Community-building versus career-building research: the challenges, risks, and responsibilities of conducting research with Aboriginal and Native American communities

Community engagement approaches for Indigenous health research: recommendations based on an integrative review

OBJECTIVE

Community engagement practices in Indigenous health research are promoted as a means of decolonising research, but there is no comprehensive synthesis of approaches in the literature. Our aim was to assemble and qualitatively synthesise a comprehensive list of actionable recommendations to enhance community engagement practices with Indigenous peoples in Canada, the USA, Australia and New Zealand.

DESIGN

Integrative review of the literature in medical (Medline, Cumulative Index to Nursing and Allied Health Literature and Embase) and Google and WHO databases (search cut-off date 21 July 2020).

ARTICLE SELECTION

Studies that contained details regarding Indigenous community engagement frameworks, principles or practices in the field of health were included, with exclusion of non-English publications. Two reviewers independently screened the articles in duplicate and reviewed full-text articles.

ANALYSIS

Recommendations for community engagement approaches were extracted and thematically synthesised through content analysis.

RESULTS

A total of 63 studies were included in the review, with 1345 individual recommendations extracted. These were synthesised into a list of 37 recommendations for community engagement approaches in Indigenous health research, categorised by stage of research. In addition, activities applicable to all phases of research were identified: partnership and trust building and active reflection.

CONCLUSIONS

We provide a comprehensive list of recommendations for Indigenous community engagement approaches in health research. A limitation of this review is that it may not address all aspects applicable to specific Indigenous community settings and contexts. We encourage anyone who does research with Indigenous communities to reflect on their practices, encouraging changes in research processes that are strengths based.

Reliability, construct validity, and measurement invariance of the PROMIS Physical Function 8b-Adult Short Form v2.0

PURPOSE

The National Institutes of Health established the Patient-Reported Outcomes Measurement Information System (PROMIS) to assess health across various chronic illnesses. The standardized PROMIS measures have been used to assess symptoms in studies that included Native American participants, although the psychometric properties of these measures have not been assessed among a solely Native American population. This study aimed to assess the reliability, construct validity, and measurement invariance of a widely used PROMIS Physical Function survey among Native Americans residing on or near the Apsáalooke (Crow) Reservation who were living with chronic illnesses.

METHODS

Participants aged 24 to 82 years and living with at least one chronic illness were recruited for a community-based participatory research project. Baseline data were used for the current study (N = 210). The 8-item PROMIS Physical Function 8b-Adult Short Form v2.0 was used to assess the function of upper and lower extremities, central core regions, and the ability to complete daily activities on a 5-point Likert scale.

RESULTS

Results indicated that the above PROMIS survey had high internal consistency (Cronbach's α = 0.95) and split-half (r = 0.92, p < 0.001) reliabilities. Confirmatory factor analyses supported construct validity among females of the above population and when the two sex groups were combined. Results also indicated that corresponding thresholds and factor loadings were invariant across male and female groups.

CONCLUSIONS

The above PROMIS measure had good psychometric properties in females and when the two sex groups were combined among Native American adults living on or near the Apsáalooke reservation with chronic illnesses. Thresholds and factor loadings appeared to be invariant by sex. Future studies with a larger sample size among males and more studies on the psychometric properties of other PROMIS measures among Native American populations are needed.

Our practice of outreach during the Ice Monitoring project in Nunavik: an early-career researcher perspective

Inuit Nunangat, including Nunavik, is seeing an ever-increasing number of research projects. While mainstream approaches to research are colonial in nature and have historically contributed to the oppression of Indigenous peoples, a new paradigm is now emerging from Indigenous recommendations. Researchers are encouraged to collaborate with Inuit or Northern communities, organizations, and governments and to develop communication strategies to keep local populations informed. This paper focuses on outreach activities organized on several occasions throughout the Ice Monitoring project, in which we participated as PhD students. We share details on this periodic outreach program, which included a Facebook page, hosting an information table at the Co-op store, activities with high school classes, and participation in Raglan Mine’s Environmental Forum. We also discuss lessons learned and the transformation of our practice.

