Knowledge translation approaches and practices in Indigenous health research: A systematic review

Knowledge translation in Indigenous health research: voices from the field

OBJECTIVES

To better understand what knowledge translation activities are effective and meaningful to Indigenous communities and what is required to advance knowledge translation in health research with, for, and by Indigenous communities.

STUDY DESIGN

Workshop and collaborative yarning.

SETTING

Lowitja Institute International Indigenous Health Conference, Cairns, June 2023.

PARTICIPANTS

About 70 conference delegates, predominantly Indigenous people involved in research and Indigenous health researchers who shared their knowledge, experiences, and recommendations for knowledge translation through yarning and knowledge sharing.

RESULTS

Four key themes were developed using thematic analysis: knowledge translation is fundamental to research and upholding community rights; knowledge translation approaches must be relevant to local community needs and ways of mobilising knowledge; researchers and research institutions must be accountable for ensuring knowledge translation is embedded, respected and implemented in ways that address community priorities; and knowledge translation must be planned and evaluated in ways that reflect Indigenous community measures of success.

CONCLUSION

Knowledge translation is fundamental to making research matter, and critical to ethical research. It must be embedded in all stages of research practice. Effective knowledge translation approaches are Indigenous-led and move beyond Euro-Western academic metrics. Institutions, funding bodies, and academics should embed structures required to uphold Indigenous knowledge translation. We join calls for reimaging health and medical research to embed Indigenous knowledge translation as a prerequisite for generative knowledge production that makes research matter.

Best practice models of aged-care implemented for First Nations people: a systematic review aligned with the Good Spirit Good Life quality of life principles

BACKGROUND

Aged-care programs that are based in First Nations worldviews are believed to translate to improved quality of life for First Nations Elders. First Nations perspectives of health and well-being incorporates social and cultural determinants in addition to traditional Western biomedical approaches. This is exemplified by the Good Spirit Good Life (GSGL) framework, which comprises 12 strength-based factors determined by First Nations Elders as constituting culturally appropriate ageing. Our objective was to conduct a systematic review of existing aged care models of practice to determine the degree of alignment with the GSGL framework. Recommendations of the national Australian Royal Commission into Aged Care Quality and Safety informed this work.

METHODS

We conducted a systematic search of academic and grey literature in the PubMed, Scopus, Ovid Embase, and Informit online databases. Inclusion criteria comprised English language, original research describing the implementation of First Nations culturally appropriate aged care models, published before August 2022. Research that was not focused on First Nations Elders' perspectives or quality of life was excluded. We subsequently identified, systematically assessed, and thematically analyzed 16 articles. We assessed the quality of included articles using the Aboriginal and Torres Strait Islander Quality Assessment Tool (ATSIQAT), and the Joanna Briggs Institute (JBI) critical appraisal tool for qualitative research.

RESULTS

Most studies were of medium to high quality, while demonstrating strong alignment with the 12 GSGL factors. Nine of the included studies detailed whole service Models of care while 7 studies described a single program or service element. Thematic analysis of included studies yielded 9 enablers and barriers to implementing models of care.

CONCLUSIONS

Best-practice First Nations aged care requires a decolonizing approach. Programs with strong adherence to the 12 GSGL factors are likely to improve Elders' quality of life.

Producing knowledge together: a participatory approach to synthesising research across a large-scale collaboration in Aboriginal and Torres Strait Islander health

BACKGROUND

Despite that stakeholder participation in evidence synthesis could result in more useful outcomes, there are few examples of processes that actively involve them in synthesis work. Techniques are needed that engage diverse stakeholders as equal partners in knowledge co-production. The aims of this paper are to describe an innovative participatory process of synthesising a large body of academic research products and compare the findings of the participatory process against two traditional approaches to synthesis: a rapid review and a structured review.

