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Cassidy-Matthews C, Pearce M, Hussaini T, Spittal P, Caron N, Daley C, Alfred R, Yoshida EM. "My feelings and my thoughts are my lived experience, not the numbers they show me on a piece of paper": Indigenous experiences of liver transplantation in British Columbia, Canada. Int J Circumpolar Health 2024; 83:2359747. [PMID: 38805610 PMCID: PMC11136460 DOI: 10.1080/22423982.2024.2359747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
Indigenous Peoples in Canada face healthcare inequities impacting access to solid organ transplantation. The experiences of Indigenous patients during the liver transplant process, and how transplant professionals perceive challenges faced by Indigenous Peoples, has not been studied. Thirteen semi-structured qualitative interviews were conducted via telehealth with Indigenous liver transplant patients (n = 7) and transplant care providers (n = 6) across British Columbia, Canada between April 2021-May 2022. Themes were identified to inform clinical approaches and transplant care planning and validated by Indigenous health experts. Among patient participants: transplants occurred between 1992-2020; all were women; and the mean age at the time of interview was 60 years. Among transplant care provider participants: roles included nursing, social work, and surgery; 83% were women; and the median number of years in transplant care was ten. Three broad themes were identified: Indigenous strengths and resources, systemic and structural barriers, and inconsistent care and cultural safety across health professions impact Indigenous patient care during liver transplantation. This study contributes insights into systemic barriers and Indigenous resilience in the liver transplant journey. Dismantling structural barriers to early linkage to care is needed, and training for transplant clinicians on Indigenous histories, cultural protocols, and cultural safety is strongly recommended.
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Affiliation(s)
- Chenoa Cassidy-Matthews
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Margo Pearce
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Trana Hussaini
- The Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Patricia Spittal
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Nadine Caron
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- The Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
| | - Cole Daley
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- The Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ruth Alfred
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Eric M. Yoshida
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
- The Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- The Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Bertheussen M, Riva M, Jock BWI, Fletcher C, Ayotte P, Muckle G, Poliakova N, Bélanger R. Using latent class analysis to operationalize a wholistic assessment of Inuit health and well-being. Int J Circumpolar Health 2024; 83:2322186. [PMID: 38465869 DOI: 10.1080/22423982.2024.2322186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/19/2024] [Indexed: 03/12/2024] Open
Abstract
Many indigenous cultures conceptualize health wholistically, whereby physical, mental, spiritual and relational dimensions of health are interconnected. Yet, quantitative approaches to studying Indigenous health remain anchored in western perspectives, that separate the dimensions of health. This paper aims to operationalize a wholistic indicator of health based on the IQI model of Inuit health. Variables from the 2017 Nunavik Health Survey (N = 1196) were selected based on their representativeness of IQI model. Exploratory Latent Class Analysis (LCA) was used to identify wholistic health profiles. Once participants assigned to their health profile, sociodemographic characteristics were compared across profiles, and multinomial regression models were used to examine the relationship between community-level social determinants of health and the profiles. The LCA revealed three health profiles, labelled as "excellent", "good" and "fair" based on the distribution of answers to the indicators. Nunavimmiut in "excellent" and "good" health were more likely to: rate their health positively; be over 30 years old; be in a relationship; and have participated or volunteered in community events. Nunavimmiut in "fair" health tended to report lower levels of community cohesion, family relationships, and emotional support. Intergrating culturally relevant models of health can support improved health status assessments and identify opportunities for health promotion.