Ethnic discordance: Why do some patients prefer to be treated by physicians from other ethnic groups?

Current literature on patient-physician concordance emphasizes its advantages. Racial, ethnic, cultural and linguistic concordance was found to impact patient-physician communication positively and to lead to improved healthcare quality and outcomes. Patients' preference for ethnic discordance, on the other hand, appears anomalous and has barely been studied. The present research sought to evaluate the rates of patients from the Jewish majority and the Arab minority populations in Israel who prefer patient-physician ethnic discordance, and to examine the reasons for this preference. A mixed method methodology was employed: a survey (n = 760; 505 Jews, 255 Arabs), as well an exploratory qualitative study based on in-depth interviews with 38 Jewish and Arab patients in Israel. The survey's findings indicate that Arabs are more likely to prefer to be treated by a Jewish physician than are Jews to prefer an Arab physician (family physician - 4.3% vs. 0.4%, p < .0001; surgeon - 5.9% vs. 0.8%, p < .0001). The difference is age-dependent: young Arabs are more likely than older ones to prefer a Jewish physician. The reasons for Arabs' preference for a Jewish physician are fear of a breach of confidentiality, and internalized racism. The reasons for Jews' preference for an Arab physician are the disposition and professionalism attributed to the latter, which are perceived to stem from their need, as a minority population, to excel and to prove themselves. Despite the emphasis placed in scholarship and clinical practice on the importance of cultural and linguistic competency in healthcare, a preference for ethnic discordance should also be taken into account, especially regarding patients from minority collectivist populations.

Highlighting the potential of peer-led workshops in training early-career researchers for conducting research with Indigenous communities

For decades, Indigenous voices have called for more collaborative and inclusive research practices. Interest in community-collaborative research is consequently growing among university-based researchers in Canada. However, many researchers receive little formal training on how to collaboratively conduct research with Indigenous communities. This is particularly problematic for early-career researchers (ECRs) whose fieldwork often involves interacting with communities. To address this lack of training, two peer-led workshops for Canadian ECRs were organized in 2016 and 2017 with the following objectives: ( i) to cultivate awareness about Indigenous cultures, histories, and languages; ( ii) to promote sharing of Indigenous and non-Indigenous ways of knowing; and ( iii) to foster approaches and explore tools for conducting community-collaborative research. Here we present these peer-led Intercultural Indigenous Workshops and discuss workshop outcomes according to five themes: scope and interdisciplinarity, Indigenous representation, workshop environment, skillful moderation, and workshop outcomes. Although workshops cannot replace the invaluable experience gained through working directly with Indigenous communities, we show that peer-led workshops can be an effective way for ECRs to develop key skills for conducting meaningful collaborative research. Peer-led workshops are therefore an important but insufficient step toward more inclusive research paradigms in Canada.

Decades of Doing: Indigenous Women Academics Reflect on the Practices of Community-Based Health Research

It has been several decades since the establishment of Ownership, Control, Access, and Possession (OCAP®) and the proliferation of work on Indigenous research ethics. Most of this dialogue emerged because of egregious health research practices in Indigenous communities and has since taken a foothold across all disciplines. Community-engaged research in Indigenous communities is challenging. It is important to reflect on some of the early ethical and methodological debates, which shape how we currently work with communities. This research describes the themes that emerged when two Indigenous scholars interviewed their Indigenous university-based colleagues who work in Indigenous health. These interviews uncovered four critical themes that were prominent and related specifically to understanding research ethics in Indigenous health research specifically. These themes included research in relationship, creating partnerships and negotiating across systems, self-determination applied to research, and community-engaged research.