METHODS

First, a rapid synthesis of all research outputs (n = 86) was conducted by researchers with in-depth knowledge of the collaboration's research. Second, a team of researchers and service providers conducted a structured synthesis of seventy-eight peer-reviewed articles and reports generated by the collaboration. Fifty-five publications were brought forward for further synthesis in part three, a facilitated participatory synthesis. Finally, we explored the value added by the participatory method by comparing findings generated across the three synthesis approaches.

RESULTS

Twelve researchers and 11 service providers/policy partners-8 self-identified as Aboriginal and/or Torres Strait Islander-participated in two facilitated workshops (totalling 4 h). Workshop activities engaged participants in reviewing publication summaries, identifying key findings, and evoked review, discussion and refinement. The process explicitly linked experiential knowledge to citations of academic research, clearly connecting the two knowledge types. In comparing the findings generated across all three methods we found mostly consistencies; the few discrepancies did not contradict but gave deeper insights into statements created by the other methods. The participatory synthesis generated the most, detailed, and unique findings, and contextual insights about the relevance of the key messages for practice.

CONCLUSION

The participatory synthesis engaged stakeholders with diverse backgrounds and skillsets in synthesising a large body of evidence in a relatively short time. The participatory approach produced findings comparable to traditional synthesis methods while extending knowledge and identifying lessons most relevant for the participants who, ultimately, are the end users of the research. This process will interest other large-scale research collaborations seeking to engage stakeholders in evidence synthesis.

We're here too: child health information-seeking experiences and preferences of Red River Métis families - a qualitative study

BACKGROUND

Red River Métis families need access to meaningful and appropriate resources when their children are sick. At the invitation of the Manitoba Métis Federation (MMF) to partner in this research, our aim was to understand Red River Métis parents' experiences and preferences for seeking child health information when their child is acutely ill, to inform the adaptation of existing parent resources.

METHODS

A qualitative descriptive approach underpinned by a participatory paradigm guided this study. Semi-structured interviews were conducted with 19 Red River Métis parents and Elders via Zoom or telephone. An inductive thematic analysis approach was used to explore patterns and themes across the data.

RESULTS

Analysis generated four themes: (1) We're here too; (2) We are not all the same; (3) Finding trustworthy information; and (4) Information needs to be widely available. Red River Métis pride was prominent in the results. Parents provided tangible ways to modify existing parent resources, including adding information on how to access Elders, healers and/or traditional medicines and showing different family structures, transport, living situations, Métis names, and incorporating Métis languages. While most parents reported looking for child health information online, they also stressed the need to provide multiple options, including information sheets, recognizing that parents seek information in different contexts. Parents also emphasized the importance of accessible, safe spaces to find child health information, including local schools, community centres, healthcare organizations and the MMF.

CONCLUSION

There is a lack of child health information created specifically for Red River Métis families. The development of this information can support their information needs and preferences and the ongoing efforts to revitalize Red River Métis culture and language. Study findings will inform the adaptation and dissemination of existing child health resources to ensure they reflect Red River Métis parents' information needs and preferences. This research is a critical step in addressing an identified need for Red River Métis families to have culturally relevant and meaningful child health resources, and in the pursuit of equitable care for all children in Canada.

TRIAL REGISTRATION

N/A.

Coproducing health research with Indigenous peoples

The coproduction of health research represents an important advance in the realm of participatory methodologies, which have evolved over the past five decades. This transition to a collaborative approach emphasizes shared control between academic researchers and their partners, fostering a more balanced influence on the research process. This shift not only enhances the quality of the research and the evidence generated, but also increases the likelihood of successful implementation. For Indigenous peoples, coproduced research represents a critical development, enabling a shift from being mere 'subjects' of research to being active controllers of the process-including addressing the extractive and oppressive practices of the past. In this Review, we explore how research coproduction with Indigenous peoples is evolving. An 'Indigenous turn' embraces the concept of shared control while also considering the principles of reciprocity, the incommensurability of Western and Indigenous knowledge systems, divergent ethical standards, strategic and political differences, and the broader impact of processes and outcomes. To illustrate these ideas, we present examples involving New Zealand's Māori communities and offer recommendations for further progress.

