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Cordes A, Bak M, Lyndon M, Hudson M, Fiske A, Celi LA, McLennan S. Competing interests: digital health and indigenous data sovereignty. NPJ Digit Med 2024; 7:178. [PMID: 38965365 PMCID: PMC11224364 DOI: 10.1038/s41746-024-01171-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/14/2024] [Indexed: 07/06/2024] Open
Abstract
Digital health is increasingly promoting open health data. Although this open approach promises a number of benefits, it also leads to tensions with Indigenous data sovereignty movements led by Indigenous peoples around the world who are asserting control over the use of health data as a part of self-determination. Digital health has a role in improving access to services and delivering improved health outcomes for Indigenous communities. However, we argue that in order to be effective and ethical, it is essential that the field engages more with Indigenous peoples´ rights and interests. We discuss challenges and possible improvements for data acquisition, management, analysis, and integration as they pertain to the health of Indigenous communities around the world.
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Affiliation(s)
- Ashley Cordes
- Environmental Studies Program and Department of Data Science, University of Oregon, Eugene, OR, USA
| | - Marieke Bak
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Ethics, Law and Humanities, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mataroria Lyndon
- Centre for Medical and Health Sciences Education, School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Maui Hudson
- Te Kotahi Research Institute, University of Waikato, Hamilton, New Zealand
| | - Amelia Fiske
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Leo Anthony Celi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stuart McLennan
- Institute of History and Ethics in Medicine, Department of Preclinical Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
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Gray M, Williams K, Oster RT, Bruno G, Cooper A, Healy C, Rich R, Scott Claringbold S, Teare G, Wessel S, Henderson RI. Indigenous identity identification in administrative health care data globally: A scoping review. J Health Serv Res Policy 2024; 29:210-221. [PMID: 38099443 PMCID: PMC11151709 DOI: 10.1177/13558196231219955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally. METHODS A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield's Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective. RESULTS In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12 years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research. CONCLUSION There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research.
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Affiliation(s)
- Mandi Gray
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kienan Williams
- Indigenous Wellness Core, Alberta Health Services, Canada, Edmonton, AB, Canada
| | - Richard T. Oster
- Indigenous Wellness Core, Alberta Health Services, Canada, Edmonton, AB, Canada
| | - Grant Bruno
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Annelies Cooper
- Indigenous Health and Environmental Justice, Critical Health and Social Action Lab., University of Toronto, Toronto, ON, Canada
| | - Chyloe Healy
- Blackfoot Confederacy Tribal Council, Calgary, AB, Canada
| | | | - Shayla Scott Claringbold
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gary Teare
- Provincial Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Samara Wessel
- Counselling Psychology, Department of Educational Psychology, University of Calgary, Calgary, AB, Canada
| | - Rita I. Henderson
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Smylie J, Bourgeois C, Snyder M, Maddox R, McConkey S, Rotondi M, Prince C, Dokis B, Hardy M, Joseph S, Kilabuk A, Mattina JA, Cyr M, Blais G. Design and implementation of the Our Health Counts (OHC) methodology for First Nations, Inuit, and Metis (FNIM) health assessment and response in urban and related homelands. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2024:10.17269/s41997-024-00867-9. [PMID: 38619750 DOI: 10.17269/s41997-024-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/09/2024] [Indexed: 04/16/2024]
Abstract
OBJECTIVES Methods for enumeration and population-based health assessment for First Nations, Inuit, and Metis (FNIM) living in Canadian cities are underdeveloped, with resultant gaps in essential demographic, health, and health service access information. Our Health Counts (OHC) was designed to engage FNIM peoples in urban centres in "by community, for community" population health assessment and response. METHODS The OHC methodology was designed to advance Indigenous self-determination and FNIM data sovereignty in urban contexts through deliberate application of Indigenous principles and linked implementation strategies. Three interwoven principles (good relationships are foundational; research as gift exchange; and research as a vehicle for Indigenous community resurgence) provide the framework for linked implementation strategies which include actively building and maintaining relationships; meaningful Indigenous community guidance, leadership, and participation in all aspects of the project; transparent and equitable sharing of project resources and benefits; and technical innovations, including respondent-driven sampling, customized comprehensive health assessment surveys, and linkage to ICES data holdings to generate measures of health service use. RESULTS OHC has succeeded across six urban areas in Ontario to advance Indigenous data sovereignty and health assessment capacity; recruit and engage large population-representative cohorts of FNIM living in urban and related homelands; customize comprehensive health surveys and data linkages; generate previously unavailable population-based FNIM demographic, health, and social information; and translate results into enhanced policy, programming, and practice. CONCLUSION The OHC methodology has been demonstrated as effective, culturally relevant, and scalable across diverse Ontario cities.
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Affiliation(s)
- Janet Smylie
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada.
- Dalla Lana School of Public Health and Department of Family & Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | | | - Marcie Snyder
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Raglan Maddox
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
- National Centre for Epidemiology and Public Health, College of Health & Medicine, The Australian National University, Canberra, Australia
| | - Stephanie McConkey
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | | | - Brian Dokis
- Southwest Ontario Aboriginal Health Access Centre, London, ON, Canada
| | - Michael Hardy
- Anishnawbe Mushkiki Aboriginal Health Access Centre, Thunder Bay, ON, Canada
| | - Serena Joseph
- Waasegiizhig Nanaandawe'iyewigamig Aboriginal Health Access Centre, Kenora, ON, Canada
| | | | - Jo-Ann Mattina
- De dwa da dehs nye>s Aboriginal Health Centre, Hamilton, ON, Canada
| | - Monica Cyr
- Aboriginal Health & Wellness Centre, Winnipeg, MB, Canada
| | - Genevieve Blais
- Well Living House, Li Ka Shing Research Institute, Unity Health Toronto, Toronto, ON, Canada
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Owosela BO, Steinberg RS, Leslie SL, Celi LA, Purkayastha S, Shiradkar R, Newsome JM, Gichoya JW. Identifying and improving the "ground truth" of race in disparities research through improved EMR data reporting. A systematic review. Int J Med Inform 2024; 182:105303. [PMID: 38088002 DOI: 10.1016/j.ijmedinf.2023.105303] [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: 09/04/2023] [Revised: 10/20/2023] [Accepted: 11/18/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Studies about racial disparities in healthcare are increasing in quantity; however, they are subject to vast differences in definition, classification, and utilization of race/ethnicity data. Improved standardization of this information can strengthen conclusions drawn from studies using such data. The objective of this study is to examine how data related to race/ethnicity are recorded in research through examining articles on race/ethnicity health disparities and examine problems and solutions in data reporting that may impact overall data quality. METHODS In this systematic review, Business Source Complete, Embase.com, IEEE Xplore, PubMed, Scopus and Web of Science Core Collection were searched for relevant articles published from 2000 to 2020. Search terms related to the concepts of electronic medical records, race/ethnicity, and data entry related to race/ethnicity were used. Exclusion criteria included articles not in the English language and those describing pediatric populations. Data were extracted from published articles. This review was organized and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement for systematic reviews. FINDINGS In this systematic review, 109 full text articles were reviewed. Weaknesses and possible solutions have been discussed in current literature, with the predominant problem and solution as follows: the electronic medical record (EMR) is vulnerable to inaccuracies and incompleteness in the methods that research staff collect this data; however, improved standardization of the collection and use of race data in patient care may help alleviate these inaccuracies. INTERPRETATION Conclusions drawn from large datasets concerning peoples of certain race/ethnic groups should be made cautiously, and a careful review of the methodology of each publication should be considered prior to implementation in patient care.
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Affiliation(s)
- Babajide O Owosela
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Rebecca S Steinberg
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, USA
| | - Sharon L Leslie
- Emory University, Woodruff Health Sciences Center Library, Atlanta, GA, USA
| | - Leo A Celi
- Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Saptarshi Purkayastha
- Indiana University-Purdue University Indianapolis, Department of BioHealth Informatics, Indianapolis, IN, USA
| | - Rakesh Shiradkar
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Janice M Newsome
- Emory University School of Medicine, Department of Radiology, Atlanta, GA, USA
| | - Judy W Gichoya
- Emory University School of Medicine, Department of Radiology, Atlanta, GA, USA.
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Morisano D, Robinson M, Rush B, Linklater R. Conducting research with Indigenous Peoples in Canada: ethical and policy considerations. Front Psychol 2024; 14:1214121. [PMID: 38356990 PMCID: PMC10866143 DOI: 10.3389/fpsyg.2023.1214121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 12/13/2023] [Indexed: 02/16/2024] Open
Abstract
The international context of Indigenous mental health and wellbeing has been shaped by a number of key works recognizing Indigenous rights. Despite international recognitions, the mental health and wellness of Indigenous Peoples continues to be negatively affected by policies that ignore Indigenous rights, that frame colonization as historical rather than ongoing, or that minimize the impact of assimilation. Research institutions have a responsibility to conduct ethical research; yet institutional guidelines, principles, and policies often serve Indigenous Peoples poorly by enveloping them into Western knowledge production. To counter epistemological domination, Indigenous Peoples assert their research sovereignty, which for the purposes of this paper we define as autonomous control over research conducted on Indigenous territory or involving Indigenous Peoples. Indigenous sovereignty might also be applied to research impacting the landscape and the web of animal and spiritual lives evoked in a phrase such as "all my relations." This narrative review of material developed in the Canadian context examines the alignment with similar work in the international context to offer suggestions and a practice-based implementation tool to support Indigenous sovereignty in research related to wellness, mental health, and substance use. The compilation of key guidelines and principles in this article is only a start; addressing deeper issues requires a research paradigm shift.
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Affiliation(s)
- Dominique Morisano
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Ottawa, Ottawa, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Margaret Robinson
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Departments of English and Sociology & Social Anthropology, Dalhousie University, Halifax, NS, Canada
| | - Brian Rush
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Renee Linklater
- Shkaabe Makwa, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Muir NM, Rotondi M, Brar R, Rotondi NK, Bourgeois C, Dokis B, Hardy M, Maddox R, Smylie J. Our Health Counts: Examining associations between colonialism and ever being incarcerated among First Nations, Inuit, and Métis people in London, Thunder Bay, and Toronto, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023:10.17269/s41997-023-00838-6. [PMID: 38158518 DOI: 10.17269/s41997-023-00838-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Indigenous peoples have a disproportionately high prevalence of incarceration in the Canadian justice system. However, there is limited Indigenous-driven research examining colonialism and the justice system, specifically associations between racism, externally imposed family disruptions, and history of ever being incarcerated. Therefore, this study examined the association between the proportion of previous incarceration and family disruption, experiences of racism, and victimization for Indigenous adults in London, Thunder Bay, and Toronto, Ontario, Canada. The three communities expressed that they did not want comparison between the communities; rather, they wanted analysis of their community to understand where more supports were needed. METHODS Indigenous community partners used respondent-driven sampling (RDS) to collect data from First Nations, Inuit, and Métis (FNIM) peoples in London, Thunder Bay, and Toronto. Prevalence estimates, 95% confidence intervals, and relative risk were reported using unweighted Poisson models and RDS-adjusted proportions. RESULTS Proportions of ever being incarcerated ranged from 43.0% in London to 54.0% in Toronto and 72.0% in Thunder Bay. In all three cities, history of child protection involvement and experiencing racism was associated with an approximate 25.0% increase in risk for previous incarceration. In Toronto and London, victimization was associated with increased risk for incarceration. CONCLUSION This research highlights disproportionately high prevalence of ever being incarcerated among FNIM living in three Ontario cities. Experiencing racism, family disruption, and victimization are associated with incarceration. Decreasing the rates of family disruption, experiences of racism, and victimization should inform future policy and services to reduce the disproportionately high prevalence of incarceration for FNIM people living in urban settings.
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Affiliation(s)
| | | | - Raman Brar
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | | | | | - Brian Dokis
- Southwest Ontario Aboriginal Health Access Centre (SOAHAC), London, ON, Canada
| | | | - Raglan Maddox
- Research School of Population Health, Australian National University, Canberra, Australia
| | - Janet Smylie
- Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, ON, Canada
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Gartner DR, Maples C, Nash M, Howard-Bobiwash H. Misracialization of Indigenous people in population health and mortality studies: a scoping review to establish promising practices. Epidemiol Rev 2023; 45:63-81. [PMID: 37022309 DOI: 10.1093/epirev/mxad001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 02/27/2023] [Accepted: 04/03/2023] [Indexed: 04/07/2023] Open
Abstract
Indigenous people are often misracialized as other racial or ethnic identities in population health research. This misclassification leads to underestimation of Indigenous-specific mortality and health metrics, and subsequently, inadequate resource allocation. In recognition of this problem, investigators around the world have devised analytic methods to address racial misclassification of Indigenous people. We carried out a scoping review based on searches in PubMed, Web of Science, and the Native Health Database for empirical studies published after 2000 that include Indigenous-specific estimates of health or mortality and that take analytic steps to rectify racial misclassification of Indigenous people. We then considered the weaknesses and strengths of implemented analytic approaches, with a focus on methods used in the US context. To do this, we extracted information from 97 articles and compared the analytic approaches used. The most common approach to address Indigenous misclassification is to use data linkage; other methods include geographic restriction to areas where misclassification is less common, exclusion of some subgroups, imputation, aggregation, and electronic health record abstraction. We identified 4 primary limitations of these approaches: (1) combining data sources that use inconsistent processes and/or sources of race and ethnicity information; (2) conflating race, ethnicity, and nationality; (3) applying insufficient algorithms to bridge, impute, or link race and ethnicity information; and (4) assuming the hyperlocality of Indigenous people. Although there is no perfect solution to the issue of Indigenous misclassification in population-based studies, a review of this literature provided information on promising practices to consider.