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Affiliation(s)
| | - Mylene Riva
- Department of Geography, McGill University, Montreal, Canada
| | | | - Christopher Fletcher
- Department of Social and preventative medecine, Laval University, Quebec, Canada
| | - Pierre Ayotte
- Department of Social and preventative medecine, Laval University, Quebec, Canada
| | - Gina Muckle
- Department of Social and preventative medecine, Laval University, Quebec, Canada
| | - Natalia Poliakova
- Population Health and Optimal Health Practices Branch, CHU deQuébec Research Centre, Quebec, Canada
| | - Richard Bélanger
- Department of Social and preventative medecine, Laval University, Quebec, Canada
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Sharma N, Walker JD, Wenghofer E, Moeke-Pickering T, Lindenbach J. Indigenous approaches to health assessment: a scoping review protocol. Syst Rev 2024; 13:78. [PMID: 38424631 PMCID: PMC10903070 DOI: 10.1186/s13643-024-02496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 02/18/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Health assessment tools developed using mainstream or Western concepts have been widely used in clinical practice worldwide. However, even culturally adapted or culturally based tools may not be relevant in other social contexts if they are grounded in Western beliefs and perspectives. The application of mainstream assessment tools, when used in Indigenous populations, can lead to the inappropriate application of normative data and inaccurate or biased diagnosis of conditions as Indigenous concepts of health differ from Western biomedical concepts of health. Thus, considering the need for culturally meaningful, sensitive, safe, and unbiased health assessment approaches and instruments over recent years, tools have been developed or adapted by and with Indigenous populations in Australia, Aotearoa/New Zealand, Canada, and the United States. However, there is no existing systematic or scoping review to identify the methods and approaches used in adapting or developing health assessment tools for use with the Indigenous population in Australia, Aotearoa/New Zealand, Canada, and the United States. METHODS In response to these gaps, we are working with a First Nations Community Advisory Group in Northern Ontario, Canada, to undertake a scoping review following the 2020 JBI methodology for scoping reviews. A systematic search will be conducted in PubMed, APA PsychINFO, CINAHL, MEDLINE, Web of Science, Bibliography of Native North Americans, Australian Indigenous Health info data set, and Indigenous Health Portal. Two reviewers will independently screen all abstracts and full-text articles for inclusion using criteria co-developed with an advisory group. We will chart the extracted information and summarize and synthesize the data. The summarized findings will be presented to a Community Advisory Group, including First Nations community partners, an Elder, and community members, and their feedback will be incorporated into the discussion section of the scoping review. DISCUSSION This scoping review involves iterative consultation with the Indigenous and non-Indigenous scholars, First Nations Community Advisory Group, and community partners throughout the research process. This review aims to summarize the evidence on standard ethical approaches and practices used in Indigenous research while adapting or developing health assessment tools. It will inform the larger study focused on developing an Indigenous Functional Assessment tool. Further, it will seek whether the Indigenous ways of knowing and equitable participation of Indigenous people and communities are incorporated in the Indigenous research process. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/yznwk .
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Affiliation(s)
- Nabina Sharma
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada.
| | - Jennifer D Walker
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Wenghofer
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, ON, Canada
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Tremblay M, Sydora BC, Listener LJ, Kung JY, Lightning R, Rabbit C, Oster RT, Kruschke Z, Ross S. Indigenous gender and wellness: a scoping review of Canadian research. Int J Circumpolar Health 2023; 82:2177240. [PMID: 36803328 PMCID: PMC9946324 DOI: 10.1080/22423982.2023.2177240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
This scoping review examined research publications related to health and/or wellness along with gender among Canadian Indigenous populations. The intent was to explore the range of articles on this topic and to identify methods for improving gender-related health and wellness research among Indigenous peoples. Six research databases were searched up to 1 February 2021. The final selection of 155 publications represented empirical research conducted in Canada, included Indigenous populations, investigated health and/or wellness topics and focused on gender. Among the diverse range of health and wellness topics, most publications focused on physical health issues, primarily regarding perinatal care and HIV- and HPV-related issues. Gender diverse people were seldom included in the reviewed publications. Sex and gender were typically used interchangeably. Most authors recommended that Indigenous knowledge and culture be integrated into health programmes and further research. More health research with Indigenous peoples must be conducted in ways that discern sex from gender, uplift the strengths of Indigenous peoples and communities, privilege community perspectives, and attend to gender diversity; using methods that avoid replicating colonialism, promote action, change stories of deficit, and build on what we already know about gender as a critical social determinant of health.
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Affiliation(s)
- Melissa Tremblay
- Department of Educational Psychology, University of Alberta, 5-127 Education North, University of Alberta, Edmonton, Alberta, Canada,CONTACT Melissa Tremblay Department of Educational Psychology, University of Alberta, 5-127 Education North, University of Alberta, Edmonton, AB T6G 2G5, Canada
| | - Beate C. Sydora
- Department of Obstetrics & Gynecology, University of Alberta, Position: Research Associate, 626-1 Community Service Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Luwana Joyce Listener
- Department of Obstetrics & Gynecology, University of Alberta, Position: Research Assistant, 5S141 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Janice Y. Kung