The Unexpected Benefits of a Decolonized Knowledge Translation Initiative for Indigenous Mother Participants

Western health research's approach to knowledge translation (KT) has been criticized by Indigenous scholars, leaders, and communities for its misalignment with Indigenous ways of knowing and relational approaches to sharing knowledge. Conversely, Indigenous KT is understood as 'sharing what we know about living a good life' (Kaplan-Myrth & Smylie, 2006). Whereas KT in Euro-Western science contexts focuses on closing the know-do gap implying a separation of knowledge and action, knowledge in the Indigenous context is inherently practical and based on centuries old practices including oral traditions, experiential knowledge, and cross-cultural sharing. This article describes the development of a decolonized KT strategy. This community-engaged KT initiative was developed at the suggestion of Indigenous mothers who participated in a research study in Hamilton, Canada, which examined their experiences using health care to meet the health needs of their infants. Indigenous mothers participated in three main roles related to the KT activities: sharing their story in video, participating as team members on an Advisory Board, and directing the creation of a video series and website educational resource (KT strategy). Five Indigenous mothers participated as members of the Advisory Board. The process of participating had positive impacts on the mothers, namely, empowerment, strength, 'I am not alone', and healing. These unexpected findings, which go beyond the original project purpose to create an educational resource, show the significant and important benefits for research participants, particularly those from Indigenous communities, to be involved in decolonized KT strategies.

Ethical publishing in 'Indigenous' contexts

Ethical publishing practices are vital to tobacco control research practice, particularly research involving Indigenous (Indigenous peoples: For the purposes of this Special Communication, we use the term Indigenous people(s) to include self-identified individuals and communities who frequently have historical continuity with precolonial/presettler societies; are strongly linked to the land on which they or their societies reside; and often maintain their own distinct language(s), belief and social-political systems, economies and sciences. The authors humbly acknowledge, respect and value that Indigenous peoples are diverse and constitute many nations, cultures and language groups. Many Indigenous peoples also exist as governments in treaty relations with settler-colonial societies, and all Indigenous peoples have inherent rights under international law. The language and terminology used should reflect the local context(s) and could include, but are not limited to, terms such as Aboriginal, Bagumani, Cherokee, First Peoples, First Nations, Inuit, Iwaidja, Kungarakan, Lakota, Māori, Mѐtis, American Indian, Navajo, Wagadagam, Wiradjuri, Yurok, etc) people. These practices can minimise, correct and address biases that tend to privilege Euro-Western perspectives. Ethical publishing practices can minimise and address harms, such as appropriation and misuse of knowledges; strengthen mechanisms of accountability to Indigenous peoples and communities; ensure that tobacco control research is beneficial and meaningful to Indigenous peoples and communities; and support Indigenous agency, sovereignty and self-determination. To ensure ethical practice in tobacco control, the research methodology and methods must incorporate tangible mechanisms to include and engage those Indigenous peoples that the research concerns, affects and impacts.Tobacco Control is currently missing an ethical research and evaluation publishing protocol to help uphold ethical practice. The supporters of this Special Communication call on Tobacco Control to adopt publication practice that explicitly upholds ethical research and evaluation practices, particularly in Indigenous contexts. We encourage researchers, editors, peer reviewers, funding bodies and those publishing in Tobacco Control to reflect on their conduct and decision-making when working, developing and undertaking research and evaluation of relevance to Indigenous peoples.Tobacco Control and other publishers, funding bodies, institutions and research teams have a fundamental role in ensuring that the right peoples are doing the right work in the right way. We call for Tobacco Control to recognise, value and support ethical principles, processes and practices that underpin high-quality, culturally safe and priority-driven research, evaluation and science that will move us to a future that is commercial tobacco and nicotine free.

