1
|
Bacciaglia M, Neufeld HT, Neiterman E, Krishnan A, Johnston S, Wright K. Indigenous maternal health and health services within Canada: a scoping review. BMC Pregnancy Childbirth 2023; 23:327. [PMID: 37158865 PMCID: PMC10165845 DOI: 10.1186/s12884-023-05645-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Globally, there are disparities in access to maternal health care services and equity in maternal health outcomes between Indigenous and non-Indigenous populations. While the literature is growing, it has not been systematically synthesized. This review addresses this gap by synthesizing the existing literature on the organizational structure of maternity care, accessibility and delivery of services, and clinical disparities impacting Indigenous maternal health within Canada. It also identifies current knowledge gaps in research on these topics. METHODS A scoping review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines and the extension for scoping reviews. The search for relevant papers was performed in PubMed, CINAHL, and SCOPUS electronic databases and included any empirical literature written in English and published during 2006 - 2021. The research team inductively coded 5 articles to develop a coding scheme, which was then applied to the remaining articles. RESULTS A total of 89 articles were included in the review, of which 32 were qualitative papers, 40 quantitative, 8 were mixed-methods publications, and 9 were review papers. The analysis of the articles resulted in identifying a range of overarching themes pertaining to the maternal health of Indigenous women within Canada including provision of services, clinical issues, education, health disparities, organization, spatial context, and impact of informal support. The results suggest that physical, psychological, organizational, and systemic barriers inhibit the quality-of-care pregnant Indigenous women receive, and that maternal health services are not consistently provided in a culturally safe manner. Results also suggest that, compared to non-Indigenous pregnant women, Indigenous women are more likely to develop clinical complications during pregnancy, reflecting the structural impacts of colonization that continue to negatively influence Indigenous maternal health and well-being. CONCLUSIONS There are many complex barriers that prevent Indigenous women from receiving high quality and culturally appropriate maternal care. Possible areas that could address the service gaps illuminated through this review include the implementation of cultural considerations across health care jurisdictions within Canada.
Collapse
Affiliation(s)
- Meagan Bacciaglia
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, Canada
| | - Hannah Tait Neufeld
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, Canada.
| | - Elena Neiterman
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, Canada
| | - Akanksha Krishnan
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, Canada
| | - Sophie Johnston
- Faculty of Arts, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Kyla Wright
- School of Public Health Sciences, The University of Waterloo, Waterloo, ON, Canada
| |
Collapse
|
2
|
Mayer S, Langheimer V, Nolan S, Boyd J, Small W, McNeil R. Emergency department experiences of people who use drugs who left or were discharged from hospital against medical advice. PLoS One 2023; 18:e0282215. [PMID: 36821576 PMCID: PMC9949621 DOI: 10.1371/journal.pone.0282215] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND People who use drugs (PWUD) frequent emergency departments at a higher rate than the general population, and experience a greater frequency of soft tissue infections, pneumonia, and chronic conditions such as, HIV/AIDs and hepatitis C. This population has distinct health care considerations (e.g. withdrawal management) and are also more likely to leave or be discharged from hospital against medical advice. METHODS This study examines the experiences of PWUD who have left or been discharged from hospital against medical advice to understand the structural vulnerabilities that shape experiences with emergency departments. Semi-structured qualitative interviews were conducted with 30 PWUD who have left or been discharged from hospital against medical advice within the past two years as part of a larger study on hospital care and drug use in Vancouver, Canada. RESULTS Findings characterize the experiences and perceptions of PWUD in emergency department settings, and include: (1) stigmatization of PWUD and compounding experiences of discrimination; (2) perceptions of overall neglect; (3) inadequate pain and withdrawal management; and (4) leaving ED against medical advice and a lack of willingness to engage in future care. CONCLUSIONS Structural vulnerabilities in ED can negatively impact the care received among PWUD. Findings demonstrate the need to consider how structural factors impact care for PWUD and to leverage existing infrastructure to incorporate harm reduction and a structural competency focused care. Findings also point to the need to consider how withdrawal and pain are managed in emergency department settings.