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Affiliation(s)
- Danielle R Gartner
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI 48824, United States
| | - Ceco Maples
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Madeline Nash
- Department of Sociology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
| | - Heather Howard-Bobiwash
- Department of Anthropology, College of Social Science, Michigan State University, East Lansing, MI 48824, United States
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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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Hummelen R, Sodhi S, Poirier J, Gordon J, Asokan S, Matsumoto CL, Kelly L. Progression From Gestational Diabetes Mellitus to Type 2 Diabetes Mellitus Among First Nations Women in Northwest Ontario: A Retrospective Cohort Study. Can J Diabetes 2023; 47:566-570. [PMID: 37196981 DOI: 10.1016/j.jcjd.2023.05.003] [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: 05/09/2022] [Revised: 03/07/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Our aim in this study was to identify the incidence of type 2 diabetes mellitus among First Nations women in northwest Ontario with a history of gestational diabetes mellitus (GDM). METHODS This work was a retrospective cohort study of women diagnosed with GDM using a 50-gram oral glucose challenge test or a 75-gram oral glucose tolerance test from January 1, 2010, to December 31, 2017, at the Sioux Lookout Meno Ya Win Health Centre. Outcomes were assessed based on glycated hemoglobin (A1C) measurements performed between January 1, 2010, and December 31, 2019. RESULTS The cumulative incidence of T2DM among women with a history of GDM was 18% (42 of 237) at 2 years and 39% (76 of 194) at 6 years. Women with GDM who developed T2DM were of similar age and parity and had equivalent C-section rates (26%) compared to those who did not develop T2DM. They had higher birth weights (3,866 grams vs 3,600 grams, p=0.006) and rates of treatment with insulin (24% vs 5%, p<0.001) and metformin (16% vs 5%, p=0.005). CONCLUSIONS GDM confers a significant risk for the development of T2DM in First Nations women. Broad community-based resources, food security, and social programming are required.
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Affiliation(s)
- Ruben Hummelen
- Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, Ontario, Canada
| | - Sumeet Sodhi
- Department of Family and Community Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jenna Poirier
- Sioux Lookout Northern Ontario School of Medicine Local Education Group, Sioux Lookout, Ontario, Canada
| | - Janet Gordon
- Sioux Lookout First Nations Health Authority, Sioux Lookout, Ontario, Canada
| | - Shanthive Asokan
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada
| | - Cai-Lei Matsumoto
- Sioux Lookout Northern Ontario School of Medicine Local Education Group, Sioux Lookout, Ontario, Canada
| | - Len Kelly
- Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada.
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Lee NR, King A, Vigil D, Mullaney D, Sanderson PR, Ametepee T, Hammitt LL. Infectious diseases in Indigenous populations in North America: learning from the past to create a more equitable future. THE LANCET. INFECTIOUS DISEASES 2023; 23:e431-e444. [PMID: 37148904 PMCID: PMC10156139 DOI: 10.1016/s1473-3099(23)00190-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/08/2023]
Abstract
The COVID-19 pandemic, although a profound reminder of endured injustices by and the disparate impact of infectious diseases on Indigenous populations, has also served as an example of Indigenous strength and the ability to thrive anew. Many infectious diseases share common risk factors that are directly tied to the ongoing effects of colonisation. We provide historical context and case studies that illustrate both challenges and successes related to infectious disease mitigation in Indigenous populations in the USA and Canada. Infectious disease disparities, driven by persistent inequities in socioeconomic determinants of health, underscore the urgent need for action. We call on governments, public health leaders, industry representatives, and researchers to reject harmful research practices and to adopt a framework for achieving sustainable improvements in the health of Indigenous people that is both adequately resourced and grounded in respect for tribal sovereignty and Indigenous knowledge.
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Affiliation(s)
- Naomi R Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Alexandra King
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Deionna Vigil
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dustin Mullaney
- Department of Biology, Northern Arizona University, Flagstaff, AZ, USA
| | - Priscilla R Sanderson
- Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, AZ, USA
| | - Taiwo Ametepee
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Stieb DM, Smith‐Doiron M, Quick M, Christidis T, Xi G, Miles RM, van Donkelaar A, Martin RV, Hystad P, Tjepkema M. Inequality in the Distribution of Air Pollution Attributable Mortality Within Canadian Cities. GEOHEALTH 2023; 7:e2023GH000816. [PMID: 37654974 PMCID: PMC10465848 DOI: 10.1029/2023gh000816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/14/2023] [Accepted: 07/20/2023] [Indexed: 09/02/2023]
Abstract
Recent studies have identified inequality in the distribution of air pollution attributable health impacts, but to our knowledge this has not been examined in Canadian cities. We evaluated the extent and sources of inequality in air pollution attributable mortality at the census tract (CT) level in seven of Canada's largest cities. We first regressed fine particulate matter (PM2.5) and nitrogen dioxide (NO2) attributable mortality against the neighborhood (CT) level prevalence of age 65 and older, low income, low educational attainment, and identification as an Indigenous (First Nations, Métis, Inuit) or Black person, accounting for spatial autocorrelation. We next examined the distribution of baseline mortality rates, PM2.5 and NO2 concentrations, and attributable mortality by neighborhood (CT) level prevalence of these characteristics, calculating the concentration index, Atkinson index, and Gini coefficient. Finally, we conducted a counterfactual analysis of the impact of reducing baseline mortality rates and air pollution concentrations on inequality in air pollution attributable mortality. Regression results indicated that CTs with a higher prevalence of low income and Indigenous identity had significantly higher air pollution attributable mortality. Concentration index, Atkinson index, and Gini coefficient values revealed different degrees of inequality among the cities. Counterfactual analysis indicated that inequality in air pollution attributable mortality tended to be driven more by baseline mortality inequalities than exposure inequalities. Reducing inequality in air pollution attributable mortality requires reducing disparities in both baseline mortality and air pollution exposure.
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Affiliation(s)
- David M. Stieb
- Environmental Health Science and Research BureauHealth CanadaVancouverBCCanada
- Environmental Health Science and Research BureauHealth CanadaOttawaONCanada
- School of Epidemiology and Public HealthUniversity of OttawaOttawaONCanada
| | - Marc Smith‐Doiron
- Environmental Health Science and Research BureauHealth CanadaOttawaONCanada
| | - Matthew Quick
- Health Analysis DivisionStatistics CanadaOttawaONCanada
| | | | - Guoliang Xi
- Environmental Health Science and Research BureauHealth CanadaOttawaONCanada
| | - Rosalin M. Miles
- Faculty of EducationIndigenous Health & Physical Activity ProgramUniversity of British ColumbiaVancouverBCCanada
- Physical Activity and Chronic Disease Prevention UnitFaculty of EducationUniversity of British ColumbiaVancouverBCCanada
- Indigenous Physical Activity and Cultural CircleVancouverBCCanada
| | - Aaron van Donkelaar
- Department of EnergyEnvironmental & Chemical EngineeringWashington UniversitySt. LouisMOUSA
| | - Randall V. Martin
- Department of EnergyEnvironmental & Chemical EngineeringWashington UniversitySt. LouisMOUSA
| | - Perry Hystad
- College of Public Health and Human SciencesOregon State UniversityCorvallisORUSA
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12
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Norton A, Rakowska S, Galloway T, Wilson K, Rosella L, Adams M. Are at-risk sociodemographic attributes stable across COVID-19 transmission waves? Spat Spatiotemporal Epidemiol 2023; 45:100586. [PMID: 37301601 DOI: 10.1016/j.sste.2023.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/03/2023] [Accepted: 04/07/2023] [Indexed: 06/12/2023]
Abstract
COVID-19 health impacts and risks have been disproportionate across social, economic, and racial gradients (Chen et al., 2021; Thompson et al., 2021; Mamuji et al., 2021; COVID-19 and Ethnicity, 2020). By examining the first five waves of the pandemic in Ontario, we identify if Forward Sortation Area (FSAs)based measures of sociodemographic status and their relationship to COVID-19 cases are stable or vary by time. COVID-19 waves were defined using a time-series graph of COVID-19 case counts by epi-week. Percent Black visible minority, percent Southeast Asian visible minority and percent Chinese visible minority at the FSA level were then integrated into spatial error models with other established vulnerability characteristics. The models indicate that area-based sociodemographic patterns associated with COVID-19 infection change over time. If sociodemographic characteristics are identified as high risk (increased COVID-19 case rates) increased testing, public health messaging, and other preventative care may be implemented to protect populations from the inequitable burden of disease.
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Affiliation(s)
- Amanda Norton
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Scarlett Rakowska
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Tracey Galloway
- Department of Anthropology, University of Toronto Mississauga, HSC354, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Kathleen Wilson
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada
| | - Laura Rosella
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College St, Health Sciences Bldg., 6th floor, Toronto, ON M5T 3M7, Canada
| | - Matthew Adams
- Department of Geography, Geomatics & Environment, University of Toronto Mississauga, DV3284, 3359 Mississauga Road, Mississauga, ON L5L 1C6, Canada.
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Hicks LJ, Mushquash CJ, Toombs E. A national-level examination of First Nations peoples’ mental health data: Predicting mental well-being from social determinants of health using the 2017 Aboriginal Peoples Survey. Front Public Health 2023; 11:1073817. [PMID: 37064658 PMCID: PMC10102338 DOI: 10.3389/fpubh.2023.1073817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
IntroductionA history of colonization and assimilation have resulted in social, economic, and political disparities for Indigenous people in Canada. Decades of discriminatory policies (e.g., the Indian Act, the Residential School System) have led to numerous health and mental health inequities, which have been intergenerationally maintained. Four main social determinants of health (i.e., income, education, employment, and housing) disproportionately influence the health of Indigenous peoples. These four social determinants have also been used within the Community Well-Being (CWB) index, which assesses the socio-economic wellbeing of a community. This study sought to extend previous research by assessing how specific indicators of CWB predict self-reported mental wellbeing within First Nations populations across Canada in a national dataset with more recent data.MethodsThis study utilized the 2017 Aboriginal Peoples Survey, which includes data on the social and economic conditions of First Nations people living off reserve aged 15 years and over.ResultsResults from a factorial ANOVA indicated that perceptions of income security, housing satisfaction, higher education, and employment are associated with increased self-reported mental health among First Nations individuals living off-reserve.DiscussionThese results support the idea that individual mental health interventions on their own are not enough; instead, broader social interventions aimed at addressing inequities in various social determinants of health (e.g., housing first initiatives) are needed to better support individual wellbeing.
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Affiliation(s)
- Lydia J. Hicks
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Christopher J. Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
- Dilico Anishinabek Family Care, Thunder Bay, ON, Canada
- Center for Rural and Northern Health Research, Lakehead University, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Sciences Center, Lakehead University, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Research Institute, Lakehead University, Thunder Bay, ON, Canada
| | - Elaine Toombs
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
- Dilico Anishinabek Family Care, Thunder Bay, ON, Canada
- *Correspondence: Elaine Toombs,
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14
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Chan J, Griffiths K, Turner A, Tobias J, Clarmont W, Delaney G, Hutton J, Olson R, Penniment M, Bourque JM, Brundage M, Rodin D, Slotman B, Yap ML. Radiation Therapy and Indigenous Peoples in Canada and Australia: Building Paths Toward Reconciliation in Cancer Care Delivery. Int J Radiat Oncol Biol Phys 2023; 116:421-429. [PMID: 36990919 DOI: 10.1016/j.ijrobp.2022.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/17/2022] [Accepted: 09/28/2022] [Indexed: 03/29/2023]
Abstract
Indigenous peoples represent approximately 5% of the world's population and reside in over 90 countries worldwide. They embody a rich diversity of cultures, traditions, languages and relationships with the land that are shared through many generations and that are distinct from those of the settler societies within which they now live. Many Indigenous peoples have a shared experience of discrimination, trauma, and violation of rights, rooted in complex sociopolitical relationships with settler societies that are still ongoing. This results in continuing social injustices and pronounced disparities in health for many Indigenous peoples around the globe. Indigenous peoples exhibit a significantly higher cancer incidence, mortality, and poorer survival compared to non-Indigenous peoples. Cancer services, including radiotherapy, have not been designed to support the specific values and needs of Indigenous populations, resulting in poorer access to cancer services for Indigenous peoples globally across the entire cancer care spectrum. Specific to radiotherapy, available evidence demonstrates disparities in radiotherapy uptake between Indigenous and non-Indigenous patients. Radiotherapy centres are also located disparately further away from Indigenous communities. Studies are limited by a lack of Indigenous-specific data to help inform effective radiotherapy delivery. Recent Indigenous-led partnerships and initiatives have helped to address existing gaps in cancer care, and radiation oncologists play an important role in supporting such efforts. In this article, we present an overview of access to radiotherapy for Indigenous peoples in Canada and Australia, with a focus on strengthening cancer care delivery through education, partnerships, and research.
