Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment

Introduction

Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments for substance use disorders (SUD) to fit the needs of their communities. D&I science offers frameworks, models, and theories to increase implementation success, but research is needed to center Indigenous knowledge, enhancing D&I so that it is more applicable within Indigenous contexts. In this scoping review, we examined the current state of D&I science for SUD interventions among Indigenous communities and identified best-practice SUD implementation approaches.

Methods

PubMed and PsycINFO databases were queried for articles written in English, published in the United States, Canada, Australia, and New Zealand. We included key search terms for Indigenous populations and 35 content keywords. We categorized the data using the adapted and extended Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework that emphasizes equity and sustainability. RE-AIM has also been used as a primary model to consistently identify implementation outcomes.

Results

Twenty articles were identified from the original unduplicated count of over 24,000. Over half the articles discussed processes related to Reach, Adoption, and Implementation. Effectiveness was discussed by 50% of the studies (n = 10), with 25% of the articles discussing Maintenance/sustainability (n = 4). Findings also highlighted the importance of the application of each RE-AIM domain for meaningful, well-defined community-engaged approaches.

Conclusion

Finding indicated a need to prioritize Indigenous methods to culturally center, re-align and adapt Western treatments and frameworks to increase health equity and improve SUD treatment outcomes. Utility in the use of the modified RE-AIM and the continued modification for Indigenous communities was also noted.

Culturally Safe Practices in the Co-creation of Medical Education Curriculum with Indigenous Animators: Outcomes From an Indigenous Learning Circle

OBJECTIVES

To explore the experiences of Indigenous patient actors who co-created and enacted Indigenous patient scenarios in collaboration with medical school faculty. We critically examine the structures and systems in a medical school that mediate cultural safety for Indigenous patient actors. The Truth and Reconciliation Commission of Canada has called on medical schools and healthcare institutions to help address the intergenerational harms inflicted on Indigenous people by the Indian residential school (IRS) system. Institutions are striving to incorporate cultural competency, conflict resolution, human rights, and anti-racism education into their curricula. However, the structural inequities within undergraduate, postgraduate, and continuing medical education practices must be identified and challenged to ensure that medical education is authentic and culturally safe for those involved in the development and delivery of the Indigenous health curriculum. To explore potential structural inequities in the co-creation process of simulated cultural communication scenarios (SCCS), the Indigenous animators at Debajehmujig Storytellers and collaborating faculty and professional staff at the Northern Ontario School of Medicine University (NOSM U) examined cultural safety in their curriculum design and delivery process.

METHODS

We utilized the qualitative Indigenous research methodology of the Learning Circle to deconstruct the co-creation process and to explore the experience of cultural safety from the Indigenous animators' perspective throughout the curriculum design and delivery process.

RESULTS

A framework for culturally safe co-creation practices with Indigenous people, rooted within Indigenous teachings of the Medicine Wheel, emerged from the qualitative data.

CONCLUSIONS

This framework has the potential to guide the practice of culturally safe co-creation of Indigenous patient simulations in medical education and healthcare workplace learning. While the Medicine Wheel teachings are held by specific Indigenous nations, we anticipate that the results and recommendations of this study will apply to Indigenous co-creators and academic medical educators internationally.

Study protocol: Yarning about HPV Vaccination: a qualitative study of factors influencing HPV vaccination among Aboriginal and Torres Strait Islander adolescents in Australia

INTRODUCTION

Aboriginal and Torres Strait Islander women experience a higher burden of cervical cancer than non-Indigenous women in Australia. Cervical cancer is preventable partly through human papillomavirus (HPV) vaccination; in Australia, this is delivered through the national school-based immunisation programme. While HPV vaccination uptake is high among Australian adolescents, there remain gaps in uptake and completion among Aboriginal and Torres Strait Islander adolescents. This study aims to gain a comprehensive understanding of the barriers and facilitators to HPV vaccination uptake and completion among Aboriginal and Torres Strait Islander adolescents in Queensland, Australia.

METHODS AND ANALYSIS

The study will be guided by an Indigenist research approach and an ecological model for health promotion. Yarning, a qualitative Indigenous research method, will be conducted in up to 10 schools. Participants will include Year 7 (12/13 years old) Aboriginal and Torres Strait Islander adolescents; parents/caregivers; and local key informants and immunisation programme partners involved in the delivery of school-based HPV immunisation programme. Participants will be recruited through school representatives and investigator networks using purposive and snowball sampling and samples of convenience. Field notes, HPV vaccination clinic observations and sequential diagramming of the HPV vaccination process will be conducted. Thematic analysis of data will be led by Aboriginal and Torres Strait Islander researchers. Synthesised sequential diagrams of the process of HPV vaccination and qualitative themes summarising key findings will be produced.

ETHICS AND DISSEMINATION

The Aboriginal Health and Medical Research Council of New South Wales Ethics Committee (1646/20), the Australian National University Human Research Ethics Committee (HREC, 2020/478), the HREC of the Northern Territory Department of Health and Menzies School of Health Research (19-3484) and the Townsville Hospital and Health Service HREC (HREC/QTHS/73789) have approved the study. Dissemination will occur via conferences and peer-reviewed publications. Further dissemination will be determined in partnership with the Aboriginal and Torres Strait Islander Steering Committee, including Youth Representatives and Consultation Network.