Collapse
Affiliation(s)
- Samara Mayer
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Verena Langheimer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Seonaid Nolan
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Will Small
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Applied Research in Mental Health and Addiction, Vancouver, British Columbia, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
| |
Collapse
|
3
|
Montgomery L, Vaughn LM, Jacquez F. Engaging Adolescents in the Fight Against Drug Abuse and Addiction: A Concept Mapping Approach. HEALTH EDUCATION & BEHAVIOR 2022; 49:272-280. [PMID: 35043709 PMCID: PMC10684140 DOI: 10.1177/10901981211068416] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND To identify contextually-relevant strategies for reducing and eventually eliminating addiction, it is imperative to engage stakeholders that are most affected by drug abuse but typically left out of the conversation, such as adolescents. AIM The aim of this study was to collaborate with 45 adolescent stakeholders participating in a school-based research program to identify areas to address addiction. METHODS Guided by a modified version of the mixed-methods concept mapping approach, adolescents were asked to brainstorm and sort a list of statements about how to address addiction in their community. The data were then analyzed via multidimensional scaling and hierarchical cluster analysis. RESULTS The concept map identified eight clusters from 75 edited statements: policing/security (e.g., increase punishment for selling drugs), helping community (e.g., create more jobs), treatment (e.g., make treatments more affordable), increased awareness (e.g., identify and help at-risk youth), communication (e.g., more communication with people who are abusing drugs), increased understanding/education (e.g., online communities for people who are abusing drugs), clean up community (e.g., clean up abandoned houses) and prevent addiction (e.g., effectively deal with peer pressure). DISCUSSION These stakeholder-driven ideas are consistent with the socioecological framework of addressing substance use and add to the credibility and transferability of individual and systemic level approaches to reducing substance use in marginalized communities. CONCLUSION This study emphasizes the feasibility of engaging adolescents in the development of contextually-relevant addiction education, prevention, and treatment interventions in underserved communities.
Collapse
Affiliation(s)
| | - Lisa M. Vaughn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
- University of Cincinnati, Cincinnati, OH, USA
| | | |
Collapse
|
4
|
Allen L, Wodtke L, Hayward A, Read C, Cyr M, Cidro J. Pregnant and early parenting Indigenous women who use substances in Canada: A scoping review of health and social issues, supports, and strategies. J Ethn Subst Abuse 2022; 22:827-857. [PMID: 35238726 DOI: 10.1080/15332640.2022.2043799] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study reviews and synthesizes the literature on Indigenous women who are pregnant/early parenting and using substances in Canada to understand the scope and state of knowledge to inform research with the Aboriginal Health and Wellness Centre of Winnipeg in Manitoba and the development of a pilot Indigenous doula program. A scoping review was performed searching ten relevant databases, including one for gray literature. We analyzed 56 articles/documents. Themes include: (1) cyclical repercussions of state removal of Indigenous children from their families; (2) compounding barriers and inequities; (3) prevalence and different types of substance use; and (4) intervention strategies. Recommendations for future research are identified and discussed.