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Mendlowitz AB, Bremner KE, Feld JJ, Jones L, Hill E, Antone E, Liberty L, Boucher R, Krahn MD. Lessons from First Nations partnerships in hepatitis C research and the co-creation of knowledge. CANADIAN LIVER JOURNAL 2023; 6:46-55. [PMID: 36908573 PMCID: PMC9997512 DOI: 10.3138/canlivj-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Administrative health data provide a rich and powerful tool for health services research. Partnership between researchers and the Ontario First Nations HIV/AIDS Education Circle (OFNHAEC) allowed for comprehensive analyses of the health and economic impacts of hepatitis C virus (HCV) infection in First Nations populations across Ontario, using administrative data. Examples of meaningful involvement of First Nations partners in research using secondary data sources demonstrate how community-based participatory research principles can be adapted to empower First Nations stakeholders and decision-makers. The aim of this review is to summarize and reflect on lessons learned in producing meaningful and actionable First Nations HCV research using health administrative data, from the perspective of health services researchers who collaborated for the first time with First Nations partners. METHODS: We discuss how our relationship with OFNHAEC formed and how engagement contextualized findings and provided opportunities for fostering trust and mutual capacity building. Methods included adherence to data governance principles, agreements outlining ethical conduct, and establishing commitment between partners. RESULTS: Engagement with OFNHAEC enhanced cultural understandings in study conception, design, and analysis, and enabled meaningful lessons for both parties through contextualizing findings together. Partnership ensured attention to factors, such as strength-based approaches and limitations of administrative data in their representation of First Nations peoples, that are not considered in standard HCV health services research using administrative health data. CONCLUSIONS: Collaboration throughout the HCV research provided first-hand experience of the relevance, representation, and importance of incorporating First Nations perspectives in health services research using administrative data.
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Affiliation(s)
- Andrew B Mendlowitz
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), Toronto General Hospital, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), Toronto General Hospital, Toronto, Ontario, Canada
| | - Lyndia Jones
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Evelynne Hill
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Elly Antone
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Laura Liberty
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Rene Boucher
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Deceased 01 07 22
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16
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Rusk AM, Kanj AN, Murad MH, Hassett LC, Kennedy CC. Smoking Cessation Interventions in Indigenous North Americans: A Meta-Narrative Systematic Review. Nicotine Tob Res 2023; 25:3-11. [PMID: 35869642 PMCID: PMC9717368 DOI: 10.1093/ntr/ntac181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Indigenous North Americans have the highest cigarette smoking prevalence among all racial and ethnic groups in the United States. We seek to identify effective components of smoking cessation interventions in Indigenous people in the United States associated with favorable cessation outcomes. METHODS A review of literature studying smoking cessation interventions in Indigenous North Americans (American Indians and Alaska Natives) from January 2010 through August 2021 was completed. The primary objective of this study was to identify components of interventions associated with positive smoking cessation outcomes in Indigenous people. The studies identified were synthesized in a meta-narrative approach. RESULTS Ten studies out of 608 titles were included (6 randomized trials, 2 single-arm studies, 1 cohort study, and 1 prospective observational study). Five categories of smoking cessation interventions were identified; phone or web-based tools, culturally-tailored interventions, the inclusion of Indigenous study personnel, pharmaceutical cessation aids, and behavioral health interventions. Phone and web tools, cultural tailoring, and inclusion of Indigenous personnel conditions inconsistently influenced smoking cessation. Pharmaceutical aids were viewed favorably among participants. Individualized behavioral counseling sessions were effective at promoting smoking cessation, as was input from local communities in the planning and implementation phases of study. CONCLUSION A successful smoking cessation intervention in Indigenous North Americans includes Tribal or community input in intervention design and implementation; should provide individualized counseling sessions for participants, and offer access to validated smoking cessation tools including pharmacotherapy. IMPLICATIONS This study identifies a paucity of smoking interventions utilizing standard of care interventions in Indigenous North Americans. Standard of care interventions including individualized cessation counseling and pharmacotherapy were effective at promoting cessation. The use of novel culturally tailored cessation interventions was not more effective than existing evidence-based care with the exception of including Tribal and local community input in intervention implementation. Future smoking cessation interventions in Indigenous North Americans should prioritize the use of standard of care cessation interventions.
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Affiliation(s)
- Ann M Rusk
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
- Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN, USA
| | - Amjad N Kanj
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN, USA
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA
- Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN, USA
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17
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Panofsky S, Buchanan MJ, Wilat (Susan Alfred) TZ, Madeek (Jeffrey Brown) DZ, Neekupdeh (Daren George) DZ, Smogelgem (Warner Naziel) DZ, Woodman G, Brown T, Lewis R, We’es Tes (Sandra Harris) TZ, Wilawhl (Lorraine Naziel) TZ, Dumont J, Andrew J, Ferguson A, Hare J, John R. The Wet’suwet’en Nation’s Mobilization of Indigenous Focusing Oriented Therapy: An Exploratory Study. COUNSELING PSYCHOLOGIST 2022. [DOI: 10.1177/00110000221146571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Indigenous mental health research is beginning to address colonization, however, Indigenous approaches to wellness have largely been overlooked. There is a paucity of research exploring psychological trauma interventions with Indigenous peoples. The Wet’suwet’en hereditary chiefs recognize the profound impacts of historical trauma among their people and are utilizing Indigenous focusing oriented therapy (IFOT), a trauma model that is collective, land-based, and intergenerational, as a part of their wellness framework. This collaborative research study explored the question: How is IFOT shaped by Wet’suwet’en ways of knowing and mobilized by individuals, families, house groups, and the Nation? Wet’suwet’en IFOT practitioners participated in sharing circles for data collection and interpretation. The exploratory findings revealed that the strategic application of IFOT by Wet’suwet’en hereditary chiefs created a culturally relevant model for land-based healing wherein Wet’suwet’en people were able to experience greater connection with their own yintah (land) and c’idede’ (history).
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Affiliation(s)
- Sarah Panofsky
- Department of Educational and Counselling Psychology and Special Education, The University of British Columbia, Vancouver, BC, Canada
| | - Marla J. Buchanan
- Department of Educational and Counselling Psychology and Special Education, The University of British Columbia, Vancouver, BC, Canada
| | - Ts’akë ze’ Wilat (Susan Alfred)
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | - Dinï ze’ Madeek (Jeffrey Brown)
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | - Dinï ze’ Neekupdeh (Daren George)
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | | | - Gretchen Woodman
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | - Tanya Brown
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | - Russell Lewis
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | | | | | - Jeremy Dumont
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | - Jolene Andrew
- Department of Educational and Counselling Psychology and Special Education, Wet’suwet’en Nation (Office of the Wet’suwet’en), Canada
| | - Alanaise Ferguson
- Department of Educational and Counselling Psychology and Special Education, Simon Fraser University, Burnaby, BC, Canada
| | - Jan Hare
- Department of Educational and Counselling Psychology and Special Education, The University of British Columbia, Vancouver, BC, Canada
| | - Roger John
- Department of Educational and Counselling Psychology and Special Education, The University of British Columbia, Vancouver, BC, Canada
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Moorthie S, Peacey V, Evans S, Phillips V, Roman-Urrestarazu A, Brayne C, Lafortune L. A Scoping Review of Approaches to Improving Quality of Data Relating to Health Inequalities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15874. [PMID: 36497947 PMCID: PMC9740714 DOI: 10.3390/ijerph192315874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Identifying and monitoring of health inequalities requires good-quality data. The aim of this work is to systematically review the evidence base on approaches taken within the healthcare context to improve the quality of data for the identification and monitoring of health inequalities and describe the evidence base on the effectiveness of such approaches or recommendations. Peer-reviewed scientific journal publications, as well as grey literature, were included in this review if they described approaches and/or made recommendations to improve data quality relating to the identification and monitoring of health inequalities. A thematic analysis was undertaken of included papers to identify themes, and a narrative synthesis approach was used to summarise findings. Fifty-seven papers were included describing a variety of approaches. These approaches were grouped under four themes: policy and legislation, wider actions that enable implementation of policies, data collection instruments and systems, and methodological approaches. Our findings indicate that a variety of mechanisms can be used to improve the quality of data on health inequalities at different stages (prior to, during, and after data collection). These findings can inform us of actions that can be taken by those working in local health and care services on approaches to improving the quality of data on health inequalities.
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Affiliation(s)
- Sowmiya Moorthie
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
| | - Vicki Peacey
- Cambridgeshire County Council, Alconbury, Huntingdon PE28 4YE, UK
| | - Sian Evans
- Local Knowledge Intelligence Service (LKIS) East, Office for Health Improvements and Disparities, UK
| | - Veronica Phillips
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
| | - Andres Roman-Urrestarazu
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
| | - Carol Brayne
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
| | - Louise Lafortune
- Cambridge Public Health, Interdisciplinary Research Centre, University of Cambridge, Cambridge CB2 OSZ, UK
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Stewart M, Ryu H, Blaque E, Hassan A, Anand P, Gómez-Ramirez O, MacKinnon KR, Worthington C, Gilbert M, Grace D. Cisnormativity as a structural barrier to STI testing for trans masculine, two-spirit, and non-binary people who are gay, bisexual, or have sex with men. PLoS One 2022; 17:e0277315. [PMID: 36441729 PMCID: PMC9704602 DOI: 10.1371/journal.pone.0277315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/24/2022] [Indexed: 11/30/2022] Open
Abstract
Trans masculine, two-spirit, and non-binary people who are gay, bisexual or otherwise have sex with men (TGBM) are under-tested for sexually transmitted infections (STI) and may face complex, intersectional barriers that prevent them from accessing STI testing. As part of a study on gay, bisexual and other men who have sex with men's (GBM) experiences of current STI testing systems in Ontario, Canada, this paper reports on the findings from TGBM participants' experiences with in-person STI testing in a range of venues (i.e. Family doctors, walk-in clinics, and community-based organizations) to explore testing barriers specific to TGBM. Using a community-based research approach, between June 2020 and December 2021 peer researchers who identified as GBM conducted focus groups and interviews with 38 cis and trans GBM, 13 of whom identified as TGBM. Data were analyzed following grounded theory. When questioned about past experiences with testing, TGBM participants reported several barriers to STI testing within current testing models in Ontario due to cisnormativity and heteronormativity. Cisnormativity is the assumption that everyone identifies as the gender they were assigned at birth, and those who do not are considered "abnormal", while heteronormativity is when it is assumed that everyone is heterosexual. From our research we identified three overarching themes concerning testing barriers among TGBM participants: (1) non-inclusive clinic environments, (2) lack of provider knowledge and competency, and (3) legal documentation. Inherent cis and heteronormativity in healthcare institutions appear to be factors shaping the historical under-testing for STI in the TGBM population. These findings suggest the relevance of implementing trans-specific clinical practices that reduce the stigma and barriers faced by TGBM in STI testing contexts, including: hosting all-gender testing hours, opening more LGBTQ+ clinics, offering training in transgender health to testing providers, and conducting a review of how gender markers on health documents can be more inclusive of trans, two-spirit, and non-binary communities.
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Affiliation(s)
- Mackenzie Stewart
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Heeho Ryu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ezra Blaque
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Abdi Hassan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Praney Anand
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Oralia Gómez-Ramirez
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | | | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Mark Gilbert
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Rusk AM, Giblon RE, Chamberlain AM, Patten CA, Felzer JR, Bui YT, Wi CI, Destephano CC, Abbott BA, Kennedy CC. Indigenous Smoking Behaviors in Olmsted County, Minnesota: A Longitudinal Population-Based Study. Mayo Clin Proc 2022; 97:1836-1848. [PMID: 36202495 PMCID: PMC9918799 DOI: 10.1016/j.mayocp.2022.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe smoking behaviors and pharmaceutical cessation aid uptake in a population-based Indigenous cohort compared with an age- and sex-matched non-Indigenous cohort. PATIENTS AND METHODS Using the health record-linkage system of the Rochester Epidemiology Project (January 1, 2006, to December 31, 2019), smoking data of Indigenous residents of Olmsted County in Minnesota were abstracted to define the smoking prevalence, incidence, cessation, relapse after cessation, and pharmaceutical smoking cessation aid uptake compared with a matched non-Indigenous cohort. Prevalence was analyzed with a modified Poisson regression; cessation and relapse were evaluated with generalized estimating equations. Incidence was evaluated with a Cox proportional hazards model. RESULTS Smoking prevalence was higher in the Indigenous cohort (39.0% to 47.0%; n=898) than the matched cohort (25.6% to 30.3%; n=1780). Pharmaceutical uptake was higher among the Indigenous cohort (35.8% of n=584 ever smokers vs 16.3% of n=778 ever smokers; P<.001). Smoking cessation events occurred more frequently in the Indigenous cohort (relative risk, 1.10; 95% CI, 1.06 to 1.13; P<.001). Indigenous former smokers were more likely to resume smoking (relative risk, 3.03; 95% CI, 2.93 to 3.14; P<.001) compared with the matched cohort. These findings were independent of socioeconomic status, age, and sex. CONCLUSION Smoking in this Indigenous cohort was more prevalent compared with a sex- and age-matched non-Indigenous cohort despite more smoking cessation events and higher use of smoking cessation aids in the Indigenous cohort. The relapse rate after achieving cessation in the Indigenous cohort was more than three times higher than the non-Indigenous cohort. This finding has not been previously described and represents a potential target for relapse prevention efforts in US Indigenous populations.
