy generated 5,290 initial results, which were then sorted. Studies were retained if they were peer-reviewed and the research concentrated on the perspectives of Aboriginals and Torres Strait Islanders, as well as on the conceptualization of resilience in Australia. Only eight studies were retained for analysis.

The authors adopted a decolonizing approach and a process of critical reflection to ground their work in Indigenous worldviews. The authors were also able to benefit from the involvement of local Aboriginal Research Cultural Advisory Groups, who participated in the research strategy, approved the analysis of the findings and collaborated in writing the article. Finally, the approach adopted enabled the authors to explore the tension between the influence of prevailing views and the space available to Indigenous voices in defining resilience.

What was learned?

The contents of the eight studies were grouped into five themes: exploring definitions and concepts of resilience, the relationship between the unique adversity experienced by Aboriginal people and their resilience, the key characteristics of the resilience of Australian Aboriginal people, the means explored in some studies to measure the impact of certain factors on the resilience of Aboriginal people, and, finally, strategies to strengthen protective factors for individuals, families and communities.

The results obtained enabled the authors to broaden the concept of resilience beyond an individual’s capacity to face adversity. Aboriginal concepts generally encompass family, culture, identity, belonging and social relationships, access to land, and community. The authors suggest that reframing resilience in an Aboriginal perspective, advancing adaptation strategies developed to deal with past adversities, and focusing on Aboriginal protective factors offers potential to protect against adversity attributable to the impacts of colonialism and racism. Including community strengths in the definition of resilience, especially, makes it possible to affirm the determination of communities (as a collective) in the search for solutions and to foster wellbeing in Aboriginal communities across Australia.

Limitations

The authors believe that the small number of studies retained may have been influenced by the choice of inclusion criteria. They also recognize that Aboriginal authors are underrepresented in the scientific literature and that Indigenous peoples privilege other means for sharing information and knowledge, especially the spoken word, storytelling and art. Finally, the authors explain that their results may not reflect the needs of all Aboriginal populations across Australia.

Characteristics of Indigenous healing strategies in Canada: A scoping review

Yu, Z., Steenbeek, A., Biderman, M., Macdonald, M., Carrier, L., et MacDonald, C. (2020). Characteristics of Indigenous healing strategies in Canada: A scoping review. JBI Evidence Synthesis, 18(12), 2512-2555.
Open access: PDF.

Context

The holistic perspective of health used in Indigenous healing asserts that an individual’s personhood is indissociable from their environment. This concept is even more relevant in Canada because of efforts to develop respectful relations between Indigenous and settler populations. The Truth and Reconciliation Commission of Canada’s Calls to Action have led to a growing interest in Indigenous healing strategies, whose relevance is now acknowledged in many clinical, community and political spheres. This interest has also motivated a study of new research approaches for use in Indigenous contexts. To date, no clear understanding exists as to what characterizes Indigenous healing strategies in Canada.

Objective

The purpose of this scoping review was to identify the characteristics of Indigenous healing strategies in Canada, as well as culturally relevant approaches in an Indigenous context.

Methodology

This article uses the JBI scoping review methodology and a previously published protocol. The following databases were used: CINAHL Full Text, Sociological Abstracts, PsycINFO, MEDLINE, and Academic Search Premier. Searches for grey literature were conducted in iPortal, Canadian Electronic Library and several websites of Canadian government and Indigenous organizations. Only articles in English published since 2008 were included, while theses and dissertations were excluded.

What was learned?

According to the articles selected, Indigenous healing strategies are characterized by:

  • Guiding principles based in respect, culture and traditions, the medicine wheel, and a strength-based/empowerment approach;
  • Central components including artistic expression (singing, dance and drums), ceremonies (smudging and sweat lodges), and games and exercises;
  • Human resources that include recruiting community members to assume different roles (mentor, volunteer, facilitator, etc.), local agencies, and Knowledge Keepers.

Approaches to improve the cultural relevance of healing strategies in Indigenous contexts most often included participatory/consultative research and the use of Indigenous protocols.

The results of this scoping review point to the use of a decolonial approach that supports Indigenous knowledge, respects Indigenous rights to self-determination, and recognizes Indigenous resilience and agency.

Limitations

Theses and dissertations were not considered because of time constraints. Only articles published in English were taken into account, which excluded strategies that may have been written in another language or published in another format (such as art or ceremonies). This study looked at healing strategies in Canada, which may limit its international relevance.