Collapse
Affiliation(s)
| | | | | | - Chris Read
- McMaster University, Hamilton, Ontario, Canada
| | - Monica Cyr
- Aboriginal Health and Wellness Centre, Winnipeg, Manitoba, Canada
| | - Jaime Cidro
- University of Winnipeg, Winnipeg, Manitoba, Canada
| |
Collapse
|
5
|
Williams JE, Gifford W, Vanderspank-Wright B, Phillips JC. Violence and Health Promotion Among First Nations, Métis, and Inuit Women: A Systematic Review of Qualitative Research. TRAUMA, VIOLENCE & ABUSE 2021; 22:996-1012. [PMID: 31514690 DOI: 10.1177/1524838019875696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Indigenous women experience a disproportionate burden of intimate partner violence (IPV) compared to other women in post-colonial countries such as Canada. Intersections between IPV and other forms of structural violence including racism and gender-based discrimination create a dangerous milieu where 'help seeking' may be deterred and poor health outcomes occur. The aim of this review was to explore the perspectives of First Nations, Métis and Inuit (FNMI) women living in Canada about how violence influenced their health and wellbeing. This systematic review of qualitative research used thematic analysis to produce a configurative synthesis. A comprehensive search of electronic databases was conducted. Two reviewers screened studies for relevance and congruence with eligibility criteria. Sixteen studies were included in the review. Four themes with subthemes emerged: 1) ruptured connections between family and home, 2) that emptiness… my spirit being removed, 3) seeking help and being unheard, and 4) a core no one can touch. Together these themes form complex pathways that influenced health among women exposed to violence. Findings from this review highlight the need for collaboration with FNMI women and their communities to prevent IPV and ensure access to trauma and violence informed care (TVIC). The strength and resiliency of FNMI women is fundamental to healing from violence. Working with FNMI women and their communities to build effective interventions and promote culturally meaningful care will be important directions for researchers and policy makers.
Collapse
Affiliation(s)
- Julie E Williams
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | | | - J Craig Phillips
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
6
|
Ritland L, Thomas V, Jongbloed K, Zamar DS, Teegee MP, Christian WK, Richardson CG, Guhn M, Schechter MT, Spittal PM. The Cedar Project: Relationship between child apprehension and attempted suicide among young Indigenous mothers impacted by substance use in two Canadian cities. PLoS One 2021; 16:e0252993. [PMID: 34111186 PMCID: PMC8191959 DOI: 10.1371/journal.pone.0252993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
Indigenous leaders are gravely concerned over disproportionate representation of Indigenous children in Canada's child welfare systems. Forced separation from children is deeply traumatizing for mothers and detrimental to the wellbeing of Indigenous families, communities and Nations. This study examined relationships between child apprehension and suicide attempt within a cohort of young Indigenous women impacted by substance use. We utilized data collected every 6 months (2008-2016) by the Cedar Project, an Indigenous-governed cohort study involving young Indigenous people who use drugs in British Columbia, Canada. Recent child apprehension was defined as having a child apprehended by the Ministry of Child and Family Development since last visit. Recurrent event Cox proportional hazards models estimated the independent effect of child apprehension on maternal suicide attempt. Among 293 participants, 78 (27%) reported 136 child apprehensions; incidence of first apprehension was 6.64 (95%CI: 5.25-8.29) per 100 person-years. Forty-seven (16%) participants reported 75 suicide attempts with an incidence of 4.00 (95%CI: 2.94-5.33) per 100 person-years. Participants who reported recent child apprehension (HR: 1.88, 95%CI: 1.00-3.55), had a parent attend residential school (HR: 4.12, 95%CI: 1.63-10.46), experienced recent sexual assault (HR: 4.04, 95%CI: 2.04-7.99), violence (HR: 2.54, 95%CI: 1.52-4.27) or overdose (HR: 4.97, 95%CI: 2.96-8.35) were more likely to attempt suicide. Participants who had a traditional language spoken in the home growing up were half as likely to attempt suicide (HR: 0.49, 95%CI: 0.23-1.01). Results suggest that child welfare systems in Canada perpetuate historical and intergenerational trauma among young Indigenous mothers. Indigenous self-determination over child welfare and culturally safe services are urgently needed to end cycles of child apprehension and support the wellbeing of families, communities and Nations.
