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Engstrom T, Lobo EH, Watego K, Nelson C, Wang J, Wong H, Kim SL, Oh SI, Lawley M, Gorse AD, Ward J, Sullivan C. Indigenous data governance approaches applied in research using routinely collected health data: a scoping review. NPJ Digit Med 2024; 7:68. [PMID: 38491156 PMCID: PMC10943072 DOI: 10.1038/s41746-024-01070-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 03/18/2024] Open
Abstract
Globally, there is a growing acknowledgment of Indigenous Peoples' rights to control data related to their communities. This is seen in the development of Indigenous Data Governance standards. As health data collection increases, it's crucial to apply these standards in research involving Indigenous communities. Our study, therefore, aims to systematically review research using routinely collected health data of Indigenous Peoples, understanding the Indigenous Data Governance approaches and the associated advantages and challenges. We searched electronic databases for studies from 2013 to 2022, resulting in 85 selected articles. Of these, 65 (77%) involved Indigenous Peoples in the research, and 60 (71%) were authored by Indigenous individuals or organisations. While most studies (93%) provided ethical approval details, only 18 (21%) described Indigenous guiding principles, 35 (41%) reported on data sovereignty, and 28 (33%) addressed consent. This highlights the increasing focus on Indigenous Data Governance in utilising health data. Leveraging existing data sources in line with Indigenous data governance principles is vital for better understanding Indigenous health outcomes.
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Affiliation(s)
- Teyl Engstrom
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Elton H Lobo
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia.
| | - Kristie Watego
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Jinxiang Wang
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Howard Wong
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Sungkyung Linda Kim
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | - Soo In Oh
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
| | | | | | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Herston, QLD, Australia
| | - Clair Sullivan
- Queensland Digital Health Centre, Centre for Health Services Research, The University of Queensland, Herston, QLD, Australia
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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Doherty S, Asghari S, Heeley T, House-Denine M, Hall A, Swab M. Postpartum haemorrhage in rural Indigenous women: scoping review of a global obstetrical challenge. Int J Circumpolar Health 2022; 81:2090066. [PMID: 35722854 PMCID: PMC9225700 DOI: 10.1080/22423982.2022.2090066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/24/2022] [Accepted: 06/12/2022] [Indexed: 11/05/2022] Open
Abstract
We conducted a scoping review to determine incidence and risk factors for postpartum haemorrhage (PPH) in rural Indigenous women. We systematically searched PubMed (Medline), EMBASE, and CINAHL for all peer-reviewed articles and grey literature regarding Indigenous ethnicity, rural settings, and PPH incidence, risk factors, or maternal outcomes published from inception to 11 January 2021. Eleven articles were deemed relevant after screening and quality assessment using the National Institutes of Health scoring system for mixed study reviews. Of these, 3 articles were good quality, 1 was fair, and 7 were poor. Nine possible risk factors were recorded. The outcomes studied were transfusion, hysterectomy and mortality. PPH research in rural Indigenous women is scarce, mostly low quality and fails to represent most Indigenous cultures and countries. Women from Indigenous groups in rural Canada, Australia and the USA are at higher risk for PPH but specific risk factors are unknown. While widely differing populations made the data difficult to synthesise, this inaugural scoping review highlights a need for further research and increased obstetrical resources in areas where rural Indigenous women reside.
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Affiliation(s)
- Sean Doherty
- Qikiqtani General Hospital, Iqaluit, Nunavut (NU), Canada
| | - Shabnam Asghari
- St. John’s, Newfoundland and Labrador, Memorial University of Newfoundland Discipline of Family Medicine, Canada
| | - Thomas Heeley
- St. John’s, Newfoundland and Labrador, Memorial University of Newfoundland Discipline of Family Medicine, Canada
| | - Marissa House-Denine
- St. John’s, Newfoundland and Labrador, Memorial University of Newfoundland Discipline of Family Medicine, Canada
| | - Amanda Hall
- St. John’s, Newfoundland and Labrador, Memorial University of Newfoundland Discipline of Family Medicine, Canada
| | - Michelle Swab
- St. John’s, Newfoundland and Labrador, Health Sciences Library, Canada
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Wright AL, Ballantyne M, Wahoush O. Caring for indigenous families in the neonatal intensive care unit. Nurs Inq 2020; 27:e12338. [PMID: 32030852 DOI: 10.1111/nin.12338] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 11/29/2022]
Abstract
Inequitable access to health care, social inequities, and racist and discriminatory care has resulted in the trend toward poorer health outcomes for Indigenous infants and their families when compared to non-Indigenous families in Canada. How Indigenous mothers experience care during an admission of their infant to the Neonatal Intensive Care Unit has implications for future health-seeking behaviors which may influence infant health outcomes. Nurses are well positioned to promote positive health care interactions and improve health outcomes by effectively meeting the needs of Indigenous families. This qualitative study was guided by interpretive description and the Two-Eyed Seeing framework and aimed to understand how Indigenous mothers experience accessing and using the health care system for their infants. Data were collected by way of interviews and a discussion group with self-identifying Indigenous mothers of infants less than two years of age living in Hamilton, Ontario, Canada. Data underwent thematic analysis, identifying nursing strategies to support positive health care interactions and promote the health and wellness of Indigenous infants and their families. Building relationships, providing holistic care, and taking a trauma-informed approach to the involvement of child protection services are three key strategies that nurses can use to positively impact health care experiences for Indigenous families.