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Affiliation(s)
- Ann M Rusk
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN
| | - Rachel E Giblon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christi A Patten
- Division of Behavioral Health Research, Mayo Clinic, Rochester, MN, USA
| | - Jamie R Felzer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN
| | - Yvonne T Bui
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher C Destephano
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Obstetrics and Gynecology, Mayo Clinic, Jacksonville, FL, USA
| | - Barbara A Abbott
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Respiratory Health Equity Clinical Research Laboratory at Mayo Clinic, Rochester, MN.
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Santos JDM, Fowler S, Jennings D, Brass C, Porter L, Porter R, Sanderson R, Peña-Sánchez JN. Health care utilization differences between First Nations people and the general population with inflammatory bowel disease: a retrospective cohort study from Saskatchewan, Canada. CMAJ Open 2022; 10:E964-E970. [PMID: 36319027 PMCID: PMC9633056 DOI: 10.9778/cmajo.20220118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Indigenous people in Canada often face barriers to access specialized care, with limited data in evaluating health care utilization among Indigenous people with inflammatory bowel disease (IBD). We aimed to compare health care utilization between First Nations patients and those in the general population diagnosed with IBD in Saskatchewan. METHODS We conducted a patient-oriented, population-based, retrospective cohort study by linking administrative health databases of Saskatchewan between fiscal years 1998/99 and 2017/18. We designed and completed this study in partnership with Indigenous patients and family advocates. We applied a validated algorithm to identify IBD incident cases and then used the self-declared First Nations status variable to divide those cases. We applied a 1:5 ratio for age and sex matching and used Cox proportional models to assess associations. Hazard ratios (HRs) and 95% confidence intervals (CIs) were reported. RESULTS We created a matched cohort with 696 IBD incident cases: 116 First Nations patients and 580 patients in the general population. We observed differences between the groups for IBD-specific hospital admissions (HR 1.33, 95% CI 1.01-1.75), IBD-related hospital admissions (HR 1.55, 95% CI 1.20-2.01), medication claims for IBD (HR 0.52, 95% CI 0.41-0.65) and 5-aminosalicylic acid claims (HR 0.56, 95% CI 0.45-0.71) adjusting by rural or urban residence and diagnosis type. There were no significant differences in the hazard rate of outpatient gastroenterology visits (HR 1.13, 95% CI 0.90-1.41), colonoscopies (HR 1.14, 95% CI 0.92-1.41) and surgeries for IBD (HR 1.14, 95% CI 0.80-1.64). INTERPRETATION We identified that First Nations patients diagnosed with IBD had a higher rate of hospital admissions owing to IBD than patients in the general population diagnosed with IBD. We also found an inverse association between First Nations status and having prescription medication claims for IBD.
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Affiliation(s)
- José Diego Marques Santos
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Sharyle Fowler
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Derek Jennings
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Colten Brass
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Linda Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Robert Porter
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Rhonda Sanderson
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask
| | - Juan Nicolás Peña-Sánchez
- Departments of Community Health and Epidemiology (Marques Santos, Peña-Sánchez), and Medicine (Fowler), University Saskatchewan, Saskatoon, Sask.; Sac and Fox (Jennings), Quapaw Nation, Quapaw, Okla.; School of Public Health (Jennings), University of Washington, Seattle, Wash.; Muskoday First Nation (Brass), Muskoday, Sask.; One Arrow First Nation (L. Porter), Saskatoon, Sask.; York Factory First Nation (R. Porter), Landing, Man.; James Smith Cree Nation (Sanderson), Kinistino, Sask.
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Smylie J, McConkey S, Rachlis B, Avery L, Mecredy G, Brar R, Bourgeois C, Dokis B, Vandevenne S, Rotondi MA. Uncovering SARS-COV-2 vaccine uptake and COVID-19 impacts among First Nations, Inuit and Métis Peoples living in Toronto and London, Ontario. CMAJ 2022; 194:E1018-E1026. [PMID: 35918087 PMCID: PMC9481260 DOI: 10.1503/cmaj.212147] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background: First Nations, Inuit and Métis Peoples across geographies are at higher risk of SARS-CoV-2 infection and COVID-19 because of high rates of chronic disease, inadequate housing and barriers to accessing health services. Most Indigenous Peoples in Canada live in cities, where SARS-CoV-2 infection is concentrated. To address gaps in SARS-CoV-2 information for these urban populations, we partnered with Indigenous agencies and sought to generate rates of SARS-CoV-2 testing and vaccination, and incidence of infection for First Nations, Inuit and Métis living in 2 Ontario cities. Methods: We drew on existing cohorts of First Nations, Inuit and Métis adults in Toronto (n = 723) and London (n = 364), Ontario, who were recruited using respondent-driven sampling. We linked to ICES SARS-CoV-2 databases and prospectively monitored rates of SARS-CoV-2 testing, diagnosis and vaccination for First Nations, Inuit and Métis, and comparator city and Ontario populations. Results: We found that SARS-CoV-2 testing rates among First Nations, Inuit and Métis were higher in Toronto (54.7%, 95% confidence interval [CI] 48.1% to 61.3%) and similar in London (44.5%, 95% CI 36.0% to 53.1%) compared with local and provincial rates. We determined that cumulative incidence of SARS-CoV-2 infection was not significantly different among First Nations, Inuit and Métis in Toronto (7364/100 000, 95% CI 2882 to 11 847) or London (7707/100 000, 95% CI 2215 to 13 200) compared with city rates. We found that rates of vaccination among First Nations, Inuit and Métis in Toronto (58.2%, 95% CI 51.4% to 64.9%) and London (61.5%, 95% CI 52.9% to 70.0%) were lower than the rates for the 2 cities and Ontario. Interpretation: Although Ontario government policies prioritized Indigenous populations for SARS-CoV-2 vaccination, vaccine uptake was lower than in the general population for First Nations, Inuit and Métis Peoples in Toronto and London. Ongoing access to culturally safe testing and vaccinations is urgently required to avoid disproportionate hospital admisson and mortality related to COVID-19 in these communities.
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Affiliation(s)
- Janet Smylie
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont.
| | - Stephanie McConkey
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Beth Rachlis
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Lisa Avery
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Graham Mecredy
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Raman Brar
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Cheryllee Bourgeois
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Brian Dokis
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Stephanie Vandevenne
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
| | - Michael A Rotondi
- Well Living House (Smylie, McConkey, Brar), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie, McConkey, Rachlis, Avery), University of Toronto; ICES (Smylie, Rachlis, Mecredy); Princess Margaret Cancer Centre (Avery), University Health Network; Seventh Generations Midwives Toronto (Bourgeois); Call Auntie Clinic (Bourgeois); School of Kinesiology and Health Science (Rotondi), York University, Toronto, Ont.; Southwest Ontario Aboriginal Health Access Centre (Dokis, Vandevenne), London, Ont
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Kassim SA, Gartner JB, Labbé L, Landa P, Paquet C, Bergeron F, Lemaire C, Côté A. Benefits and limitations of business process model notation in modelling patient healthcare trajectory: a scoping review protocol. BMJ Open 2022; 12:e060357. [PMID: 35636803 PMCID: PMC9152926 DOI: 10.1136/bmjopen-2021-060357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The adoption of business process model notation (BPMN) in modelling healthcare trajectory can enhance the efficiency and efficacy of healthcare organisations, improve patient outcomes while restraining costs. Existing systematic reviews have been inconclusive regarding the effectiveness of BPMN in modelling healthcare trajectory. The aims of this scoping review are to map and aggregate existing evidence on the benefits and limitations associated with BPMN in healthcare trajectory, highlighting areas of improvement on BPMN and its extensions in healthcare. We will assess BPMN's ability to model key dimensions or concepts of the healthcare process and to meet the needs of stakeholders. The review will highlight the advantages of this approach to support clinical activities and decision-making processes associated with the healthcare trajectory, proposing a conceptual framework for improving the use of BPMN in healthcare. METHODS AND ANALYSIS This study will be performed in accordance with the methodological framework suggested by Arksey and O'Malley. A wide range of electronic databases and grey literature sources will be systematically searched using predefined keywords. The review will include any study design focusing on the application of the BPMN approach for optimising healthcare trajectories, published in either English or French from 1 January 2004 to 9 December 2021. Two reviewers will independently screen titles, abstracts and full-text articles and select articles meeting the inclusion criteria. A customised data extraction form will be used to extract data. The results will be presented using descriptive statistics and thematic analysis on qualitative data. ETHICS AND DISSEMINATION Research ethics approval is not required. Review findings will be used to advance understanding about BPMN, its extensions and application in healthcare trajectory optimisation. The review will develop recommendations on tailoring BPMN strategies for optimising care pathways and decision-making processes. Findings will be disseminated in peer-reviewed journals, conferences and discussions with relevant organisations and stakeholders.
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Affiliation(s)
- Said Abasse Kassim
- Département de management, Faculté des sciences de l'administration, Universite Laval, Quebec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- VITAM Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Jean-Baptiste Gartner
- Département de management, Faculté des sciences de l'administration, Universite Laval, Quebec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- VITAM Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, CISSS de Chaudière-Appalaches, Québec, QC, Canada
| | - Laurence Labbé
- Département de management, Faculté des sciences de l'administration, Universite Laval, Quebec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec, QC, Canada
| | - Paolo Landa
- Département d'opérations et systèmes de décision, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- Centre de Recherche CHU de Québec, Université Laval, Québec, QC, Canada
| | - Catherine Paquet
- Centre de Recherche CHU de Québec, Université Laval, Québec, QC, Canada
- Département de Marketing, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
- Centre Nutrition, santé et société (NUTRISS), INAF, Université Laval, Québec, QC, Canada
| | - Frédéric Bergeron
- Bibliothèque, Direction des services-conseils, Université Laval, Québec, QC, Canada
| | - Célia Lemaire
- Laboratoire Humanis, EM Strasbourg-Business School, Université de Strasbourg, Strasbourg, France
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Universite Laval, Quebec, QC, Canada
- Centre de recherche en gestion des services de santé, Université Laval, Quebec, QC, Canada
- Centre de recherche du CHU de Québec, Université Laval, Québec, QC, Canada
- VITAM Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Centre de recherche du CISSS de Chaudière-Appalaches, CISSS de Chaudière-Appalaches, Québec, QC, Canada
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Bowker SL, Williams K, Wingert A, Boyd JM, Potestio ML, Gates M, Wright E, Bagshaw SM. Incidence and outcomes of critical illness in Indigenous Peoples: a systematic review protocol. Syst Rev 2022; 11:65. [PMID: 35418109 PMCID: PMC9006439 DOI: 10.1186/s13643-022-01948-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous Peoples experience health inequities across the continuum of health services. Improvements for Indigenous patients and their families during vulnerable experiences with the healthcare system may have a significant impact on the patient experience and outcomes. Improved understanding of the occurrence of critical illness in Indigenous Peoples and their use of critical care services, as a strategic priority, may aid in the development of initiatives for improving health equity. A global focus was selected to learn from Indigenous populations' experiences with critical care, as the understanding of critical illness among Indigenous Peoples in Canada is not well understood. This protocol outlines a systematic review focused on describing the incidence of critical illness and utilization of critical care services among Indigenous Peoples. METHODS Ovid MEDLINE/PubMed, Ovid EMBASE, Google Scholar, and Cochrane Central Register of Controlled Trials will be searched. Relevant Canadian sites for gray literature (National Collaborating Centre for Indigenous Health, First Nations Health Authority, Canadian Institutes of Health Research Institute of Indigenous Peoples' Health, National Association of Friendship Centres, the Alberta First Nations Information Governance Centre, Métis Nation of Alberta) will also be searched. We will include studies of adults (≥18 years) either without critical illness (i.e., general population) or with critical illness (i.e., admitted to an intensive care unit (ICU)). The exposure of interest will be Indigenous identity. Primary outcome measures are ICU admission and ICU mortality. Because heterogeneity in populations, comparisons, and outcome measures is anticipated, it is likely that the findings will be summarized using a narrative synthesis. A meta-analysis will be performed if there is sufficient evidence on one or more outcomes of interest. DISCUSSION This systematic review will provide a better understanding of the epidemiology, risk factors, and outcomes of critical illness and utilization of critical care services among Indigenous Peoples. The knowledge generated will be applied to a broader program of work designed to create ethical space to co-design, implement, and evaluate a culturally competent, safe, and innovative model for critical care services for Indigenous People. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021254661.
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Affiliation(s)
- Samantha L Bowker
- Critical Care Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada.,Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G2B7, Canada
| | - Kienan Williams
- Indigenous Wellness Core™, Alberta Health Services, Calgary, AB, Canada
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, University of Alberta, 4-486C Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Jamie M Boyd
- Indigenous Wellness Core™, Alberta Health Services, Calgary, AB, Canada
| | | | - Michelle Gates
- Alberta Research Centre for Health Evidence, University of Alberta, 4-486C Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Erica Wright
- Alberta Research Centre for Health Evidence, University of Alberta, 4-486C Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Sean M Bagshaw
- Critical Care Strategic Clinical Network™, Alberta Health Services, Edmonton, AB, Canada. .,Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G2B7, Canada.