Collapse
Affiliation(s)
- Lisa Ritland
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Victoria Thomas
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- Wuikinuxv Nation
| | - Kate Jongbloed
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David S. Zamar
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Mary P. Teegee
- Takla Lake First Nation, Carrier Sekani Family Services, Prince George, BC, Canada
| | - Wenecwtsin-Kukpi Christian
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
- Splatsin te Secwepemc
| | - Chris G. Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, BC, Canada
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Martin T. Schechter
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M. Spittal
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | |
Collapse
|
7
|
Culturally Safe, Strengths-Based Parenting Programs Supporting Indigenous Families Impacted by Substance Use—a Scoping Review. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00237-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
8
|
Jongbloed K, Pearce ME, Thomas V, Sharma R, Pooyak S, Demerais L, Lester RT, Schechter MT, Spittal PM. The Cedar Project - Mobile Phone Use and Acceptability of Mobile Health Among Young Indigenous People Who Have Used Drugs in British Columbia, Canada: Mixed Methods Exploratory Study. JMIR Mhealth Uhealth 2020; 8:e16783. [PMID: 32716311 PMCID: PMC7427984 DOI: 10.2196/16783] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/16/2020] [Accepted: 02/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background Indigenous leaders continue to be concerned about high rates of HIV and barriers to HIV treatment among young Indigenous people involved in substance use. Growing evidence suggests that using mobile phones for health (mHealth) may be a powerful way to support connection with health services, including HIV prevention and treatment. Objective This study examined the patterns of mobile phone ownership and use among young Indigenous people who have used drugs living with or vulnerable to HIV and explored the acceptability of mHealth to support access to health care in this population. Methods The Cedar Project is a cohort study involving young Indigenous people who have used drugs in Vancouver and Prince George, British Columbia. This mixed methods exploratory study involved 131 Cedar Project participants enrolled in our WelTel mHealth program. At enrollment, participants completed a questionnaire related to mobile phone use and interest in mHealth. Data were linked to Cedar Project questionnaires and serodata. We present comparative statistics (quantitative) and results of a rapid thematic analysis (qualitative) related to mobile phone patterns and interest in receiving mHealth. Results Less than half of the participants (59/130; 45.4%) reported owning a phone. Among those with a phone, the majority owned a smartphone (46/59; 78%). Most participants with a phone reported having an unlimited texting plan (39/55; 71%), using the internet on their phone (44/59; 75%), and texting daily (44/55; 80%). A majority reported that using a mobile phone for health would be invaluable (120/130; 92.3%). There were no differences in mHealth acceptance between participants who owned a phone and those who did not (P>.99). All but one participant living with HIV felt using a mobile phone would be helpful for their health, while a small proportion of HIV-negative participants remained unsure (1.9% vs 11.7%; P=.047). In response to open-ended questions asking why using a mobile phone may be helpful for health, participants identified a diverse set of anticipated benefits: (1) connection for emotional, mental, and spiritual support, (2) connection to family, (3) staying in touch and/or being reachable, (4) overcoming current barriers to phone use, (5) convenience, privacy, and safety, and (6) access to health care and emergency services. Conclusions We observed high acceptance and interest in using mobile phone technology for health despite low rates of personal mobile phone connectivity among young Indigenous people who have used drugs living with and vulnerable to HIV in British Columbia, Canada. Mobile phones were viewed as a way to support connections and relationships that are seen as critical to health and well-being among young Indigenous people in this study. Findings may be useful for health care providers preparing to scale up mHealth programs to support HIV prevention and treatment in this population.
