Prioritizing Indigenous Elders’ Knowledge for Intergenerational Well-being

Mexican American Intergenerational Research: Transformative Model of Occupational Therapy

Thirty-seven interviews of Mexican American women who crossed the border into the United States during the era of the Mexican Revolution of 1910 were analyzed using constructivist grounded theory methods. The intent is to expand the occupational therapy profession's occupational consciousness and cultivate cultural humility. Four themes emerged from the data: suffering, work, yearning for an education, and compassion for others. The findings suggest that environmental barriers such as hierarchy (patriarchy and discrimination) and physical barriers (limited access to built environments, lack of nonexploitative work opportunities, and hostile educational institutions) prevented occupational participation. Small acts of resistance through everyday living (finding joy, playing, self-sufficiency, and community organizing) were identified as facilitators of occupational participation. The research findings challenge proposed assumptions found within the occupational therapy literature: (1) humans and occupations exist as separate from their environments, and (2) work, productivity, and leisure contribute positively to health. The Transformative Model of Occupational Therapy is introduced as a decolonized framework that inextricably links individual health to community and global health. The model centers play, social participation, work, and education as occupations that contribute to the common good. These occupations are kept in equilibrium within the Four Pillars of Culture (self-determination, compassion, sustainability, and language) or the cultural values identified and derived from the stories.

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.

Looking beyond the individual-The importance of accessing health and cultural services for Indigenous women in Thunder Bay, Ontario

Access to cultural activities and culturally relevant healthcare has always been significant for achieving holistic Indigenous health and continues to be a key factor in shaping the health journey of Indigenous individuals and communities. Previous research has indicated the importance of cultural practices and services in sustaining cultural identity for Indigenous peoples, which is a major influence on their wellbeing. This study marks the first phase in a project aimed at establishing an Indigenous healing program and uses a qualitative research approach to understand the health and cultural services that Indigenous women want and require in Thunder Bay, Ontario. During interviews, participants (n = 22) answered questions around their understandings of health and wellbeing, and how they are able to incorporate cultural practices into their circle of care. Thematic analysis was performed on interview transcripts, and 4 key themes were identified: 'independence and self-care', 'external barriers to accessing services', 'finding comfort in the familiar' and 'sense of community'. Together these themes illustrate how Indigenous women feel a strong sense of personal responsibility for maintaining their health despite the multiple environmental factors that may act as barriers or supports. Furthermore, the necessity of embedding cultural practices into Indigenous women's circle of care is highlighted by the participants as they describe the mental, spiritual, social, and emotional health benefits of engaging in cultural activities within their community. The findings demonstrate the need for current modes of care to look beyond the individual and consider the impacts that socio-environmental factors have on Indigenous women. To accomplish this, we hope to increase access to health and cultural services through the creation of an Indigenous healing program that can be adequately incorporated into Indigenous women's circle of care if they wish to do so.

Grounding Wellness: Coloniality, Placeism, Land, and a Critique of "Social" Determinants of Indigenous Mental Health in the Canadian Context

Authored by a small team of settler and Indigenous researchers, all of whom are deeply involved in scholarship and activism interrogating ongoing processes of coloniality in lands now known to many as Canada, this paper critically examines "social" and grounded determinants of Indigenous mental health and wellness. After placing ourselves on the grounds from which we write, we begin by providing an overview of the social determinants of health (SDOH), a conceptual framework with deep roots in colonial Canada. Though important in pushing against biomedical framings of Indigenous health and wellness, we argue that the SDOH framework nevertheless risks re-entrenching deeply colonial ways of thinking about and providing health services for Indigenous people: SDOH, we suggest, do not ultimately reckon with ecological, environmental, place-based, or geographic determinants of health in colonial states that continue to occupy stolen land. These theoretical interrogations of SDOH provide an entry point to, first, an overview of Indigenous ways of understanding mental wellness as tethered to ecology and physical geography, and second, a collection of narrative articulations from across British Columbia: these sets of knowledge offer clear and unequivocal evidence, in the form of Indigenous voices and perspectives, about the direct link between land, place, and mental wellness (or a lack thereof). We conclude with suggestions for future research, policy, and health practice actions that move beyond the current SDOH model of Indigenous health to account for and address the grounded, land-based, and ecologically self-determining nature of Indigenous mental health and wellness.