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25
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Sergeant A, Saha S, Lalwani A, Sergeant A, McNair A, Larrazabal E, Yang K, Bogler O, Dhoot A, Werb D, Maghsoudi N, Richardson L, Hawker G, Siddiqi A, Verma A, Razak F. Diversity among health care leaders in Canada: a cross-sectional study of perceived gender and race. CMAJ 2022; 194:E371-E377. [PMID: 35288408 PMCID: PMC8920524 DOI: 10.1503/cmaj.211340] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Diverse health care leadership teams may improve health care experiences and outcomes for patients. We sought to explore the race and gender of hospital and health ministry executives in Canada and compare their diversity with that of the populations they serve. METHODS This cross-sectional study included leaders of Canada's largest hospitals and all provincial and territorial health ministries. We included individuals listed on institutional websites as part of the leadership team if a name and photo were available. Six reviewers coded and analyzed the perceived race and gender of leaders, in duplicate. We compared the proportion of racialized health care leaders with the race demographics of the general population from the 2016 Canadian Census. RESULTS We included 3056 leaders from 135 institutions, with reviewer concordance on gender for 3022 leaders and on race for 2946 leaders. Reviewers perceived 37 (47.4%) of 78 health ministry leaders as women, and fewer than 5 (< 7%) of 80 as racialized. In Alberta, Saskatchewan, Prince Edward Island and Nova Scotia, provinces with a centralized hospital executive team, reviewers coded 36 (50.0%) of 72 leaders as women and 5 (7.1%) of 70 as racialized. In British Columbia, New Brunswick and Newfoundland and Labrador, provinces with hospital leadership by region, reviewers perceived 120 (56.1%) of 214 leaders as women and 24 (11.5%) of 209 as racialized. In Manitoba, Ontario and Quebec, where leadership teams exist at each hospital, reviewers perceived 1326 (49.9%) of 2658 leaders as women and 243 (9.2%) of 2633 as racialized. We calculated the representation gap between racialized executives and the racialized population as 14.5% for British Columbia, 27.5% for Manitoba, 20.7% for Ontario, 12.4% for Quebec, 7.6% for New Brunswick, 7.3% for Prince Edward Island and 11.6% for Newfoundland and Labrador. INTERPRETATION In a study of more than 3000 health care leaders in Canada, gender parity was present, but racialized executives were substantially under-represented. This work should prompt health care institutions to increase racial diversity in leadership.
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Affiliation(s)
- Anjali Sergeant
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Sudipta Saha
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Anushka Lalwani
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Anand Sergeant
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Avery McNair
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Elias Larrazabal
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Kelsey Yang
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Orly Bogler
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Arti Dhoot
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Dan Werb
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Nazlee Maghsoudi
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Lisa Richardson
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Gillian Hawker
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Arjumand Siddiqi
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Amol Verma
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont
| | - Fahad Razak
- Faculty of Health Sciences (Anjali Sergeant), McMaster University, Hamilton, Ont.; Li Ka Shing Knowledge Institute (Saha, Lalwani, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Schulich School of Medicine & Dentistry (Anand Sergeant), Western University, London, Ont.; School of Population and Public Health (McNair), University of British Columbia, Vancouver, BC; Arts and Science Program (Larrazabal), McMaster University, Hamilton, Ont.; Temerty Faculty of Medicine (Yang, Bogler, Dhoot, Richardson, Verma, Razak), University of Toronto; Centre on Drug Policy Evaluation (Werb), Unity Health Toronto, Toronto, Ont.; Division of Infectious Diseases and Public Health (Werb), University of San Diego, La Jolla, Calif.; Centre on Drug Policy Evaluation (Maghsoudi), Unity Health Toronto; Institute of Health Policy, Management and Evaluation (Maghsoudi), University of Toronto; Department of Medicine (Richardson, Hawker), University of Toronto; Dalla Lana School of Public Health (Siddiqi), University of Toronto, Toronto, Ont.
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Understanding Social Determinants of First Nations Health Using a Four-Domain Model of Health and Wellness Based on the Medicine Wheel: Findings from a Community Survey in One First Nation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052836. [PMID: 35270529 PMCID: PMC8910369 DOI: 10.3390/ijerph19052836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
We examined the explanatory roles of social determinants of health (SDOH) for First Nations people using a four-domain model of health and wellness based on the Medicine Wheel (i.e., physical, mental, emotional, and spiritual health), including colonial-linked stressors (i.e., historical trauma, childhood adversities, racial discrimination) and cultural resilience factors (i.e., cultural strengths, traditional healing practices, social support). Data were collected in partnership with a First Nation in Ontario, Canada in 2013 through a community survey (n = 194). For each outcome (physical, mental, emotional, and spiritual health), a modified Poisson regression model estimated prevalence ratios for the SDOH, adjusting for age, sex, education, and marital status. Negative associations were found for historical trauma with physical, mental, emotional, and spiritual health; for childhood adversities with mental health; and for racial discrimination with physical, mental, and emotional health. Positive associations were found for cultural strengths with physical, mental, and emotional health and for social support with physical, mental, emotional, and spiritual health. We observed negative associations between use of traditional healing practices and mental and emotional health. Our findings suggest that these SDOH may play important roles in relation to wellness through associations with the domains of health modelled by the Medicine Wheel.
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Patterson KA, Yang S, Sargeant J, Lwasa S, Berrang-Ford L, Kesande C, Communities B, Twesigomwe S, Anyango Rhoda J, Nkalubo J, Harper SL. Socio-demographic associations with pregnancy loss among Bakiga and Indigenous Batwa women in Southwestern Uganda. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100700. [DOI: 10.1016/j.srhc.2022.100700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/02/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022]
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McLane P, Barnabe C, Mackey L, Bill L, Rittenbach K, Holroyd BR, Bird A, Healy B, Janvier K, Louis E, Rosychuk RJ. First Nations status and emergency department triage scores in Alberta: a retrospective cohort study. CMAJ 2022; 194:E37-E45. [PMID: 35039386 PMCID: PMC8900783 DOI: 10.1503/cmaj.210779] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies have found that race is associated with emergency department triage scores, raising concerns about potential health care inequity. As part of a project on quality of care for First Nations people in Alberta, we sought to understand the relation between First Nations status and triage scores. METHODS We conducted a population-based retrospective cohort study of health administrative data from April 2012 to March 2017 to evaluate acuity of triage scores, categorized as a binary outcome of higher or lower acuity score. We developed multivariable multilevel logistic mixed-effects regression models using the levels of emergency department visit, patient (for patients with multiple visits) and facility. We further evaluated the triage of visits related to 5 disease categories and 5 specific diagnoses to better compare triage outcomes of First Nations and non-First Nations patients. RESULTS First Nations status was associated with lower odds of receiving higher acuity triage scores (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.92-0.94) compared with non-First Nations patients in adjusted models. First Nations patients had lower odds of acute triage for all 5 disease categories and for 3 of 5 diagnoses, including long bone fractures (OR 0.82, 95% CI 0.76-0.88), acute upper respiratory infection (OR 0.90, 95% CI 0.84-0.98) and anxiety disorder (OR 0.67, 95% CI 0.60-0.74). INTERPRETATION First Nations status was associated with lower odds of higher acuity triage scores across a number of conditions and diagnoses. This may reflect systemic racism, stereotyping and potentially other factors that affected triage assessments.
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Affiliation(s)
- Patrick McLane
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta.
| | - Cheryl Barnabe
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Leslee Mackey
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Lea Bill
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Katherine Rittenbach
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Brian R Holroyd
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Anne Bird
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Bonnie Healy
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Kris Janvier
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Eunice Louis
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
| | - Rhonda J Rosychuk
- Alberta Health Services (McLane, Rittenbach, Holroyd), Strategic Clinical Networks; Department of Emergency Medicine (McLane, Mackey, Holroyd), University of Alberta, Edmonton, Alta.; Departments of Medicine and of Community Health Sciences (Barnabe) University of Calgary; Alberta First Nations Information Governance Centre (Bill); Department of Psychiatry (Rittenbach), University of Calgary, Calgary, Alta.; Department of Psychiatry (Rittenbach), University of Alberta, Edmonton, Alta.; Yellowhead Tribal Council (Bird), Edmonton, Alta.; Blackfoot Confederacy Tribal Council (Healy), Standoff, Alta.; Organization of Treaty 8 First Nations of Alberta (Janvier), Edmonton, Alta.; Maskwacis Health Services (Louis), Maskwacis, Alta.; Department of Pediatrics (Rosychuk), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alta
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Katz A, Urquia ML, Star L, Lavoie JG, Taylor C, Chateau D, Enns JE, Tait MJ, Burchill C. Changes in health indicator gaps between First Nations and other residents of Manitoba. CMAJ 2021; 193:E1830-E1835. [PMID: 34872954 PMCID: PMC8648361 DOI: 10.1503/cmaj.210201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/06/2022] Open
Abstract
Background: The Truth and Reconciliation Commission of Canada has called for better reporting of health disparities between First Nations people and other Canadians to close gaps in health outcomes. We sought to evaluate changes in these disparities using indicators of health and health care use over the last 2 decades. Methods: We used linked, whole-population, administrative claims data from the Manitoba Centre for Health Policy for fiscal years 1994/95 to 1998/99 and 2012/13 to 2016/17. We measured indicators of health and health care use among registered First Nations and all other Manitobans, and compared differences between these groups over the 2 time periods. Results: Over time, the relative gap between First Nations and all other Manitobans widened by 51% (95% confidence interval [CI] 42% to 60%) for premature mortality rate. For potential years of life lost, the gap widened by 54% (95% CI 51% to 57%) among women and by 32% (95% CI 30% to 35%) among men. The absolute gap in life expectancy widened by 3.14 years (95% CI 2.92 to 3.36) among men and 3.61 years (95% CI 3.38 to 3.84) among women. Relative gaps widened by 20% (95% CI 12% to 27%) for ambulatory specialist visits, by 14% (95% CI 12% to 16%) for hospital separations and by 50% (95% CI 39% to 62%) for days spent in hospital, but narrowed by 33% (95% CI −36% to −30%) for ambulatory primary care visits, by 22% (95% CI −27% to −16%) for mammography and by 27% (95% CI −40% to −23%) for injury hospitalizations. Interpretation: Disparities between First Nations and all other Manitobans in many key indicators of health and health care use have grown larger over time. New approaches are needed to address these disparities and promote better health with and for First Nations.
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Affiliation(s)
- Alan Katz
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta.
| | - Marcelo L Urquia
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Leona Star
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Josée G Lavoie
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Carole Taylor
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Dan Chateau
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Jennifer E Enns
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Myra J Tait
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
| | - Charles Burchill
- Manitoba Centre for Health Policy (Katz, Urquia, Taylor, Chateau, Enns, Burchill) and Family Medicine (Katz), Departments of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba; First Nations Health and Social Secretariat of Manitoba (Star); Department of Community Health Sciences (Lavoie), Ongomiizwin Research, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Faculty of Humanities & Social Sciences, Governance, Law and Management (Tait), Athabasca University, Athabasca, Alta
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Patterson K, Sargeant J, Yang S, McGuire-Adams T, Berrang-Ford L, Lwasa S, Communities B, Steele V, Harper SL. Are Indigenous research principles incorporated into maternal health research? A scoping review of the global literature. Soc Sci Med 2021; 292:114629. [PMID: 34896728 DOI: 10.1016/j.socscimed.2021.114629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 11/05/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Indigenous women world-wide are diverse and heterogenous, yet many have similar experiences of colonization, land dispossession, and discrimination. These experiences along with inequitable access to, and quality of, maternal healthcare increase adverse maternal health outcomes. To improve health outcomes for Indigenous women, studies must be conducted with Indigenous involvement and reflect Indigenous research principles. Objectives/Aim: The aim of this review was to explore the range, extent, and nature of Indigenous maternal health research and to assess the reporting of Indigenous research principles in the global Indigenous maternal health literature. METHODS Following a systematic scoping review protocol, four scholarly electronic databases were searched. Articles were included if they reported empirical research published between 2000 and 2019 and had a focus on Indigenous maternal health. Descriptive data were extracted from relevant articles and descriptive analysis was conducted. Included articles were also assessed for reporting of Indigenous research principles, including Indigenous involvement, context of colonization, Indigenous conceptualizations of health, community benefits, knowledge dissemination to participants or communities, and policy or intervention recommendations. RESULTS Four-hundred and forty-one articles met the inclusion criteria. While studies were conducted in all continents except Antarctica, less than 3% of articles described research in low-income countries. The most researched topics were access to and quality of maternity care (25%), pregnancy outcome and/or complications (18%), and smoking, alcohol and/or drug use during pregnancy (14%). The most common study design was cross-sectional (49%), and the majority of articles used quantitative methods only (68%). Less than 2% of articles described or reported all Indigenous research principles, and 71% of articles did not report on Indigenous People's involvement. CONCLUSIONS By summarizing the trends in published literature on Indigenous maternal health, we highlight the need for increased geographic representation of Indigenous women, expansion of research to include important but under-researched topics, and meaningful involvement of Indigenous Peoples.