Participatory Research in Pediatric Palliative Care: Benefits and Challenges

Participatory research is an approach wherein all parties concerned play an active role throughout the research process, from initial design to the interpretation and dissemination of results. This article reports on two participatory research projects evaluating a new in-home respite program for children requiring pediatric palliative care and their families. Some of the realities, benefits, and challenges resulting from a participatory approach to research in pediatric palliative care are described. The outcomes of these two studies highlight the conclusion that organizations, professionals, volunteers, and family members accompanying the dying benefit from a participatory research method that actively engages their involvement. This approach offers participants the opportunity to voice concerns as well as supports a sense of empowerment. From the researcher's point of view, a participatory process can serve to increase both the social relevancy and impact of the research.

A culturally tailored research ethics training curriculum for American Indian and Alaska Native communities: a randomized comparison trial

The primary aim of this study was to develop an American Indian and Alaska Native (AIAN) tailored research with human subjects curriculum that would increase the participation of AIAN members in research affecting their communities. We used a community-engaged research approach to co-design and evaluate a culturally tailored online human subjects curriculum among a national sample of AIAN community members (n = 244) with a standard nationally used online curriculum (n = 246). We evaluated pre-and post-test measures to assess group differences in ethics knowledge, perceived self-efficacy to apply such knowledge to protocol review, and trust in research. Analysis of regional tribal differences assessed curriculum generalizability. Using an 80% correct item cut-off at first attempt as passing criterion, the tailored curriculum achieved a 59.3% passing rate versus 28.1% in the standard curriculum (p < .001). For both arms, participants reported a significant increase in trust in research and in research review efficacy. Participants took less time to complete the training and reported significantly higher acceptability, satisfaction, and understandability of the curriculum for the tailored curriculum. This culturally tailored research ethics curriculum has the potential to increase participation in AIAN communities in research affecting tribal members. The AIAN curriculum achieved significantly higher levels of participants' research ethics knowledge, self-efficacy in reviewing research protocols, trust in research, and completion of the training requirements. Culturally grounded training curricula may help remedy the impact of historical research ethics abuses involving AIAN communities that have contributed to mistrust of research and lack of community engagement in research.

Ethical Challenges in Community-Based Participatory Research: A Scoping Review

Ethical challenges in community-based participatory research (CBPR) are of increasing interest to researchers; however, it is not known how widespread these challenges are or how extensively the topic has been explored. Using Arksey and O'Malley's scoping review method, studies on ethical challenges in CBPR were mapped. Findings indicate that researchers continue to raise questions about ethics associated with CBPR. Our purpose in this article is to present a thematic summary of international ethical challenges as a guide for researchers interested in community participatory approaches and to better prepare them for qualitative health research with communities.

More than words: Using visual graphics for community-based health research

With increased attention to knowledge translation and community engagement in the applied health research field, many researchers aim to find effective ways of engaging health policy and decision makers and community stakeholders. While visual graphics such as graphs, charts, figures and photographs are common in scientific research dissemination, they are less common as a communication tool in research. In this commentary, I illustrate how and why visual graphics were created and used to facilitate dialogue and communication throughout all phases of a community-based health research study with a rural Indigenous community, advancing community engagement and knowledge utilization of a research study. I suggest that it is essential that researchers consider the use of visual graphics to accurately communicate and translate important health research concepts and content in accessible forms for diverse research stakeholders and target audiences.RéSUMé: Avec l'attention croissante que l'on porte à l'application des connaissances et à la mobilisation communautaire dans le domaine de la recherche appliquée en santé, de nombreux chercheurs cherchent des moyens efficaces d'intéresser les responsables et les décideurs des politiques de santé et les acteurs communautaires. Bien que l'on utilise couramment des éléments graphiques de visualisation (graphes, diagrammes, figures et photographies) pour diffuser la recherche scientifique, on les utilise moins souvent comme outils de communication dans la recherche. Dans mon commentaire, j'explique comment et pourquoi des éléments graphiques de visualisation ont été créés et utilisés pour faciliter le dialogue et la communication à toutes les étapes d'une étude de recherche en santé communautaire auprès d'une communauté rurale autochtone, ce qui a favorisé la mobilisation communautaire et l'utilisation des connaissances de l'étude. Je suggère qu'il est essentiel que les chercheurs songent à utiliser des éléments graphiques de visualisation pour communiquer avec précision, et pour appliquer d'importants concepts et contenus de recherche en santé sous des formes accessibles aux divers acteurs et aux publics cibles de la recherche.