Collapse
Affiliation(s)
- Kate Jongbloed
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Margo E Pearce
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vicky Thomas
- The Cedar Project, Prince George, BC, Canada.,Wuikinuxv Nation, Prince George, BC, Canada
| | - Richa Sharma
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sherri Pooyak
- Aboriginal HIV/AIDS Community-Based Research Collaborative Centre, Victoria, BC, Canada.,Cree, Victoria, BC, Canada
| | - Lou Demerais
- Cree & Métis, Surrey, BC, Canada.,The Cedar Project, Vancouver, BC, Canada
| | - Richard T Lester
- Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Martin T Schechter
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patricia M Spittal
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | -
- The Cedar Project, Prince George, BC, Canada.,The Cedar Project, Vancouver, BC, Canada
| |
Collapse
|
9
|
O'Connor A, Harris E, Hamilton D, Fisher C, Sachmann M. The experiences of pregnant women attending a specialist service and using methamphetamine. Women Birth 2020; 34:170-179. [PMID: 32061546 DOI: 10.1016/j.wombi.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pregnant women attending the Specialist Drug and Alcohol Service in Perth use methamphetamine as their primary drug of choice. This is the only tertiary service for pregnant and postnatal women with complex Alcohol and Other Drug Use in Western Australia. It is a midwifery-led multidisciplinary team. Many of the women struggle with addiction, polysubstance use, co-occurring mental health, family and domestic violence, complex trauma and fear of Child Protection and infant removal. Therefore, the aim of this study was to understand the impact of methamphetamine use of pregnant women attending the service and explore and highlight the potential barriers to engagement and follow-up. METHODS A qualitative study informed by phenomenological methods was undertaken using semi-structured interviews with 20 women with methamphetamine use attending the service in order to explore and understand the experience of using methamphetamine in pregnancy and the postpartum period. A thematic analysis was undertaken with data from the women in the study (n=20) to identify key themes. RESULTS Key themes that emerged from the women's experiences detail their resilience and experience with methamphetamine and the impact that methamphetamine has on their life. A key concern for women regarding methamphetamine use and engagement with specialist services was the welfare of their child(ren). Agencies charged with child protection was a barrier to treatment because women feared disclosure of methamphetamine use would result in loss of child custody. Themes highlighted the multiple layers of adversities, and trauma from childhood to adulthood including, co-occurring drug use, mental health and life histories of trauma (abuse, violence, and neglect; intergenerational trauma; intergenerational drug and alcohol use, and child removal), the omnipresence of methamphetamine, and the impact on pregnancy and mothering. CONCLUSION We conclude that understanding the experiences of women and the impact methamphetamine use has on their life is paramount to providing effective and appropriate care to support pregnant women in a trauma-informed and woman-centred approach. Poor engagement in pregnancy care for women with methamphetamine use has significant impacts on mother and infant.
Collapse
Affiliation(s)
- Angela O'Connor
- King Edward Memorial Hospital, Australian College of Nursing (ACN), (ACM) Australian College of Midwives, Australia. Angela.O'
| | | | - Dale Hamilton
- King Edward Obstetrics and Gynaecology, FRANZCOG, Australia.
| | | | | |
Collapse
|
10
|
Wolfson L, Poole N, Morton Ninomiya M, Rutman D, Letendre S, Winterhoff T, Finney C, Carlson E, Prouty M, McFarlane A, Ruttan L, Murphy L, Stewart C, Lawley L, Rowan T. Collaborative Action on Fetal Alcohol Spectrum Disorder Prevention: Principles for Enacting the Truth and Reconciliation Commission Call to Action #33. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091589. [PMID: 31067652 PMCID: PMC6539919 DOI: 10.3390/ijerph16091589] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 11/16/2022]
Abstract
The association between fetal alcohol spectrum disorder (FASD), residential schools and subsequent assimilatory policies in Canada is of such significance that it was included in the groundbreaking Truth and Reconciliation Commission of Canada’s Final Report through Call to Action #33, which focuses on collaboratively developing FASD prevention programs in Indigenous communities. A consensus statement with eight tenets for enacting Call to Action #33 was co-developed in May 2017 using a Two-Eyed Seeing approach during and after a meeting on Indigenous approaches to FASD prevention held in Canada. The consensus statement provides guidance for creating community-based, culture-led FASD prevention programs in Indigenous communities. The eight tenets reflect the diverse perspectives of Indigenous and non-Indigenous participants, are grounded in available research evidence, and align with Indigenous worldviews and wellness models. This paper uses the consensus statement and eight exemplary FASD prevention programs from Indigenous communities and organizations across Canada to highlight identity, culture, and relationships as central elements of FASD prevention in Indigenous communities. The consensus statement provides guidance for developing community- and culture-led FASD prevention programs and highlights the importance of Indigenous knowledge systems in developing and researching FASD prevention in, and with, Indigenous communities.