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Affiliation(s)
- Kaitlin Patterson
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Jan Sargeant
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, Purvis Hall, McGill University, 1020 Pine Avenue West, Montreal, Quebec, H3A 1A2, Canada.
| | - Tricia McGuire-Adams
- Faculty of Education, University of Ottawa, 145 Jean-Jacques-Lussier Private, Ottawa, Ontario, K1N 6N5, Canada
| | - Lea Berrang-Ford
- Priestley International Centre for Climate, University of Leeds, Leeds, LS2 9JT, United Kingdom.
| | - Shuaib Lwasa
- Department of Geography, Geo-Informatics and Climatic Sciences, School of Forestry, Environmental and Geographical Sciences, College of Agricultural and Environmental Sciences, Makerere University, Arts Building, South Wing Ground Floor, P.O Box, 7062, Kampala, Uganda.
| | | | - Vivienne Steele
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada; School of Public Health, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada.
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DECOLONIZING CANCER CARE IN CANADA. J Cancer Policy 2021; 30:100309. [DOI: 10.1016/j.jcpo.2021.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
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Goodyear T, Slemon A, Richardson C, Gadermann A, Salway T, Dhari S, Knight R, Jenkins E. Increases in Alcohol and Cannabis Use Associated with Deteriorating Mental Health among LGBTQ2+ Adults in the Context of COVID-19: A Repeated Cross-Sectional Study in Canada, 2020-2021. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12155. [PMID: 34831910 PMCID: PMC8620284 DOI: 10.3390/ijerph182212155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
Abstract
Lesbian, gay, bisexual, trans, other queer, and Two-Spirit (LGBTQ2+) people are particularly at risk for the psycho-social consequences of the COVID-19 pandemic, though population-tailored research within this context remains limited. This study examines the extent of, and associations between, increased alcohol and cannabis use and deteriorating mental health among LGBTQ2+ adults in Canada during the COVID-19 pandemic. Data are drawn from LGBTQ2+ respondents to a repeated, cross-sectional survey administered to adults living in Canada (May 2020-January 2021). Bivariate cross-tabulations and multivariable logistic regression models were utilized to examine associations between increased alcohol and cannabis use, and self-reported mental health, overall coping, and suicidal thoughts. Five-hundred and two LGBTQ2+ participants were included in this analysis. Of these, 24.5% reported increased alcohol use and 18.5% reported increased cannabis use due to the pandemic. In the adjusted analyses, increased alcohol use was associated with poor overall coping (OR = 2.28; 95% CI = 1.28-4.07) and worse self-reported mental health (OR = 1.98; 95% CI = 1.21-3.25), whereas increased cannabis use was associated with suicidal thoughts (OR = 2.30; 95% CI = 1.16-4.55). These findings underscore the need for population-tailored, integrated substance use and mental health supports to address interrelated increases in alcohol/cannabis use and worsening mental health among LGBTQ2+ adults, in the context of the COVID-19 pandemic and beyond.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada;
| | - Allie Slemon
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
| | - Chris Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (C.R.); (A.G.)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; (C.R.); (A.G.)
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
- The Human Early Learning Partnership, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Travis Salway
- British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada;
- Centre for Gender and Sexual Health Equity, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Shivinder Dhari
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
| | - Rod Knight
- British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada;
- Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada; (T.G.); (A.S.); (S.D.)
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Measuring What Counts to Advance Indigenous Self-Determination: A Case Study of the Nisg̱a'a Lisims Government's Quality of Life Framework and Survey. INTERNATIONAL JOURNAL OF COMMUNITY WELL-BEING 2021; 4:415-441. [PMID: 34790890 PMCID: PMC8562362 DOI: 10.1007/s42413-020-00088-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/09/2020] [Indexed: 11/22/2022]
Abstract
Modern Treaties are presented as a means for improving the lives of First Nations, Inuit, and Métis peoples in Canada by providing specific rights, and negotiated benefits. However, the positive impacts of Modern Treaties on Indigenous well-being are contested (Borrows and Coyle 2017; Coulthard 2014; Guimond et al. 2013; Miller 2009; Poelzer and Coates 2015). Developing a more transparent, consistent, collaborative and contextual way of measuring well-being relevant to the cultural realities of Modern Treaty beneficiaries is an important step for generating comparative methods that could systematically demonstrate whether, and under what conditions, such agreements can effectively reduce socio-economic disparities and improve the quality of life of Indigenous communities. The authors first examine previous attempts at measuring Indigenous well-being, then reflect on well-being in relation to the Modern Treaty context. Subsequently, the authors provide an example from one Self-Governing Indigenous Government, the Nisga’a Lisims Government, to collect well-being data through the Nisga’a Nation Household Survey using a mixed quantitative-qualitative method developed through a culturally grounded and participatory approach.
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Hayward A, Wodtke L, Craft A, Robin T, Smylie J, McConkey S, Nychuk A, Healy C, Star L, Cidro J. Addressing the need for indigenous and decolonized quantitative research methods in Canada. SSM Popul Health 2021; 15:100899. [PMID: 34584930 PMCID: PMC8455856 DOI: 10.1016/j.ssmph.2021.100899] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 12/01/2022] Open
Abstract
Though qualitative methods are often an appropriate Indigenous methodology and have dominated the literature on Indigenous research methods, they are not the only methods available for health research. There is a need for decolonizing and Indigenizing quantitative research methods, particularly in the discipline of epidemiology, to better address the public health needs of Indigenous populations who continue to face health inequities because of colonial systems, as well as inaccurate and incomplete data collection about themselves. For the last two decades, researchers in colonized countries have been calling for a specifically Indigenous approach to epidemiology that recognizes the limits of Western epidemiological methods, incorporates more Indigenous research methodologies and community-based participatory research methods, builds capacity by training more Indigenous epidemiologists, and supports Indigenous self-determination. Indigenous epidemiology can include a variety of approaches, including: shifting standards, such as age standardization, according to Indigenous populations to give appropriate weight to their experiences; carefully setting recruitment targets and using appropriate recruitment methods to fulfill statistical standards for stratification; acting as a bridge between Indigenous and Western technoscientific perspectives; developing culturally appropriate data collection tools; and developing distinct epidemiological methods based on Indigenous knowledge systems. This paper explores how decolonization and Indigenization of epidemiology has been operationalized in recent Canadian studies and projects, including the First Nations Regional Longitudinal Health Survey and how this decolonization and Indigenization might be augmented with the capacity-building of the future Our Health Counts Applied Indigenous Epidemiology, Health Information, and Health Services and Program Evaluation Training and Mentorship Program in Canada.
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Key Words
- CBPR, community-based participatory research
- CIHR, Canadian Institutes of Health Research
- Capacity-building
- Community-based participatory research
- Decolonized
- Epidemiology
- FNIGC, First Nations Information Governance Centre
- FNIM, First Nations Inuit and Métis
- ISC, Indigenous Services of Canada
- Indigenous research methods
- NEIHR, Network Environments for Indigenous Health Research
- OHC-NET, Our Health Counts Applied Indigenous Epidemiology, Health Information and Health Services and Program Evaluation Training and Mentorship Program
- PAHO, Pan American Health Organization
- Quantitative methods
- RHS, The First Nations Regional Longitudinal Health Survey
- TEC, Tribal Epidemiology Centers
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Affiliation(s)
- Ashley Hayward
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada
| | - Larissa Wodtke
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada
| | - Aimée Craft
- University of Ottawa, 57 Louis Pasteur Street, Ottawa, Ontario, K1N 6N5, Canada
| | - Tabitha Robin
- University of Manitoba, 66 Chancellors Circle, Winnipeg, Manitoba, R3T 2N2, Canada
| | - Janet Smylie
- Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Stephanie McConkey
- Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
| | - Alexandra Nychuk
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada
| | - Chyloe Healy
- Blackfoot Confederacy, 820 59th Ave S.E., Unit 100, Calgary, AB, T2H 2G5, Canada
| | - Leona Star
- First Nations Health and Social Secretariat of Manitoba, 74-360 Kernaghan Avenue, Winnipeg, Manitoba, R2C 5G1, Canada
| | - Jaime Cidro
- University of Winnipeg, 515 Portage Avenue, Winnipeg, Manitoba, R3B 2E9, Canada
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Rowe RK, Carroll SR, Healy C, Rodriguez-Lonebear D, Walker JD. The SEEDS of Indigenous population health data linkage. Int J Popul Data Sci 2021; 6:1417. [PMID: 34212119 PMCID: PMC8218891 DOI: 10.23889/ijpds.v6i1.1417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Globally, the ways that Indigenous data are collected, used, stored, shared, and analyzed are advancing through Indigenous data governance movements. However, these discussions do not always include the increasingly sensitive nature of linking Indigenous population health (IPH) data. During the International Population Data Linkage Network Conference in September of 2018, Indigenous people from three countries (Canada, New Zealand, and the United States) gathered and set the tone for discussions around Indigenous-driven IPH data linkage. OBJECTIVES Centering IPH data linkage and research priorities at the conference led to budding discussions from diverse Indigenous populations to share and build on current IPH data linkage themes. This paper provides a braided summary of those discussions which resulted in the SEEDS principles for use when linking IPH data. METHODS During the Conference, two sessions and a keynote were Indigenous-led and hosted by international collaborators that focused on regional perspectives on IPH data linkage. A retrospective document analysis of notes, discussions, and artistic contributions gathered from the conference resulted in a summary of shared common approaches to the linkage of IPH data. RESULTS The SEEDS Principles emerge as collective report that outlines a living and expanding set of guiding principles that: 1) prioritizes Indigenous Peoples' right to Self-determination; 2) makes space for Indigenous Peoples to Exercise sovereignty; 3) adheres to Ethical protocols; 4) acknowledges and respects Data stewardship and governance, and; 5) works to Support reconciliation between Indigenous nations and settler states. CONCLUSION Each of the elements of SEEDS need to be enacted together to create a positive data linkage environment. When implemented together, the SEEDS Principles can lead to more meaningful research and improved Indigenous data governance. The mindful implementation of SEEDS could lead to better measurements of health progress through linkages that are critical to enhancing health care policy and improving health and wellness outcomes for Indigenous nations.
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Affiliation(s)
- Robyn K. Rowe
- School of Rural and Northern Health, Laurentian University, Sudbury, ON., Canada, P3E2C6
| | - Stephanie Russo Carroll
- Mel and Enid Zuckerman College of Public Health and the Native Nations Institute at the Udall Center for Studies in Public Policy, University of Arizona, Tucson, Arizona, USA
| | - Chyloe Healy
- Blackfoot Confederacy Tribal Council, First Nations Health & Social Secretariat of Manitoba
| | | | - Jennifer D. Walker
- School of Rural and Northern Health, Laurentian University, Sudbury, ON., Canada, P3E2C6
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Smylie J, O'Brien K, Beaudoin E, Daoud N, Bourgeois C, George EH, Bebee K, Ryan C. Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada. CMAJ 2021; 193:E948-E955. [PMID: 34155046 PMCID: PMC8248471 DOI: 10.1503/cmaj.201903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND: For Indigenous Peoples in Canada, birthing on or near traditional territories in the presence of family and community is of foundational cultural and social importance. We aimed to evaluate the association between Indigenous identity and distance travelled for birth in Canada. METHODS: We obtained data from the Maternity Experiences Survey, a national population-based sample of new Canadian people aged 15 years or older who gave birth (defined as mothers) and were interviewed in 2006–2007. We compared Indigenous with non-Indigenous Canadian-born mothers and adjusted for geographic and sociodemographic factors and medical complications of pregnancy using multivariable logistic regression. We categorized the primary outcome, distance travelled for birth, as 0 to 49, 50 to 199 or 200 km or more. RESULTS: We included 3100 mothers living in rural or small urban areas, weighted to represent 31 100 (1800 Indigenous and 29 300 non-Indigenous Canadian-born mothers). We found that travelling 200 km or more for birth was more common among Indigenous compared with non-Indigenous mothers (9.8% v. 2.0%, odds ratio [OR] 5.45, 95% confidence interval [CI] 3.52–8.48). In adjusted analyses, the association between Indigenous identity and travelling more than 200 km for birth was even stronger (adjusted OR 16.44, 95% CI 8.07–33.50) in rural regions; however, this was not observed in small urban regions (adjusted OR 1.04, 95% CI 0.37–2.91). INTERPRETATION: Indigenous people in Canada experience striking inequities in access to birth close to home compared with non-Indigenous people, primarily in rural areas and independently of medical complications of pregnancy. This suggests inequities are rooted in the geographic distribution of and proximal access to birthing facilities and providers for Indigenous people.