Conceptualisation and operationalisation of a holistic indicator of health for older Inuit: Results of a sequential mixed-methods project

Baron, M., Riva, M., Fletcher, C., Lynch, M., Lyonnais, M.-C., et Laouan Sidi, E. A. (2021). Conceptualisation and operationalisation of a holistic indicator of health for older Inuit: Results of a sequential mixed-methods project. Social Indicators Research, 155(1), 47-72.
Click to obtain a PDF copy of the article.

Context

The Inuit, whose population is aging, define health as holistic, dynamic and multidimensional. This concept of health also influences the meaning of healthy aging for Inuit peoples. For the study results to be relevant, it is essential to incorporate Indigenous people’s conceptions of health, their realities and their culture into health research. To better understand the healthy aging of Inuit, a holistic indicator of health needs to be in line with their definition of health.

Objectives

The purpose of this project was to develop a holistic indicator of health for older Inuit in three steps:

  • Conceptualize health based on the Inuit definition of health and wellbeing, including aspects related to aging;
  • Operationalize the definition and create a holistic indicator of health using data from a study of the population’s health;
  • Evaluate the indicator’s relevance.

Methodology and data

This exploratory research project used mixed methods.

For the qualitative phase, 21 Inuit from two Nunavik communities participated in workshops that served to identify themes characterizing health and aging.

For the quantitative phase that followed, the authors created a holistic indicator of health using data about Inuit aged 50 years and older from the 2006 Aboriginal Peoples Survey (APS) combined with themes identified in the first phase that were associated with different variables of the health survey.

What was learned?

The qualitative analyses made it possible to conceptualize health according to eight themes: general health balance, mental health, spirituality, not experiencing many activity limitations, having positive relationships, being loved, speaking Inuktitut, and being free of addictions. Good health is the result of a balance between physical health, mental health, wellbeing, interpersonal relations and healthy behaviours.

The intergenerational transmission of knowledge, in part through the ability to speak Inuktitut, allows Inuit to maintain a connection with their culture and is a key to healthy aging. Having positive social relationships is another important aspect.

As they age, Inuit focus more on limitations to activities than on their illnesses. According to the participants, there is no specific universal age at which one feels old. Several participants said that they felt old when they required assistance for certain activities.

Inuit participants in the 2006 APS survey were grouped into three profiles using the holistic indicator of health created for this research:

  • Participants in good health for a majority of variables associated with the themes (36.7%);
  • Participants with good physical health but poor mental health (30%);
  • Participants with poor health for a majority of the variables associated with the themes. (33.3%).

Limitations

The lead author emphasizes that she did not participate in either collecting or analyzing data during the first phase. Moreover, the data used to operationalize the holistic indicator of health was from the 2006 health survey, while the themes were discussed in 2016. Finally, selection of variables corresponding to the themes was limited by the APS questions, which, for example, did not measure spirituality.

Social determinants of Indigenous health and wellbeing

The role of the parent–child relationship in fostering resilience in American Indian/Alaskan Native children

Tolliver‐Lynn, M. N., Marris, A. M., Sullivan, M. A., et Armans, M. (2021). The role of the parent–child relationship in fostering resilience in American Indian/Alaskan Native children. Journal of Community Psychology, 49(2), 419-431.

Context

It has been shown that a quality parent–child relationship is associated with good mental health in the child. It has also been demonstrated that symptoms of parent anxiety and depression are linked to similar symptoms in children. In the light of these two observations, the parent–child relationship may play an important role in the mental health of both parents and children. No study has documented the role played by the quality of the parent–child relationship in the mental health of parents and their preschool-age children in American Indians/Alaskan Natives (AI/AN). Demonstrating that the parent–child relationship can have a protective effect on the mental health of parents and children could contribute to continuing and developing traditional Indigenous practices that promote family ties.

Objective

The objective of the study was to examine how the quality of the parent–child relationship impacts symptoms of anxiety and depression in parents and children in American Indian/Alaskan Native populations.

Methodology and data

A total of 57 American Indian/Alaskan Native parents (average age = 33; women = 84%) were recruited with their children aged 3 to 5 by word of mouth. Parents who agreed to participate in the study completed a questionnaire about cultural identity, the quality of the parent–child relationship (using a 36-item scale to measure dysfunctions in the parent–child relationship, where a high score indicated a poor relationship), and mental health indicators (depression, anxiety and problems internalized by the child). All measurement tools demonstrated very good internal validity. Moderation analyses were conducted with the program PROCESS Version 3.0, Model 1, using bootstrapping because of the small sample size.