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Affiliation(s)
- Amy L Wright
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, ON, Canada
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Wright AL, Jack SM, Ballantyne M, Gabel C, Bomberry R, Wahoush O. How Indigenous mothers experience selecting and using early childhood development services to care for their infants. Int J Qual Stud Health Well-being 2019; 14:1601486. [PMID: 30982415 PMCID: PMC8843399 DOI: 10.1080/17482631.2019.1601486] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Promoting a child’s healthy growth and development in the first six years of life is critical to their later health and well-being. Indigenous infants experience poorer health outcomes than non-Indigenous infants, yet little is understood about how parents access and use health services to optimize their infants’ growth and development. Exploring the experiences of Indigenous mothers who select and use early childhood development (ECD) services provides important lessons into how best to promote their access and use of health services. Methods: This qualitative interpretive description study was guided by the Two-Eyed Seeing framework and included interviews with 19 Indigenous mothers of infants less than two years of age and 7 providers of ECD services. Results: Mainstream (public) and Indigenous-led health promotion programs both promoted the access and use of services while Indigenous-led programs further demonstrated an ability to provide culturally safe and trauma and violence-informed care. Conclusions: Providers of Indigenous-led services are best suited to deliver culturally safe care for Indigenous mothers and infants. Providers of mainstream services, however, supported by government policies and funding, can better meet the needs of Indigenous mothers and infants by providing cultural safe and trauma and violence-informed care.
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Affiliation(s)
- Amy L Wright
- a Lawrence S. Bloomberg Faculty of Nursing , University of Toronto , Toronto , Canada.,b School of Nursing , McMaster University , Hamilton , Canada
| | - Susan M Jack
- b School of Nursing , McMaster University , Hamilton , Canada
| | - Marilyn Ballantyne
- c School of Nursing , McMaster University, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Canada
| | - Chelsea Gabel
- d Indigenous Studies; Department of Health Aging & Society , McMaster University , Hamilton , Canada
| | - Rachel Bomberry
- e Department of Health Aging & Society , McMaster University , Hamilton , Canada
| | - Olive Wahoush
- b School of Nursing , McMaster University , Hamilton , Canada
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Wright A, Wahoush O, Ballantyne M, Gabel C, Jack SM. Selection and Use of Health Services for Infants' Needs by Indigenous Mothers in Canada: Integrative Literature Review. Can J Nurs Res 2018; 50:89-102. [PMID: 29457481 DOI: 10.1177/0844562118757096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In Canada, Indigenous infants experience significant health disparities when compared to non-Indigenous infants, including significantly higher rates of birth complications and infant mortality rates. The use of primary health care is one way to improve health outcomes; however, Indigenous children may use health services less often than non-Indigenous children. To improve health outcomes within this growing population, it is essential to understand how caregivers, defined here as mothers, select and use health services in Canada. This integrative review is the first to critique and synthesize what is known of how Indigenous mothers in Canada experience selecting and using health services to meet the health needs of their infants. Themes identified suggest both Indigenous women and infants face significant challenges; colonialism has had, and continues to have, a detrimental impact on Indigenous mothering; and very little is known about how Indigenous mothers select and use health services to meet the health of their infants. This review revealed significant gaps in the literature and a need for future research. Suggestions are made for how health providers can better support Indigenous mothers and infants in their use of health services, based on what has been explored in the literature to date.