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Affiliation(s)
- Janet Smylie
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont.
| | - Kristen O'Brien
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont
| | - Emily Beaudoin
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont
| | - Nihaya Daoud
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont
| | - Cheryllee Bourgeois
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont
| | - Evelyn Harney George
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont
| | - Kerry Bebee
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont
| | - Chaneesa Ryan
- Well Living House (Smylie), St. Michael's Hospital; Dalla Lana School of Public Health (Smylie), University of Toronto; Ontario HIV Treatment Network (O'Brien); Midwifery Education Program (Bourgeois), Ryerson University; Seventh Generations Midwives Toronto (Bourgeois), Toronto, Ont.; Department of Public Health (Daoud), Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel; National Aboriginal Council of Midwives (Harney George, Bebee), BC; Native Women's Association of Canada (Ryan), Ont.; Bridlewood Medical Centre (Beaudoin), Kanata, Ont
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Daley A, Rahman M, Watson B. A breath of fresh air: The effect of public smoking bans on Indigenous youth. HEALTH ECONOMICS 2021; 30:1517-1539. [PMID: 33860551 DOI: 10.1002/hec.4276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
In general, past studies have estimated the average effect of public smoking bans on youth, ignoring differences across sub-populations. We extend the literature by considering Indigenous youth, who are a vulnerable and previously unexamined group (however, our analysis excludes First Nations youth who live on reserve). We also consider previously unexamined outcomes among youth: self-assessed health and subjective well-being. Our difference-in-differences estimates from Canada indicate that public bans reduced youth smoking and second-hand exposure in public places, on average. There was no displacement on the extensive margin, but the bans increased the number of people who smoke in the homes of youth, conditional on the presence of smokers in the household. Beyond average effects, however, we find that public bans reduced second-hand exposure in the homes of Indigenous youth (particularly Métis youth), on the extensive and intensive margins. The same youth experienced concurrent improvements in self-assessed health and life satisfaction. We conclude that public bans mitigate disparities in health and well-being between Indigenous and non-Indigenous youth, but the extent varies across Indigenous sub-populations, even within a particular country.
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Affiliation(s)
- Angela Daley
- School of Economics, University of Maine, Orono, Maine, USA
| | | | - Barry Watson
- Faculty of Business, University of New Brunswick, Saint John, New Brunswick, Canada
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Rich R, D'Hont T, Murphy KE, Veillard J, Chatwood S. Selecting contextually appropriate performance indicators in a circumpolar context: a modified Delphi approach. BMC Health Serv Res 2021; 21:530. [PMID: 34053444 PMCID: PMC8166122 DOI: 10.1186/s12913-021-06485-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 05/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Meaningful performance measurement requires indicators to be scientifically robust and strategically focused. For many circumpolar states, indicators aligned with national strategies may ignore the priorities of northern, remote, or Indigenous populations. The aim of this project was to identify contextually appropriate performance indicators for maternity care in circumpolar regions. METHODS Fourteen maternity care and health systems experts participated in a modified Delphi consensus process. The list of proposed indicators was derived from a previously published scoping review. Fourteen participants rated each proposed indicator according to importance, circumpolar relevance, validity, and reliability and suggested additional indicators for consideration. RESULTS Consensus was achieved after two rounds, as measured by a Cronbach's alpha of 0.87. Eleven indicators, many of which represented physical health outcomes, were ranked highly on all four criteria. Twenty-nine additional indicators, largely focused on social determinants of health, health care responsiveness, and accessibility, were identified for further research. Travel for care, cultural safety and upstream structural determinants of health were identified as important themes. CONCLUSIONS This study identified the important gaps between current performance measurement strategies and the context and values that permeate maternal-child health in circumpolar regions. The indicators identified in this study provide an important foundation for ongoing work. We recommend that future work encompass an appreciation for the intersectoral nature of social, structural, and colonial determinants of maternal-child health in circumpolar regions.
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Affiliation(s)
- Rebecca Rich
- Department of Obstetrics & Gynaecology, University of Alberta, Royal Alexandra Hospital, 5S Robbins Pavilion, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada.
| | - Thomsen D'Hont
- Department of Family Medicine, University of Alberta, Suite 205 College Plaza 8215 - 112 St, Edmonton, AB, T6G 2C8, Canada
| | - Kellie E Murphy
- Division of Maternal Fetal Medicine, Obstetrics & Gynaecology, University of Toronto, Mount Sinai Hospital, Room 3-918, 700 University Avenue, Toronto, ON, M5G 1Z5, Canada
| | - Jeremy Veillard
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada
| | - Susan Chatwood
- School of Public Health, University of Alberta, 3-279 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada
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Funnell S, Walker J, Letendre A, Bearskin RLB, Manuel D, Scott M, Spruin S, Tanuseputro P. Places of death and places of care for Indigenous Peoples in Ontario: a retrospective cohort study. Canadian Journal of Public Health 2021; 112:685-696. [PMID: 34008135 DOI: 10.17269/s41997-021-00482-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Most people, including Indigenous people in Ontario, wish to die in their communities. How often Indigenous people in Ontario die in their preferred settings is unknown. This study aims to describe the places of care and death for Indigenous people in Ontario who received provincially funded home care services. METHODS We conducted a retrospective cohort study using linked health administrative databases housed at ICES. We used a population-based cohort of Indigenous and non-Indigenous people in Ontario who died between April 1, 2010 and March 31, 2015 to describe characteristics of people, places of death, and places of care. RESULTS Indigenous decedents were on average 8.8 years younger, had more chronic diseases, and lived in lower income neighbourhoods compared with their non-Indigenous counterparts. Indigenous decedents spent nearly 8 more days in acute care in the last year of life and more died in acute care (56.1% versus 46.1%). When controlling for covariates, Indigenous decedents received 1.9 fewer home care nursing hours and 5 fewer personal support worker hours and showed decreased odds (OR 0.72) of receiving a palliative physician visit in the last 90 days of life. Among Indigenous decedents, a palliative physician visit lowered odds of dying in acute care by 50% and total days in acute care by 18%. CONCLUSION Our study identified a gap in end-of-life care for Indigenous Peoples in Ontario receiving provincially funded home care. Without continued efforts to address challenges that perpetuate health inequalities, we expect many Indigenous people will continue to die in acute care away from their people, families, and culturally relevant supports.
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Affiliation(s)
- Sarah Funnell
- Department of Family Medicine, Queen's University, 220 Bagot Street, Kingston, ON, K7L 3G2, Canada.
| | | | - Angeline Letendre
- Canadian Indigenous Nurses Association (CINA), Ottawa, Ontario, Canada
| | | | - Douglas Manuel
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Statistics Canada, Ottawa, Ontario, Canada.,C.T. Lamont Primary Health Care Research Centre, Ottawa, Ontario, Canada
| | | | | | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
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First Nations emergency care in Alberta: descriptive results of a retrospective cohort study. BMC Health Serv Res 2021; 21:423. [PMID: 33947385 PMCID: PMC8096356 DOI: 10.1186/s12913-021-06415-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background Worse health outcomes are consistently reported for First Nations people in Canada. Social, political and economic inequities as well as inequities in health care are major contributing factors to these health disparities. Emergency care is an important health services resource for First Nations people. First Nations partners, academic researchers, and health authority staff are collaborating to examine emergency care visit characteristics for First Nations and non-First Nations people in the province of Alberta. Methods We conducted a population-based retrospective cohort study examining all Alberta emergency care visits from April 1, 2012 to March 31, 2017 by linking administrative data. Patient demographics and emergency care visit characteristics for status First Nations persons in Alberta, and non-First Nations persons, are reported. Frequencies and percentages (%) describe patients and visits by categorical variables (e.g., Canadian Triage and Acuity Scale). Means, medians, standard deviations and interquartile ranges describe continuous variables (e.g., age). Results The dataset contains 11,686,288 emergency care visits by 3,024,491 unique persons. First Nations people make up 4% of the provincial population and 9.4% of provincial emergency visits. The population rate of emergency visits is nearly 3 times higher for First Nations persons than non-First Nations persons. First Nations women utilize emergency care more than non-First Nations women (54.2% of First Nations visits are by women compared to 50.9% of non-First Nations visits). More First Nations visits end in leaving without completing treatment (6.7% v. 3.6%). Conclusions Further research is needed on the impact of First Nations identity on emergency care drivers and outcomes, and on emergency care for First Nations women. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06415-2.
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Jamieson L, Hedges J, Peres MA, Guarnizo-Herreño CC, Bastos JL. Challenges in identifying indigenous peoples in population oral health surveys: a commentary. BMC Oral Health 2021; 21:216. [PMID: 33910554 PMCID: PMC8082663 DOI: 10.1186/s12903-021-01455-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/22/2021] [Indexed: 12/31/2022] Open
Abstract
There are currently 370 million persons identifying as indigenous across 90 countries globally. Indigenous peoples generally face substantial exclusion/marginalization and poorer health status compared with non-indigenous majority populations; this includes poorer oral health status and reduced access to dental services. Population-level oral health surveys provide data to set priorities, inform policies, and monitor progress in dental disease experience/dental service utilisation over time. Rigorously and comprehensively measuring the oral health burden of indigenous populations is an ethical issue, though, given that survey instruments and sampling procedures are usually not sufficiently inclusive. This results in substantial underestimation or even biased estimation of dental disease rates and severity among indigenous peoples, making it difficult for policy makers to prioritise resources in this area. The methodological challenges identified include: (1) suboptimal identification of indigenous populations; (2) numerator-denominator bias and; (3) statistical analytic considerations. We suggest solutions that can be implemented to strengthen the visibility of indigenous peoples around the world in an oral health context. These include acknowledgment of the need to engage indigenous peoples with all data-related processes, encouraging the use of indigenous identifiers in national and regional data sets, and mitigating and/or carefully assessing biases inherent in population oral health methodologies for indigenous peoples.
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Affiliation(s)
- Lisa Jamieson
- Australian Research Centre for Population Oral Health, University of Adelaide Dental School, Adelaide, SA 5005 Australia
| | - Joanne Hedges
- Australian Research Centre for Population Oral Health, University of Adelaide Dental School, Adelaide, SA 5005 Australia
| | - Marco A. Peres
- National Dental Research Institute Singapore, 5 Second Hospital Ave, Singapore, 168938 Singapore
| | - Carol C. Guarnizo-Herreño
- Departamento de Salud Colectiva, Facultad de Odontología, Universidad Nacional de Colombia, Bogotá, Colombia
| | - João L. Bastos
- Post-Graduate Program in Public Health, Federal University of Santa Catarina, Florianópolis, Brazil
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Pace R, Harris S, Parry M, Zaran H. Primary and Secondary Cardiovascular Prevention Among First Nations Peoples With Type 2 Diabetes in Canada: Findings From the FORGE AHEAD Program. CJC Open 2020; 2:547-554. [PMID: 33305215 PMCID: PMC7711009 DOI: 10.1016/j.cjco.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/04/2020] [Indexed: 12/23/2022] Open
Abstract
Background First Nations (FN) peoples in Canada face spiraling rates of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Data on the extent of CVD risk-factor management in FN peoples with T2DM in Canada are scarce. Methods A T2DM registry with data from 7 FN communities in Canada was utilized to identify individuals eligible for primary and secondary CVD prevention. Proportions of individuals meeting clinical practice guideline-specified targets (hemoglobin A1c ≤7.0%; blood pressure ≤130/80 mm Hg; low-density lipoprotein ≤2 mmol/L) were calculated. Prescription of recommended cardioprotective medications (antithrombotic medication, lipid-lowering agents, renin-angiotensin-aldosterone system inhibitors, and beta-blockers) among those with CVD was assessed. χ2 tests were employed to evaluate differences between CVD prevention groups and sexes. Results Of the 2098 individuals in the registry, 18% had documented CVD (female: male = 1.12). Overall, <10% met all 3 clinical practice guideline targets. Attainment of hemoglobin A1c and blood pressure targets was comparable between primary and secondary CVD prevention groups, with<50% achieving targets. A greater proportion of the secondary prevention group met low-density lipoprotein targets compared to those without CVD (61.6% vs 40.9%, P < 0.01). In the secondary prevention group, beta-blockers were prescribed to only 20%, and <60% were prescribed antithrombotics, lipid-lowering medications, or agents targeting the renin-angiotensin-aldosterone system; <2% were prescribed medications from all 4 classes of cardioprotective medications. Conclusions Primary and secondary CVD prevention recommendations for individuals with T2DM are not being met for an alarmingly high proportion of FN peoples. These findings serve as an urgent call for proactive measures to reduce CVD events and related mortality in this high-risk population.
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Affiliation(s)
- Romina Pace
- Centre for Outcomes Research & Evaluation, Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - Stewart Harris
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Corresponding author: Dr Stewart B. Harris, Centre for Studies in Family Medicine, Western University, The Western Centre for Public Health and Family Medicine, 1151 Richmond St, London, Ontario N6A 3K7, Canada. Tel.: +1-519-858-5028; fax: +1-519-858-5029.
| | - Monica Parry
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Harsh Zaran
- Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Galloway T, Bowra A, Butsang T, Mashford-Pringle A. Education in uncertainty: Academic life as Indigenous health scholars during COVID-19. INTERNATIONAL REVIEW OF EDUCATION. INTERNATIONALE ZEITSCHRIFT FUR ERZIEHUNGSWISSENSCHAFT. REVUE INTERNATIONALE DE PEDAGOGIE 2020; 66:817-832. [PMID: 33281222 PMCID: PMC7703737 DOI: 10.1007/s11159-020-09876-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
As the COVID-19 crisis continues to develop, communities around the world find themselves living in new and uncertain times. School and university closures are significantly disrupting the lives of students, educators and researchers alike. With the sudden shift to online learning platforms, the limitations on research projects and the lack of standardised policies and procedures, many concerns arise surrounding the unequal impacts of this crisis. This article brings together diverse perspectives on the effects of COVID-19 on post-secondary life for students and scholars engaged in the field of Indigenous health research. The authors reflect on how this time has impacted them as a graduating student, incoming PhD student, junior faculty member and mid-career faculty member respectively. Their experiences of teaching and learning at a large, research-intensive university in Toronto, Canada have been profoundly transformed, and will continue to change the way they work, research and interact at the graduate level. Working with Indigenous communities and organisations requires relationship building, collaboration and ceremony. In these unprecedented times, scholars cannot simply continue "business as usual". They must adapt everything, including how they teach, learn and work with Indigenous peoples, who are particularly vulnerable to this pandemic. Reflecting on the impacts that have already occurred and those that are still likely to come, the authors discuss what changes may need to be made in academia to support diverse actors within their scholarly community. They suggest changes to their scholarship with Indigenous communities in Canada to help them continue to work in a respectful, reciprocal and culturally appropriate way.