Collapse
Affiliation(s)
- Lindsay Wolfson
- Centre of Excellence for Women's Health, Vancouver, BC V6H 3N1 Canada.
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R 0A4, Canada.
| | - Nancy Poole
- Centre of Excellence for Women's Health, Vancouver, BC V6H 3N1 Canada.
- Canada Fetal Alcohol Spectrum Disorder Research Network, Vancouver, BC V5R 0A4, Canada.
| | | | - Deborah Rutman
- Nota Bene Consulting Group, Victoria, BC V8R 1P8, Canada.
- School of Social Work, University of Victoria, Victoria, BC V8P 5C2, Canada.
| | | | | | | | - Elizabeth Carlson
- Department of Educational Psychology, University of Alberta, Edmonton, AB T6G 2R3, Canada.
| | | | - Audrey McFarlane
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB T9M 1P1, Canada.
| | - Lia Ruttan
- Independent Scholar, Edmonton, AB T6J 0V5, Canada.
| | - Lisa Murphy
- Lakeland Centre for Fetal Alcohol Spectrum Disorder, Cold Lake, AB T9M 1P1, Canada.
| | - Carmen Stewart
- Kermode Friendship Society, Terrace, BC V8G 2N7, Canada.
| | - Lisa Lawley
- Kermode Friendship Society, Terrace, BC V8G 2N7, Canada.
| | - Tammy Rowan
- Mount Carmel Clinic, Winnipeg, MB R2W 5L4, Canada.
| |
Collapse
|
11
|
Paterno MT, Low M, Gubrium A, Sanger K. Mothers and Mentors: Exploring Perinatal Addiction and Recovery Through Digital Storytelling. QUALITATIVE HEALTH RESEARCH 2019; 29:545-556. [PMID: 29871558 DOI: 10.1177/1049732318777474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Substance use disorders (SUDs) are a growing problem for pregnant and parenting women. Woman-to-woman peer support may positively influence perinatal outcomes but little is known about the impact of such support on the women who are providing support. The purpose of this study was to describe experiences of addiction in pregnancy, recovery, and subsequently serving as a peer mentor to other pregnant women with active SUD among women in recovery in a rural setting. We conducted one digital storytelling workshop with five women serving as peer mentors with lived experience of perinatal SUD. The mentors faced significant stigma in pregnancy. They had each done the "inside work" to achieve recovery, and maintained recovery by staying balanced. Peer mentoring supported their own recovery, and story sharing was integral to this process. Peer-led support models may be an effective, self-sustaining method of providing pregnancy-specific peer support for SUD.
Collapse
Affiliation(s)
- Mary T Paterno
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Maud Low
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Aline Gubrium
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Kirk Sanger
- University of Massachusetts Amherst, Amherst, Massachusetts, USA
| |
Collapse
|
12
|
Le TL, Kenaszchuk C, Milligan K, Urbanoski K. Levels and predictors of participation in integrated treatment programs for pregnant and parenting women with problematic substance use. BMC Public Health 2019; 19:154. [PMID: 30727978 PMCID: PMC6364426 DOI: 10.1186/s12889-019-6455-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 01/18/2019] [Indexed: 12/02/2022] Open
Abstract
Background Women who are seeking services for problematic substance use are often also balancing responsibilities of motherhood. Integrated treatment programs were developed to address the diverse needs of women, by offering a holistic and comprehensive mix of services that are trauma- and violence-informed, and focus on maternal and child health promotion and the development of healthy relationships. Methods Using system-level administrative data from a suite of outpatient integrated programs in Ontario, Canada, we described the clients and rates and predictors of treatment participation over a 7-year period (2008–2014; N = 5162). Results All participants were either pregnant or parenting children under 6 years old at admission to treatment. Retention (length of time between the first and last visit) averaged 124.9 days (SD = 185.6), with episodes consisting of 14.6 visits (SD = 28.6). The vast majority of women attended more than one visit (87.2%), typically returning within 2 weeks (mean 12.3 days, SD = 11.1). In addition to being pregnant or new mothers experiencing problematic substance use, most were unemployed, on social assistance, and single. Conclusions Programs appeared to be able to successfully engage most women in treatment once they accessed the programs. Although rates of treatment participation did vary across subgroups defined by sociodemographic and admission characteristics, effect sizes tended to be small on average, providing little evidence in general of sociodemographic inequities in participation. Further work is needed to study the influence of program-level factors on participation, and how these link to maternal and child outcomes.