Knowledge Translation and Implementation Planning to Promote Research Governance in Nongovernment Organizations in the Torres Strait: Descriptive Study

Background

Aboriginal and Torres Strait Islander people in Australia have participated in Western research for decades. When done well, research has resulted in significant benefits and positive impacts on society. However, the primary benefactor of this research has and continues to be researchers, with limited or no research knowledge mobilized for uptake and beneficial use by end users, such as individuals and communities. In 2021, the Torres Strait Islanders Research to Policy and Practice Hub (the Hub) at James Cook University designed and implemented several strategies, including a games-based interactive workshop with representatives from nongovernment organizations (NGOs). Feedback suggests the workshop and associated activities were a success.

Objective

We describe knowledge translation (KT) and implementation planning to design and implement strategies to increase awareness and understanding of NGOs in research governance.

Methods

This descriptive study involved representatives from NGOs on Thursday Island in the Torres Strait. We collected data from a literature review and informal discussions. We used several models and frameworks to guide our approach and underpin data collection and analysis.

Results

Designing and implementing strategies to increase awareness and understanding of NGOs in the Torres Strait to govern research involved several key steps: (1) identifying and defining what needed to change and who needed to change, (2) identifying and mapping barriers and facilitators, (3) selecting the most appropriate strategies to support change, (4) implementing activities, and (5) monitoring and evaluating our approach. We developed a program logic to understand and communicate to others how we would implement activities and what resources would be required to support this process. We drew on several evidence-based KT and implementation models and frameworks to do this. First, a KT planning template was used to inform what evidence we wanted to mobilize, to whom, and for what purpose. Based on this step, we recognized we wanted to bring about change with the target audience, and as such, we drew on the previously mentioned implementation planning models and frameworks. We collated the outcomes from these initial steps.

Conclusions

Our KT and implementation practice experience were successful. Encouraging researchers and end users to adopt similar practices requires investment in training and development of KT and implementation practice. This also entails modifying research standards and guidelines to include KT and implementation practice when working with Aboriginal and Torres Strait Islander people and other vulnerable groups, creating incentives for researchers and end users to embed KT and implementation practice in research, and recognizing and rewarding the benefits and impact beyond publication and presentation.

Knowledge translation in Aboriginal and Torres Strait Islander research contexts in Australia: scoping review protocol

INTRODUCTION

Knowledge translation (KT) involves bridging the gaps between research knowledge and research application or practice, by sharing this knowledge with knowledge-users. KT is increasingly being used in research with Indigenous peoples globally to address the top-down and inappropriate research approaches commonly used in Indigenous research. Employing KT in Indigenous research in Australia is an emergent field, despite Aboriginal and Torres Strait Islander peoples having conducted KT for generations.There is limited evidence which demonstrates how KT is applied in the Aboriginal/Torres Strait Islander context. Results will benefit researchers by demonstrating ways of appropriately translating research findings to knowledge-users, including Aboriginal and Torres Strait Islander communities, researchers and policy makers. The scoping review will also inform a KT definition, method and practices used in a large-scale, longitudinal cohort study of Aboriginal and Torres Strait Islander adults: the Mayi Kuwayu Study.

METHODS AND ANALYSIS

Under guidance of an Aboriginal and Torres Strait Islander governance committee, we will conduct a scoping review on KT in Aboriginal/Torres Strait Islander research. We will follow the scoping review method outlined by the Joanna Briggs Institute. We will search the ANU SuperSearch, and grey and hard to find literature in June 2022. Abstracts and full-text articles will be screened by two independent reviewers. We will include studies that relate to KT in Aboriginal/Torres Strait Islander research, regardless of the research topic. Results will be used to inform the KT definition, method and practices that can be used in Aboriginal/Torres Strait Islander research contexts in Australia.

ETHICS AND DISSEMINATION

The Mayi Kuwayu Study has ethics approvals from the Australian Institute of Aboriginal and Torres Strait Islander Studies, 12 Aboriginal/Torres Strait Islander organisations, and the Australian National University Human Research Ethics Committee. Results will be disseminated through peer-review publication and community workshops. Protocol registration is available online (10.17605/OSF.IO/JMFQ3).