Enhancing health and wellness by, for and with Indigenous youth in Canada: a scoping review

BACKGROUND

Indigenous youth in Canada face profound health inequities which are shaped by the rippling effects of intergenerational trauma, caused by the historical and contemporary colonial policies that reinforce negative stereotypes regarding them. Moreover, wellness promotion strategies for these youth are replete with individualistic Western concepts that excludes avenues for them to access holistic practices grounded in their culture. Our scoping review explored strategies, approaches, and ways health and wellness can be enhanced by, for, and with Indigenous youth in Canada by identifying barriers/roadblocks and facilitators/strengths to enhancing wellness among Indigenous youth in Canada.

METHODS

We applied a systematic approach to searching and critically reviewing peer-reviewed literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [PRISMA-ScR] as a reporting guideline. Our search strategy focused on specific keywords and MeSH terms for three major areas: Indigenous youth, health, and Canada. We used these keywords, to systematically search the following electronic databases published in English between January 01, 2017, to May 22, 2021: Medline [Ovid], PubMed, ERIC, Web of Science, Scopus, and iportal. We also used hand-searching and snowballing methods to identify relevant articles. Data collected were analysed for contents and themes.

RESULTS

From an initial 1695 articles collated, 20 articles met inclusion criteria for this review. Key facilitators/strengths to enhancing health and wellness by, for, and with Indigenous youth that emerged from our review included: promoting culturally appropriate interventions to engage Indigenous youth; using strength-based approaches; reliance on the wisdom of community Elders; taking responsibility; and providing access to wellness supports. Key barriers/roadblocks included: lack of community support for wellness promotion activities among Indigenous youth; structural/organizational issues within Indigenous communities; discrimination and social exclusion; cultural illiteracy among youth; cultural discordance with mainstream health systems and services; and addictions and risky behaviours.

CONCLUSION

This scoping review extracted 20 relevant articles about ways to engage Indigenous youth in health and wellness enhancement. Our findings demonstrate the importance of promoting health by, and with Indigenous youth, by engaging them in activities reflexive of their cultural norms, rather than imposing control measures that are incompatible with their value systems.

“We Cause a Ruckus”: Exploring How Indigenous Youth Navigate the Challenges of Community Engagement and Leadership

Using qualitative data from an interdisciplinary research project about mental health and community engagement with Indigenous youth in Kasabonika Lake First Nation (Ontario, Canada), this paper explores the factors that constrain and facilitate their ability to contribute to the well-being of their community. Case studies are employed to demonstrate how the youth navigate complex social and structural conditions within the context of on-going colonization through federal and provincial governance arrangements, to make a difference in the place they call home and forge unique in-roads that reflect their generational realities and aspirations. The paper contributes to ongoing discussions related to mental health, self-determination, and resilience research.

Older and Wiser? Age Moderates the Association Between Discrimination and Depressive Symptoms in American Indians and Alaska Natives

Objectives: To examine age differences in the association between discrimination and depressive symptoms among urban American Indians and Alaska Natives (AI/AN). Methods: A sample of 303 urban AI/AN (18-78 years old) reported on lifetime and past-week experiences of racial discrimination and depressive symptoms. Depressive symptoms were regressed on racial discrimination, age, and their interaction, adjusting for demographic factors and other life stressors. Results: Lifetime and past-week discrimination were significantly associated with depressive symptoms, and these associations were stronger among younger than older adult AI/AN. Discussion: The results are consistent with prior reports in other populations, but this is the first such study to focus on AI/AN, and it highlights the importance of considering life course perspectives. Conclusions are limited by the cross-sectional nature of the data. Longitudinal and qualitative work is needed to understand why discrimination may have a stronger effect on mental health for younger than older AI/AN.