- University of Alberta, Position: Librarian, John W. Scott Health Sciences Library, 2K3.28 Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Chevi Rabbit
- Community member, Position: Human rights advocate
| | - Richard T. Oster
- Indigenous Wellness Core, Alberta Health Services, Edmonton, Alberta, Canada
| | - Zoë Kruschke
- Department of Educational Psychology, University of Alberta, Position: Research Coordinator, University of Alberta, Edmonton, Alberta, Canada
| | - Susan Ross
- Departments of Obstetrics and Gynecology, and Women and Children’s Health Research Institute (WCHRI) University of Alberta, Position: Professor and Cavarzan Chair of Mature Women’s Health Research, 5S141 Lois Hole Hospital for Women, Robbins Pavilion, Royal Alexandra Hospital, Edmonton, Alberta, Canada
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Tsuji SRJ, Zuk AM, Solomon A, Edwards-Wheesk R, Ahmed F, Tsuji LJS. What Is Wellbeing, and What Is Important for Wellbeing? Indigenous Voices from across Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6656. [PMID: 37681798 PMCID: PMC10487260 DOI: 10.3390/ijerph20176656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/09/2023]
Abstract
Indigenous peoples' perceptions of wellbeing differ from non-Indigenous constructs. Thus, it is imperative to recognize that Indigenous peoples will conceptualize wellbeing from their perspectives and set their own wellbeing priorities. In keeping with this viewpoint, the aims of the present study were to conceptualize wellbeing and determine what was (and is) important for wellbeing from Canadian Indigenous peoples' perspectives. In this paper, we take a partnership approach based on the elements of respect, equity, and empowerment. One primary data source and two existing data sources were examined and analyzed thematically utilizing a combination approach of deductive and inductive coding. Indigenous leadership and organizations viewed wellbeing holistically and conceptualized wellbeing multidimensionally. From across Canada, wellbeing was communicated as physical, economic, political, social, and cultural. The scaling of wellbeing represented a collectivist perspective, and land was the connecting thread between all types of wellbeing, being a place to practice cultural traditions, reassert one's Indigenous identity, find solace, and pass on Indigenous knowledge and languages. Although wellbeing was discussed in the context of the individual, family, community, and nation, wellbeing was most often discussed at the cultural level by regional and national Indigenous leadership and organizations. Even in acknowledging the great cultural diversity among Canadian Indigenous nations, four concordant themes were identified regionally and nationally, with respect to what was important for cultural wellbeing: land and water, sustainability, and inherent obligations; being on the land, and indigenous languages and knowledge systems; sustainable development; and meaningful involvement in decision-making, and free, prior, and informed consent. Taking into account these themes is foundational for any interaction with Indigenous peoples, especially in the context of land, culture, and development. There needs to be a new beginning on the journey to reconciliation with land and cultural wellbeing at the forefront.
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Affiliation(s)
- Stephen R. J. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
- School of Environmental Studies, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Aleksandra M. Zuk
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
- School of Nursing, Queen’s University, Kingston, ON K7L 3N6, Canada
| | - Andrew Solomon
- Fort Albany First Nation, Fort Albany, ON P0L 1H0, Canada
| | | | - Fatima Ahmed
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
| | - Leonard J. S. Tsuji
- Department of Physical and Environmental Sciences, University of Toronto, Toronto, ON M1C 1A4, Canada; (A.M.Z.); (F.A.); (L.J.S.T.)
- Department of Health and Society, University of Toronto, Toronto, ON M1C 1A4, Canada
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Loukes KA, Ferreira C, Gaudet JC, McGuire-Adams T. A methodological protocol for conducting a scoping review of health research on/by/with Indigenous women in North America. Syst Rev 2022; 11:233. [PMID: 36307820 PMCID: PMC9615379 DOI: 10.1186/s13643-022-02080-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 09/23/2022] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Indigenous women in North America experience multiple inequities in terms of health and well-being when compared to non-Indigenous women and Indigenous men. In an effort to understand these health disparities, there has been a surge of research in the field of Indigenous women's health and well-being over the last 20 years. The objective of this study is to conduct a scoping review of the most current research in this field to determine which theoretical frameworks are being used to study which topics in Indigenous women's health and well-being in North America. METHODS The scoping review protocol used was designed to follow an iterative six-step process as laid out by Arksey and O'Malley. Peer-reviewed, academic articles from the following databases were identified: Academic Search Complete, Native Health Database, Web of Science, Google Scholar, Bibliography of Native North America, Sociological Abstracts, Gender Watch, and Indigenous Peoples of North America. Two team members subsequently conducted two screens of titles and abstracts to include articles which focused exclusively on Indigenous women's health and well-being published between 2011 and 2021. The literature considered focused on Indigenous women's health and well-being and explicitly states their use of critical theoretical frameworks (e.g., Indigenous feminist, intersectionality, Indigenous resurgence, feminist, critical race) or community-based participatory research (CBPR). Data analysis will involve quantitative and qualitative descriptions. DISCUSSION The results of our scoping review (in progress) will map out the current field of Indigenous women's health research. Our findings will highlight the theoretical frameworks operationalized in research on Indigenous women's health, identify gaps therein, and provide a basis for understanding how these theoretical lenses shape questions, methodologies, analysis, and implications of academic research.
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Affiliation(s)
- Keira A Loukes
- School of Outdoor Recreation, Parks, and Tourism, Lakehead University, Thunder Bay, Canada. .,School of Human Kinetics, University of Ottawa, Ottawa, Canada.