Ethical community-engaged research: a literature review

Health research has relied on ethical principles, such as those of the Belmont Report, to protect the rights and well-being of research participants. Community-based participatory research (CBPR), however, must also consider the rights and well-being of communities. This requires additional ethical considerations that have been extensively discussed but not synthesized in the CBPR literature. We conducted a comprehensive thematic literature review and summarized empirically grounded discussions of ethics in CBPR, with a focus on the value of the Belmont principles in CBPR, additional essential components of ethical CBPR, the ethical challenges CBPR practitioners face, and strategies to ensure that CBPR meets ethical standards. Our study provides a foundation for developing a working definition and a conceptual model of ethical CBPR.

Creating research capacity through a tribally based institutional review board

Tribal groups work tirelessly to maintain sovereignty rights, preserving and upholding tribal authority and protection over their land, people, businesses, and health. Moreover, the conduct of health science research by outsiders has had its share of an unethical, misguided, and abusive past. Tribally based institutional review boards (IRBs) are addressing these issues in an effort to control new health science research, set their own research agenda, and protect their people in the same spirit as has been accomplished through the perpetuation of sovereignty rights. We describe the success of a tribally based IRB at creating new capacity for health research and enhanced levels of trust, including bidirectional cultural education between academic researchers and tribal IRB committee members.

Women's experiences in a community-based participatory research randomized controlled trial

Integrating community-based participatory research (CBPR) into traditional study designs can enhance outcomes in studies with disadvantaged groups. Little is known, however, about study participants' experiences with these approaches, the underlying processes involved in creating more positive outcomes, and whether undesirable effects on study outcomes occur simultaneously. We conducted focus group interviews with 31 disadvantaged women who participated in a CBPR-driven randomized controlled trial (RCT) both to explore their study experiences and to obtain their interpretations of select study findings. Using dimensional analysis, we found the tailored health questionnaire, treatment by study staff members, and RCT participants' understandings of and responses to randomization were salient to what women described as transformative experiences that occurred over the course of the RCT. These findings have implications for understanding how CBPR and non-CBPR aspects of interventions and study designs have the potential to affect both process and endpoint study outcomes.

From patient to participant: enhancing the validity and ethics of cancer research through participatory research

Participatory health research involves a wide spectrum of participation from the population of study. We describe the participatory research processes of a large mixed method study on the psychosocial impact of dragon boating in individuals with breast cancer. In particular, we discuss the involvement of a Community Advisory Group (consisting of five breast cancer patients/survivors) in the development of the research study, data collection and analysis, and dissemination of the study results. We also outline the elements of a research workshop, in which 13 breast cancer patients/survivors were involved in the development of a provincial survey for the study. The purpose of this article is to share our experience of engaging cancer patients/survivors in a participatory research study. We discuss the value-based elements of participatory research (power sharing, voice and respect, reciprocity, and mutual benefit), and provide a case-based example of how these participatory elements were employed to potentially increase the validity of the survey instrument, to enhance the ethics of working with a cancer population, and ultimately contributed to a high survey response rate.

Lessons learned conducting breastfeeding intervention research in two northern plains tribal communities

AIM

The overall purpose of this article was to describe the challenges and benefits of conducting breastfeeding intervention research with two Native American Tribal communities.

METHODS

A focus group with an interpretive approach was used to collect data within this qualitative study as a means of incorporating a complex, holistic, subjective interpretation of the case managers' perceptions and experiences. In addition, researchers' field notes were used. Findings are discussed in relation to Rogers' Diffusion of Innovation Framework.

RESULTS

Themes that emerged during the focus group discussions were related to innovation, relative advantage, complexity, compatibility, trialability, and observability.