Collapse
Affiliation(s)
- Thao Lan Le
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Chris Kenaszchuk
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Karen Milligan
- Department of Psychology, Ryerson University, 350 Victoria Street, Toronto, ON, M5B 2K3, Canada.
| | - Karen Urbanoski
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada.,Canadian Institute for Substance Use Research, Public Health and Social Policy, University of Victoria, 2300 McKenzie Avenue, Victoria, BC, V8W 2Y2, Canada
| |
Collapse
|
13
|
Geraghty S, Doleman G, De Leo A. Midwives' attitudes towards pregnant women using substances: Informing a care pathway. Women Birth 2018; 32:e477-e482. [PMID: 30270017 DOI: 10.1016/j.wombi.2018.09.007] [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] [Received: 08/02/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to identify midwives' attitudes towards women using substances during pregnancy, which informed the development of an integrated care pathway for the provision of optimal care. METHODS A mixed methods research design was used, that included an online survey via the online survey tool Qualtrics™ which collected quantitative data, and interviews and focus groups were used to collect qualitative data. FINDINGS Participants held a positive or neutral view towards women who used substances during pregnancy, and the participants had an empathetic perception of the issue of substance use within pregnancy, believing that women were using substances due to the environment and circumstances that they lived in, and that they had been raised and socialised in. CONCLUSION Caring for women during pregnancy with substance misuse issues is complex and requires coordination and multidisciplinary care. Midwives have the capacity to provide sensitive midwifery care but require the framework to ensure women needing additional resources during pregnancy receive the services available and specific to their needs. The midwives in this study were supportive of developing an integrated care pathway to allow for collaborative care, and to enable a specialised midwifery approach.
Collapse
Affiliation(s)
- Sadie Geraghty
- Edith Cowan University, Perth, Western Australia, Australia.
| | - Gemma Doleman
- Edith Cowan University, Perth, Western Australia, Australia
| | | |
Collapse
|
14
|
Shahram SZ, Bottorff JL, Oelke ND, Kurtz DLM, Thomas V, Spittal PM, And For The Cedar Project Partnership. Mapping the social determinants of substance use for pregnant-involved young Aboriginal women. Int J Qual Stud Health Well-being 2017; 12:1275155. [PMID: 28140776 PMCID: PMC5328333 DOI: 10.1080/17482631.2016.1275155] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is a dearth of knowledge about the social determinants of substance use among young pregnant-involved Indigenous women in Canada from their perspectives. As part of life history interviews, 17 young pregnant-involved Indigenous women with experiences with substances completed a participant-generated mapping activity CIRCLES (Charting Intersectional Relationships in the Context of Life). As women created their maps, they discussed how different social determinants impacted their experiences with pregnancy and substance use. The social determinants identified and used by women to explain determinants of their substance use were grouped into 10 themes: traumatic life histories; socioeconomic status; culture, identity and spirituality; shame and guilt; mental wellness; family connections; romantic and platonic relationships; strength and hope; mothering; and the intersections of determinants. We conclude that understanding the context and social determinants of substance use from a woman-informed perspective is paramount to informing effective and appropriate programs to support young Indigenous women who use substances.