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Palmer AL, Wong-Francq K, Setton E. Cancer and the Environment projects with four First Nations organizations: working together to address concerns about carcinogens in the environment. Canadian Journal of Public Health 2021; 113:227-238. [PMID: 34669182 PMCID: PMC8975920 DOI: 10.17269/s41997-021-00571-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022]
Abstract
Setting For First Nations people, human health and well-being are interconnected with a healthy environment. First Nations organizations commonly raise concerns regarding carcinogens in the environment; however, few case studies are available as guidance for working in a participatory and respectful way to help assess and address these concerns. Intervention Through four community-led pilot projects executed over two years, we collaborated with 15 participants from four First Nations organizations across four provinces to identify concerns related to environmental carcinogens and to address those concerns through an integrated knowledge translation (KT) approach. We co-developed and implemented strategic KT plans for each pilot project, and conducted evaluation surveys and interviews with participants at multiple time points to assess process, progress, barriers and facilitators, and impact. Outcomes The activities and outputs of the pilot projects are available at www.carexcanada.ca. Participants identified 18 concerns, and we co-developed 24 knowledge products. Tailored fact sheets for communities and briefing notes for leadership were deemed most useful; interactive maps were deemed less useful. Evaluation indicated that the collaborative projects were effective in addressing the concerns raised regarding exposures to carcinogens. Implications The participant-led approach and multi-year funding to support capacity enhancement and face-to-face engagement were facilitators to project success. However, participants did face important barriers to collaborate which should be considered in future projects of this kind: the most important being a lack of resources (people and time), given competing and often more urgent priorities.
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Affiliation(s)
- Alison L Palmer
- CAREX Canada, Faculty of Health Sciences, Simon Fraser University, Harbour Centre Campus, Suite 2602, 515 West Hastings St, Vancouver, BC, V6B 5K3, Canada.
| | - Katy Wong-Francq
- Office of the Vice President, Research and International, University of Waterloo, Waterloo, ON, Canada
| | - Eleanor Setton
- Department of Geography, University of Victoria, Victoria, BC, Canada
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Eni R, Phillips-Beck W, Achan GK, Lavoie JG, Kinew KA, Katz A. Decolonizing health in Canada: A Manitoba first nation perspective. Int J Equity Health 2021; 20:206. [PMID: 34526038 PMCID: PMC8442310 DOI: 10.1186/s12939-021-01539-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION & BACKGROUND Global persistence of health inequities for Indigenous peoples is evident in ongoing discrepancies in health and standards of living. International literature suggests the key to transformation lies in Indigenous efforts to control Indigenous health and healthcare. Previous authors have focused upon participation, structural transformation, and culturally appropriate healthcare recognized as a political right as fundamental tenets of Indigenous control. Contextualizing Indigenous health and wellness falls within a growing discussion on decolonization - a resituating of expertise that privileges Indigenous voice and interests. METHODS The study is a qualitative, grounded theory analysis, which is a constructivist approach to social research allowing for generation of theory in praxis, through interactions and conversations between researchers and participants. One hundred eighty-three interviews with additional focus groups were held between 2013-15 in eight Manitoba First Nation communities representing different models of health delivery, geographies, accessibilities, and Indigenous language groups. Community research assistants and respected Elders participated in data collection, analysis and interpretation. Line-by-line coding and constant comparative method led to the discovery of converging themes. FINDINGS Ultimately four main themes arose: 1) First Nation control of healthcare; 2) traditional medicine and healing activities; 3) full and meaningful community participation; and 4) cleaning up impacts of colonization. Joint analyses and interpretation of findings revealed substantial evidence that communities were looking profoundly into problems of improperly delivered services and health inequities. Issues were consistent with those highlighted by international commissions on reconciliation, health, Indigenous rights and liberties. To those documents, these findings add ground upon which to build the transformative agenda. RESULTS & DISCUSSION Communities discussed the need for creation of protocols, constitution and laws to ensure growth of a decolonizing agenda. Inclusive to the concept are holistic, preventative, traditional health perspectives, and Indigenous languages. Colonization impacts were of critical concern and in need of undoing. Sharing of social and political efforts is seen as pivotal to change and includes all members of communities.
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Affiliation(s)
- Rachel Eni
- Community Health Sciences, College of Medicine, University of Manitoba, Independent Researcher, Victoria, BC, V9C 0M1, Canada.
| | - Wanda Phillips-Beck
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, First Nation Health and Social Secretariat Manitoba and the University of Manitoba, Winnipeg, MB, R3B 2B3, Canada
| | - Grace Kyoon Achan
- Education Indigenous Institute of Health and Healing, University of Manitoba, Winnipeg, MB, R3E 3P4, Canada
| | - Josée G Lavoie
- Department Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3E 3P5, Canada
| | - Kathi Avery Kinew
- First Nation Health and Social Secretariat Manitoba, Winnipeg, MB, R3B 2B3, Canada
| | - Alan Katz
- Department of Family Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, R3B 2B3, Canada
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