CONCLUSIONS

Conducting research in Native American Tribal communities was both enriching and challenging. The research protocol needs to be culturally appropriate, and complex components need to be videotaped for review on an ongoing basis. Time constraints of case managers need to be examined prior to development of the research protocol.

Weaving the native web: using social network analysis to demonstrate the value of a minority career development program

PURPOSE

American Indian and Alaska Native scientists are consistently among the most underrepresented minority groups in health research. The authors used social network analysis (SNA) to evaluate the Native Investigator Development Program (NIDP), a career development program for junior Native researchers established as a collaboration between the University of Washington and the University of Colorado Denver.

METHOD

The study focused on 29 trainees and mentors who participated in the NIDP. Data were collected on manuscripts and grant proposals produced by participants from 1998 to 2007. Information on authorship of manuscripts and collaborations on grant applications was used to conduct social network analyses with three measures of centrality and one measure of network reach. Both visual and quantitative analyses were performed.

RESULTS

Participants in the NIDP collaborated on 106 manuscripts and 83 grant applications. Although three highly connected individuals, with critical and central roles in the program, accounted for much of the richness of the network, both current core faculty and "graduates" of the program were heavily involved in collaborations on manuscripts and grants.

CONCLUSIONS

This study's innovative application of SNA demonstrates that collaborative relationships can be an important outcome of career development programs for minority investigators and that an analysis of these relationships can provide a more complete assessment of the value of such programs.

Screening Native American children for asthma: findings from focus group discussions

CONTEXT

Because of the past history among the Indian people related to research, it is incumbent upon those of us who wish to conduct research with these groups to protect them from exploitation, to conduct research that will be beneficial to the tribal community, and to work together to make the research as meaningful and as successful as possible. The process of conducting research among Native American tribes can appear to the novice as very time-consuming and full of barriers. These are necessary guards to protect their people. Additionally, many people of these tribes want to make sure that the research is going to benefit them. Focus groups provide a way for researchers to identify what the wishes of the tribal communities are in relation to the proposed research.

PURPOSE

The overall purpose of this study was to understand some of the concerns the tribal communities had regarding asthma among their children, as well as their perceptions of how best to implement an asthma screening program in their community.

METHODS

This was a qualitative study. An interpretative approach was selected for this research because such an approach emphasizes how a phenomenon is perceived and how meaning is constructed in situations.

FINDINGS

Findings from the focus group are discussed according to themes that surfaced during the focus group discussion.

CONCLUSIONS

Tribal community leaders and parents are interested in their children's health and do want to be involved in research to help children and others in their communities. Nurses working in tribal communities need to gain an understanding of the tribal communities' perspective prior to conducting research.

Negotiating three worlds: academia, nursing science, and tribal communities

PURPOSE

The purpose of this article is to use a cross-cultural model to guide the exploration of common issues and the dynamic interrelationships surrounding entrée to tribal communities as experienced by four nursing research teams.

METHOD

Members of four research teams discuss the primary lessons learned about successful strategies and challenges encountered during their projects' early stages.

RESULTS

Understanding the cultural values of relationship and reciprocity is critical to the success of research projects conducted in Native American communities.

DISCUSSION

Conducting cross-cultural research involves complex negotiations among members of three entities: academia, nursing science, and tribal communities. The lessons learned in these four research projects may be instructive to investigators who have the opportunity to conduct research with tribal communities.

Strategies and stakeholders: minority recruitment in cancer genetics research

The Cancer Genetics Network (CGN) is one of a growing number of large-scale registries designed to facilitate investigation of genetic and environmental contributions to health and disease. Despite compelling scientific and social justice arguments that recommend diverse participation in biomedical research, members of ethnic minority groups continue to be chronically underrepresented in such projects. The CGN studies reported in this issue used strategies well documented to increase minority participation in research activities, including use of community-targeted materials, addressing community trust concerns, and the adoption of personalized and flexible research protocols. Here, we review the outcome of these efforts to increase minority recruitment to the CGN, and ask what lessons the findings suggest for future minority recruitment initiatives.