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Affiliation(s)
- A Wright
- 1 School of Nursing, McMaster University, Dundas, ON, Canada
| | - O Wahoush
- 2 School of Nursing, McMaster University, Hamilton, ON, Canada
| | - M Ballantyne
- 3 School of Nursing, Holland Bloorview Kids Rehabilitation Hospital, McMaster University, Hamilton, ON, Canada.,4 Health Aging and Society & Indigenous Studies Program, University of Toronto, Toronto, ON, Canada
| | - C Gabel
- 1 School of Nursing, McMaster University, Dundas, ON, Canada
| | - S M Jack
- 1 School of Nursing, McMaster University, Dundas, ON, Canada
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Moffitt P, Dickinson R. Creating exclusive breastfeeding knowledge translation tools with First Nations mothers in Northwest Territories, Canada. Int J Circumpolar Health 2016; 75:32989. [PMID: 27938644 PMCID: PMC5149661 DOI: 10.3402/ijch.v75.32989] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 07/27/2016] [Accepted: 09/29/2016] [Indexed: 12/03/2022] Open
Abstract
Background Breastfeeding is an ideal method of infant feeding affecting lifelong health, and yet the uptake of breastfeeding in some Indigenous communities in Canada's north is low. Objective The aims of this project were to determine the rate and determinants of exclusive breastfeeding in a remote community in the Northwest Territories and to create knowledge translation tools to enhance breastfeeding locally. Methods The study methodology followed three steps. Firstly, a series of retrospective chart audits were conducted from hospital birth records of Tłı̨chǫ women (n=198) who gave birth during the period of 1 January 2010 to 31 December 2012. A second follow-up chart audit determined the rate of exclusive breastfeeding and was conducted in the local Community Health Centre. Chart audit data included the following factors related to breastfeeding: age of mother, parity, birthweight and Apgar scores. Secondly, semi-structured interviews with a purposive sample of Tłı̨chǫ mothers (n=8) and one Elder were conducted to identify breastfeeding practices, beliefs and the most appropriate medium to use to deliver health messages in Tłı̨chǫ. Third, based on the information obtained in Step 2, two knowledge translation tools were developed in collaboration with a local community Advisory Committee. Results The rate of exclusive breastfeeding initiation in the Tłı̨chǫ region is less than 30%. Physiological and demographic factors related to breastfeeding were identified. Thematic analysis revealed two overarching themes from the data, namely, “the pull to formula” (lifestyle preferences, drug and alcohol use, supplementation practices and limited role models) and “the pull to breast feeding” (traditional feeding method, spiritual practice and increased bonding with infant). Conclusion There are a myriad of influences on breastfeeding for women living in remote locations. Ultimately, society informs the choice of infant feeding for the new mother, since mothers’ feeding choices are based on contextual realities and circumstances in their lives that are out of their control. As health care providers, it is imperative that we recognize the realities of women's lives and the overlapping social determinants of health that may limit a mother's ability or choice to breastfeed. Further health promotion efforts, grounded in community-based research and a social determinants framework, are needed to improve prenatal and postnatal care of Indigenous women and children in Canada.
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Affiliation(s)
- Pertice Moffitt
- Health Research Programs, Aurora Research Institute, Aurora College, Yellowknife, NWT, Canada;
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Lavoie JG, Kaufert J, Browne AJ, O’Neil JD. Managing Matajoosh: determinants of first Nations' cancer care decisions. BMC Health Serv Res 2016; 16:402. [PMID: 27538389 PMCID: PMC4991084 DOI: 10.1186/s12913-016-1665-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/12/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Accessing cancer treatment requires First Nation peoples living in rural and remote communities to either commute to care, or to relocate to an urban centre for the length or part of the treatment. While Canadians living in rural and remote communities must often make difficult decisions following a cancer diagnosis, such decisions are further complicated by the unique policy and socio-historical contexts affecting many First Nation peoples in Canada. These contexts often intersect with negative healthcare experiences which can be related to jurisdictional confusion encountered when seeking care. Given the rising incidence of cancer within First Nation populations, there is a growing potential for negative health outcomes. METHODS The analysis presented in this paper focuses on the experience of First Nation peoples' access to cancer care in the province of Manitoba. We analyzed policy documents and government websites; interviewed individuals who have experienced relocation (N = 5), family members (N = 8), healthcare providers and administrators (N = 15). RESULTS Although the healthcare providers (social workers, physicians, nurses, patient navigators, and administrators) we interviewed wanted to assist patients and their families, the focus of care remained informed by patients' clinical reality, without recognition of the context which impacts and constrains access to cancer care services. Contrasting and converging narratives identify barriers to early diagnosis, poor coordination of care across jurisdictions and logistic complexities that result in fatigue and undermine adherence. Providers and decision-makers who were aware of this broader context were not empowered to address system's limitations. CONCLUSIONS We argue that a whole system's approach is required in order to address these limitations.
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Affiliation(s)
- Josée G. Lavoie
- MFN – Centre for Aboriginal Health Research, University of Manitoba, #715, 727 McDermot Avenue, Winnipeg, MB R3P 3E4 Canada
| | - Joseph Kaufert
- Department of Community Health Sciences, University of Manitoba, College of Medicine - University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada
| | - Annette J. Browne
- UBC School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC V6T 2B5 Canada
| | - John D. O’Neil
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, V5A 1S6 BC Canada
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