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Affiliation(s)
- Tracey Galloway
- Department of Anthropology, University of Toronto Mississauga, Mississauga, ON Canada
| | - Andrea Bowra
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Tenzin Butsang
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Angela Mashford-Pringle
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Churchill ME, Smylie JK, Wolfe SH, Bourgeois C, Moeller H, Firestone M. Conceptualising cultural safety at an Indigenous-focused midwifery practice in Toronto, Canada: qualitative interviews with Indigenous and non-Indigenous clients. BMJ Open 2020; 10:e038168. [PMID: 32994245 PMCID: PMC7526316 DOI: 10.1136/bmjopen-2020-038168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Cultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care. DESIGN AND SETTING Interviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens. PARTICIPANTS Saturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants). RESULTS Three domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent. CONCLUSION The Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where 'cultural safety' becomes a standard of care.
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Affiliation(s)
- Mackenzie E Churchill
- Well Living House, MAP Centre for Urban Health Solutions (C-UHS), St Michael's Hospital, Toronto, Ontario, Canada
| | - Janet K Smylie
- Well Living House, MAP Centre for Urban Health Solutions (C-UHS), St Michael's Hospital, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sara H Wolfe
- Seventh Generation Midwives Toronto (SGMT), Toronto, Ontario, Canada
| | | | - Helle Moeller
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Michelle Firestone
- MAP Centre for Urban Health Solutions (C-UHS), St. Michael's Hospital, Toronto, Ontario, Canada
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Basham CA. Regional variation in multimorbidity prevalence in British Columbia, Canada: a cross-sectional analysis of Canadian Community Health Survey data, 2015/16. Health Promot Chronic Dis Prev Can 2020; 40:225-234. [PMID: 32667879 PMCID: PMC7450904 DOI: 10.24095/hpcdp.40.7/8.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Multimorbidity represents a major concern for population health and service delivery planners. Information about the population prevalence (absolute numbers and proportions) of multimorbidity among regional health service delivery populations is needed for planning for multimorbidity care. In Canada, health region-specific estimates of multimorbidity prevalence are not routinely presented. The Canadian Community Health Survey (CCHS) is a potentially valuable source of data for these estimates. METHODS Data from the 2015/16 cycle of the CCHS for British Columbia (BC) were used to estimate and compare multimorbidity prevalence (3+ chronic conditions) through survey-weighted analyses. Crude frequencies and proportions of multimorbidity prevalence were calculated by BC Health Service Delivery Area (HSDA). Logistic regression was used to estimate differences in multimorbidity prevalence by HSDA, adjusting for known confounders. Multiple imputation using chained equations was performed for missing covariate values as a sensitivity analysis. The definition of multimorbidity was also altered as an additional sensitivity analysis. RESULTS A total of 681 921 people were estimated to have multimorbidity in BC (16.9% of the population) in 2015/16. Vancouver (adj-OR = 0.65; 95% CI: 0.44-0.97) and Richmond (adj-OR = 0.55; 95% CI: 0.37-0.82) had much lower prevalence of multimorbidity than Fraser South (reference HSDA). Missing data analysis and sensitivity analysis showed results consistent with the main analysis. CONCLUSION Multimorbidity prevalence estimates varied across BC health regions, and were lowest in Vancouver and Richmond after controlling for multiple potential confounders. There is a need for provincial and regional multimorbidity care policy development and priority setting. In this context, the CCHS represents a valuable source of information for regional multimorbidity analyses in Canada.
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Affiliation(s)
- C Andrew Basham
- University of British Columbia, Vancouver, British Columbia, Canada
- Provincial TB Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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Brubacher LJ, Dewey CE, Cunsolo A, Humphries S, Healey Akearok GK, Gong C, Harper SL. Mapping the maternal health research landscape in Nunavut: A systematic search & critical review of methodology. Soc Sci Med 2020; 262:113206. [PMID: 32823215 DOI: 10.1016/j.socscimed.2020.113206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/15/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
Nunavut's maternal healthcare system is characterized by rapid transition from community-based birth to a practice of obstetric evacuation and institutionalized birth. Given calls for Inuit self-determination in research, maternal health research - which informs healthcare practices and policies - may need to be conducted differently, using different research methodologies, to include Inuit women's voices and lived experiences. In light of these calls, this article systematically synthesized the published maternal health literature in Nunavut and critically examined reported research methods. This systematic search and critical review involved a comprehensive database search and multi-level eligibility screening conducted by two independent reviewers. Data on the temporal, geographic, methodological, and topical range of studies were extracted, then descriptive statistics were calculated to summarize these data. A hybrid inductive and deductive qualitative analysis of the full-text articles was conducted to critically analyze research methodology. The initial search yielded 2656 distinct articles and twenty-eight articles met the inclusion criteria. These articles were published from 1975 to 2016, mostly used quantitative research methodology (71.4%), were written from clinical perspectives (57.1%), and focused on maternity care (53.6%). Emergent themes related to both the contributions and areas for growth of research methodology in the conceptualization, initiation, implementation, reporting, and knowledge mobilization stages of the research process. This review revealed opportunities for maternal health researchers to: redress the ongoing impacts of colonization; further include Inuit definitions of health and perspectives on birth in study designs; explore new methodologies that resonate with Inuit ways of knowing; continue (re)aligning research with community priorities; and move from consultation and collaborative partnership in research to Inuit leadership and data ownership. Indeed, this review illustrates that at each step of the research process, opportunity exists for Inuit perspectives and active involvement to shape and define maternal health research in Nunavut.
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Affiliation(s)
- Laura Jane Brubacher
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Cate E Dewey
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Ashlee Cunsolo
- Labrador Institute of Memorial University, 219 Hamilton River Road, P.O. Box 490, Stn.B, Happy Valley-Goose Bay, Labrador, A0P 1E0, Canada.
| | - Sally Humphries
- Department of Sociology and Anthropology, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Gwen K Healey Akearok
- Qaujigiartiit Health Research Centre, 764 Fred Coman Drive, P.O. Box 11372, Iqaluit, Nunavut, X0A 0H0, Canada.
| | - Crystal Gong
- School of Public Health, University of Alberta, 3-521 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada.
| | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada; School of Public Health, University of Alberta, 3-521 Edmonton Clinic Health Academy, Edmonton, Alberta, T6G 1C9, Canada.
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Morris MI, Sioui R, Sioui M. Conference proceeding from the annual meeting of the Canadian Association of Pediatric Surgeons: "Caring for indigenous children: A CAPS perspective". J Pediatr Surg 2020; 55:793-795. [PMID: 32081360 DOI: 10.1016/j.jpedsurg.2020.01.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022]
Abstract
In 2015, the Truth and Reconciliation Commission called for health care institutions to address structural barriers that affect Indigenous families seeking health care in Canada. Pediatric care centers in Canada have failed to adequately address these, resulting in continued negative and life-threatening impacts on Indigenous children and families across Canada. Indigenous (First Nations, Metis, and Inuit) families across Canada "have an equal right to the enjoyment of the highest attainable standard of physical and mental health" according to the United Nations Declaration on the Rights of Indigenous Peoples. These rights have yet to be acknowledged or granted to Indigenous Peoples by Federal or Provincial governments in Canada. In the face of significant and long-standing disparities in health care that Indigenous children experience following surgical procedures, and in response to the Calls to Action from the Truth and Reconciliation Commission of Canada (TRC), the Canadian Association of Pediatric Surgeons (CAPS) hosted a session at their annual general meeting in the fall of 2019 entitled "Caring for Indigenous Children: A CAPS Perspective". A summary of the topics presented at the meeting are discussed in this paper.
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Affiliation(s)
| | - Roland Sioui
- First Nations of Quebec and Labrador Health and Social Services Commission, Quebec
| | - Mederik Sioui
- First Nations of Quebec and Labrador Health and Social Services Commission, Quebec
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Chan J, Friborg J, Zubizarreta E, van Eck JW, Hanna TP, Bourque JM, Gaudet M, Dennis K, Olson R, Coleman CN, Petersen AJ, Grau C, Abdel-Wahab M, Brundage M, Slotman B, Polo A. Examining geographic accessibility to radiotherapy in Canada and Greenland for indigenous populations: Measuring inequities to inform solutions. Radiother Oncol 2020; 146:1-8. [DOI: 10.1016/j.radonc.2020.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 12/15/2022]
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Hop Wo NK, Anderson KK, Wylie L, MacDougall A. The prevalence of distress, depression, anxiety, and substance use issues among Indigenous post-secondary students in Canada. Transcult Psychiatry 2020; 57:263-274. [PMID: 31575332 DOI: 10.1177/1363461519861824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to estimate the prevalence of mental illness and substance use among Indigenous students attending Canadian post-secondary institutions. We obtained data from the National College Health Assessment - American College Health Association Spring 2013 survey, which includes 34,039 participants in 32 post-secondary institutions across Canada. We calculated prevalence estimates with 95% confidence intervals (CI). We compared Indigenous and non-Indigenous students using age- and sex-adjusted prevalence ratios (PR) obtained from Poisson regression models. Of the total sample, 1,110 (3.3%) post-secondary students self-identified as Indigenous. Within the past 12 months, Indigenous students had higher odds of intentionally injuring themselves (PR = 1.53, 95% CI = 1.27-1.84), seriously considering suicide (PR = 1.32, 95% CI = 1.12-1.56), attempting suicide (PR = 1.74, 95% CI = 1.16-2.62), or having been diagnosed with depression (PR = 1.26, 95% CI = 1.08-1.47) or anxiety (PR = 1.18, 95% CI = 1.02-1.35) when compared with non-Indigenous students. Indigenous students also had higher odds of having a lifetime diagnosis of depression (PR = 1.31, 95% CI = 1.17-1.47) when compared with non-Indigenous students. Indigenous students were more likely to report binging on alcohol (PR = 1.10, 95% CI = 1.02-1.19), using marijuana (PR = 1.21, 95% CI = 1.06-1.37), and using other recreational drugs (PR = 1.32, 95% CI = 1.06-1.63) compared to non-Indigenous students. This study demonstrates that Indigenous students at post-secondary institutions across Canada experience higher prevalence of mental health and related issues compared to the non-Indigenous student population. This information highlights the need to assess the utilization and ensure the appropriate provision of mental health and wellness resources to support Indigenous students attending post-secondary institutions.
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Sheppard AJ, Chiarelli AM, Hanley AJ, Marrett LD. Influence of Preexisting Diabetes on Survival After a Breast Cancer Diagnosis in First Nations Women in Ontario, Canada. JCO Glob Oncol 2020; 6:99-107. [PMID: 32031452 PMCID: PMC6998021 DOI: 10.1200/jgo.19.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Survival after a breast cancer diagnosis is poorer in First Nations women with a preexisting comorbidity compared with comorbidity-free First Nations women in Ontario, Canada. Given the high prevalence of diabetes in this population, it is important to determine whether preexisting diabetes is related to poorer survival after a breast cancer diagnosis. METHODS All First Nations women were identified from a cohort of First Nations people diagnosed with breast cancer in diagnostic periods-1995 to 1999 and 2000 to 2004-and seen at a regional cancer program (RCP) in Ontario. Preexisting diabetes status and other factors, such as age at diagnosis, body mass index, and stage at diagnosis, were collected from medical charts at the regional cancer programs. The association between preexisting diabetes and First Nations status was examined by each of the demographic, personal, tumor, and treatment factors using logistic regression models. Survival was compared between First Nations women with (n = 67) and without (n = 215) preexisting diabetes, adjusted by significant study factors using a Cox proportional hazards regression model. RESULTS The 5-year survival rate among First Nations women with diabetes was 59.8% versus 78.7% among those without diabetes (P < .01). Preexisting diabetes significantly increased the risk of death among First Nations women with breast cancer (hazard ratio, 1.87; 95% CI, 1.12 to 3.13) after adjustment for age group, period of diagnosis, body mass index, other comorbidities at diagnosis, and stage. CONCLUSION This study recommends awareness of this survival discrepancy among the treatment team for First Nations patients with breast cancer with preexisting diabetes.
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Affiliation(s)
- Amanda J. Sheppard
- Indigenous Cancer Care Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anna M. Chiarelli
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Cancer Screening, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Anthony J.G. Hanley
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Loraine D. Marrett
- Indigenous Cancer Care Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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