What was learned?

The analyses showed that the participants presented mostly favourable profiles, with low levels of depression and anxiety, as well as good parent–child relationships. The results indicated that the association between symptoms of depression in the parent and internalized problems in the child is stronger when the quality of the parent–child relationship is lower. Similarly, the association between symptoms of anxiety in the parent and internalized problems in the child is stronger when the quality of the parent–child relationship is lower. The quality of the parent–child relationship, therefore, does indeed moderate the association between the mental health (depression or anxiety, as the case may be) of the parent and that of the child.

These results underscore the protective role a quality parent–child relationship may have on the mental health of both the parent and the child. They suggest the importance of supporting new parents in their parenting role in order to strengthen the parent–child relationship and thereby improve the resilience of Indigenous families.

Limitations

A few limitations mentioned by the authors should be considered in interpreting the results. Firstly, family members and other significant people who may have developed an important relationship with the child were not taken into consideration by the study. In addition, although the internal validity of the measurement tools used in the study was demonstrated, little information is available concerning their use in Indigenous contexts. The sample size is relatively small, although that did not prevent significant associations from being established.

Cultural safety, prevention and health promotion

Improving the service to Aboriginal and Torres Strait Islanders through innovative practices between Aboriginal hospital liaison officers and social workers in hospitals in Victoria, Australia

Bnads, H., Orr, E., et Clements, C. J. (2021). Improving the service to Aboriginal and Torres Strait Islanders through innovative practices between aboriginal hospital liaison officers and social workers in hospitals in Victoria, Australia. British Journal of Social Work, 51(1), 77-95.
Open access: PDF.

Context

The accumulation of prejudices and discrimination based in a colonial past targeting Aboriginals in Australia explains, in large part, the health inequities they experience. The health and social service professions are also marked by the colonialist past. Interactions between Aboriginal and non‑Aboriginal individuals are often difficult in the healthcare context, leading to high levels of non-adherence to treatment on the part of Aboriginal persons, as well as communication problems when care and services are provided by non-Aboriginal healthcare workers.

Objectives

This study aimed to analyze the “working together” practice on the part of Aboriginal Hospital Liaison Officers (AHLOs) and non-Aboriginal social workers (SWs) in a hospital setting in the Australian state of Victoria. “Working together” requires that Indigenous ways of knowing, being and doing coexist with Western models of health and social work. The objective of the study was to show that “working together” contributes to improving access, respect and cultural safety when providing healthcare to Aboriginal patients, and also enables health professionals to offer culturally appropriate care.

Methodology and data

The authors use a framework of six principles of best practices developed using a qualitative methodology. The data were collected through in-depth interviews and practice narratives by nine AHLOs and ten SWs, as well as three Aboriginal health policy key informants. The principles were applied to two case studies: a hypothetical case based on the accumulated testimony of the AHLOs and SWs, and another research case study that demonstrates the effects on patients and workers in a hospital setting.

What was learned?

The first case study presents the concept of “working together” and relates the experience of one AHLO and one SW around the emergency admission of an Aboriginal woman with injuries related to conjugal violence. The patient was known to have left the hospital against medical advice on two previous occasions. The application of the six principles and the coordinated efforts of the AHLO and SW in the case, as well as an understanding of and respect for their respective roles, enabled the patient to receive safe and culturally relevant support taking into account all the components of her family and social environment.

The second case study presents a cultural and professional development initiative for non-Aboriginal hospital medical staff. Partnerships between the hospital and four community or artistic Aboriginal organizations were established, and several cultural rapprochement activities organized.

The results suggest that the work of AHLOs is essential in helping Aboriginal patients to complete their care trajectory at the hospital from admission to discharge. The AHLOs also facilitate the establishment of a relationship of trust between non-Aboriginal caregivers and their patients.

The article suggests that the two-way partnership (described by one Aboriginal participant as “listening from the bottom up and the top down”), mandatory cultural safety training for non‑Aboriginal healthcare workers, visible presence of Aboriginal staff, promotion of Aboriginal cultural and art events, creation of a welcoming and culturally safe physical space, and other similar measures act as powerful visible symbols of reconciliation in a hospital setting.

Limitations

The authors did not identify any limitations.

The inclusion of articles presented in this monitoring newsletter does not represent their endorsement by the Institut. Professional judgment remains essential in assessing the value of these articles for your work. You can also consult the Methodology for Indigenous Health Research Monitoring.