Health promotion interventions supporting Indigenous healthy ageing: a scoping review

Aging well is a priority in Canada and globally, particularly for older Indigenous adults experiencing an increased risk of chronic conditions. Little is known about health promotion interventions for older Indigenous adults and most literature is framed within Eurocentric paradigms that are not always relevant to Indigenous populations. This scoping review, guided by Arksey and O'Malley's framework and the PRISMA-ScR Checklist, explores the literature on Indigenous health promoting interventions across the lifespan, with specific attention to Indigenous worldview and the role of older Indigenous adults within these interventions. To ensure respectful and meaningful engagement of Indigenous peoples, articles were included in the Collaborate or Shared Leadership categories on the Continuum of Engagement. Fifteen articles used Indigenous theories and frameworks in the study design. Several articles highlighted engaging Elders as advisors in the design and/or delivery of programs however only five indicated Elders were active participants. In this scoping review, we suggest integrating a high level of community engagement and augmenting intergenerational approaches are essential to promoting health among Indigenous populations and communities. Indigenous older adults are keepers of essential knowledge and must be engaged (as advisors and participants) in intergenerational health promotion interventions to support the health of all generations.

Being connected to nature, reindeer, and family: findings from a photovoice study on well-being among older South Sámi people

In this paper, we examine the perceptions of well-being among older South Sámi people with various experiences from reindeer herding by use of a method called photovoice. Eleven participants, including six men and five women aged 67–84 years, agreed to take photos of situations, things, or persons that made them feel a sense of well-being. When the researcher collected the photos, the participants were invited to tell their stories related to each photo. In the thematic analysis of the photos, three main themes emerged: a) well-being through connection to nature, b) well-being through connection to the reindeer, and c) well-being through connection to the family. In conclusion, we argue that if healthcare professionals are to enhance the well-being of care receivers – in this case older people with South Sami background from reindeer-herding families – they must consider the care receiver’s life story and what constitutes well-being for the individual person.

Age-Friendly Cities and Older Indigenous People: An Exploratory Study in Prince George, Canada

Cities around the world are responding to aging populations and equity concerns for older people by developing age-friendly communities plans, following the World Health Organization's guidelines. Such plans, however, often fail to account for the wide diversity of older people in cities, with the result that some older people, including Indigenous older people, do not see their needs reflected in age-friendly planning and policies. This article reports on a study involving 10 older First Nations and Métis women in the city of Prince George, Canada, comparing the expressed needs of these women with two age-friendly action plans: that of the city of Prince George, and that of the Northern Health Authority. Four main categories were raised in a group discussion and interview with these women at the Prince George Native Friendship Centre: availability of health care services, accessibility and affordability of programs and services, special roles of Indigenous Elders, and experiences of racism and discrimination. There are many areas of synergy between the needs expressed by the women and the two action plans; however, certain key areas are missing from the action plans; in particular, specific strategies for attending to the needs of Indigenous and other older populations who often feel marginalized in health care and in age-friendly planning.

"The Land Nurtures Our Spirit": Understanding the Role of the Land in Labrador Innu Wellbeing

We examined Indigenous views of wellbeing, aiming to understand how the Labrador Innu view influence of land on their health. The Innu live in two First Nation communities (Sheshatshiu and Natuashish) in the subarctic portion of the province of Newfoundland and Labrador, Canada. Their views on land and wellbeing are context specific and have not been studied; our research addresses this significant gap in literature. Findings highlight that the experience of being on the land with family and community, learning cultural knowledge, and gaining a sense of identity play a major role in enhancing wellbeing. Externally imposed policies and programs conceiving Indigenous land as a physical place only fail to understand that land sustains wellbeing by emplacing knowledge systems and cultural identity.