Collapse
Affiliation(s)
- Sana Z Shahram
- a Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | - Joan L Bottorff
- b Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada.,c Faculty of Health Sciences , Australian Catholic University , Melbourne , Australia
| | - Nelly D Oelke
- d School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | - Donna L M Kurtz
- d School of Nursing, Faculty of Health and Social Development , University of British Columbia , Kelowna , Canada
| | | | - Patricia M Spittal
- f School of Population and Public Health , University of British Columbia , Vancouver , Canada
| | | |
Collapse
|
15
|
Shahram SZ, Bottorff JL, Oelke ND, Dahlgren L, Thomas V, Spittal PM. The Cedar Project: Using Indigenous-specific determinants of health to predict substance use among young pregnant-involved Indigenous women in Canada. BMC Womens Health 2017; 17:84. [PMID: 28915868 PMCID: PMC5603064 DOI: 10.1186/s12905-017-0437-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/28/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Indigenous women in Canada have been hyper-visible in research, policy and intervention related to substance use during pregnancy; however, little is known about how the social determinants of health and substance use prior to, during, and after pregnancy intersect. The objectives of this study were to describe the social contexts of pregnant-involved young Indigenous women who use substances and to explore if an Indigenous-Specific Determinants of Health Model can predict substance use among this population. METHODS Using descriptive statistics and hierarchical logistic regression guided by mediation analysis, the social contexts of pregnant-involved young Indigenous women who use illicit drugs' lives were explored and the Integrated Life Course and Social Determinants Model of Aboriginal Health's ability to predict heavy versus light substance use in this group was tested (N = 291). RESULTS Important distal determinants of substance use were identified including residential school histories, as well as protective factors, such as sex abuse reporting and empirical evidence for including Indigenous-specific determinants of health as important considerations in understanding young Indigenous women's experiences with pregnancy and substance use was provided. CONCLUSIONS This analysis provided important insight into the social contexts of women who have experiences with pregnancy as well as drug and/or alcohol use and highlighted the need to include Indigenous-specific determinants of health when examining young Indigenous women's social, political and historical contexts in relation to their experiences with pregnancy and substance use.
Collapse
Affiliation(s)
- Sana Z. Shahram
- Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Present Address: Postdoctoral Research Fellow, Centre for Addictions Research of British Columbia, University of Victoria, PO Box 1700, STN CSC Victoria, Victoria, BC V8W 2Y2 Canada
- 15890 Greenhow Road, Oyama, BC V4V 2E6 Canada
| | - Joan L. Bottorff
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Nelly D. Oelke
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
| | - Leanne Dahlgren
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 1190 Hornby Street 4th Floor, Vancouver, BC V6Z 2K5 Canada
| | | | - Patricia M. Spittal
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - For the Cedar Project Partnership
- Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Institute for Healthy Living and Chronic Disease Prevention, and School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7 Canada
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, 1190 Hornby Street 4th Floor, Vancouver, BC V6Z 2K5 Canada
- Wuikinuxv Nation, The Cedar Project, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
- Present Address: Postdoctoral Research Fellow, Centre for Addictions Research of British Columbia, University of Victoria, PO Box 1700, STN CSC Victoria, Victoria, BC V8W 2Y2 Canada
- 15890 Greenhow Road, Oyama, BC V4V 2E6 Canada
| |
Collapse
|
16
|
Marcellus L. A Grounded Theory of Mothering in the Early Years for Women Recovering From Substance Use. JOURNAL OF FAMILY NURSING 2017; 23:341-365. [PMID: 28795852 DOI: 10.1177/1074840717709366] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Women in recovery from addiction experience significant sociostructural barriers to reestablishing self, family, and home after having a baby. The aim of this grounded theory study was to describe pathways that women and their families followed and how transitions were experienced in the early years after receiving services through an integrated community-based maternity program. Eighteen women completed questionnaires and participated in a series of semistructured interviews over 2 years. The overall process women experienced was that of holding it together, which women did by restoring their sense of self during recovery, becoming a strong center for their family, and creating a sense of home no matter what the circumstances. Key elements supporting women in their transition to recovery and parenthood included longer term health, social, and recovery programs and services that addressed determinants of health (in particular, gender, housing, and income), and receiving support provided from strengths-based perspectives.
Collapse
|