Bonding social capital and health within four First Nations communities in Canada: A cross-sectional study

To date, research on social capital in Indigenous contexts has been scarce. In this quantitative study, our objectives were to (1): Describe bonding social capital within four distinct First Nations communities in Canada, and (2) Explore the associations between bonding social capital and self-rated health in these communities. With community permission, cross-sectional data were drawn from the Canadian Alliance for Healthy Hearts and Minds study. Four reserve-based First Nations communities were included in the analysis, totaling 591 participants. Descriptive statistics were computed to examine levels of social capital among communities and logistic regression analyses were performed to identify social capital predictors of good self-rated health. Age, sex, education level, and community were controlled for in all models. Across the four communities in this study, areas of common social capital included frequent socialization among friends and large and interconnected family networks. Positive self-rated health was associated with civic engagement at federal or provincial levels (OR=1.65, p<0.05) and organizational membership (OR=1.60, p<0.05), but overall, sociodemographic variables were more significantly associated with self-rated health than social capital variables. Significant differences in social capital were found across the four communities and community of residence was a significant health outcomes predictor in all logistic regression models. In conclusion, this study represents one of the first efforts to quantitatively study First Nations social capital with respect to health in Canada. The results reflect significant differences in the social capital landscape across different First Nations communities and suggest the need for social capital measurement tools that may be adapted to unique Indigenous contexts. Further, the impact of social capital on health may be better explored and interpreted with more community-specific instruments and with supplementary qualitative inquiry.

Public health moves to innocence and evasion? Graduate training programs' engagement in truth and reconciliation for Indigenous health

OBJECTIVES

Indigenous peoples are the first peoples of what is now called Canada. Canadians have benefitted from their largesse and contributions in a myriad of ways that remain unacknowledged. Indeed, ongoing colonization and systemic anti-Indigenous racism in all quarters of our society have had heinous impacts on their health and well-being. Despite this reality and multiple calls for redress, Indigenous health is still missing from the Core Competencies for Public Health in Canada, having obvious implications for public health training programs and subsequent practice. Our objective in this paper is to critically explore the reasons behind institutional apathy for reconciliation in Indigenous health.

METHODS

Interviews were conducted with 19 leaders in Canadian Graduate Public Health Programs (CGPHPs) at 15 universities to explore the extent to which CGPHPs engage with Canada's 2015 Truth and Reconciliation Commission's Calls to Action to address Indigenous health. We used thematic discourse analysis to illuminate the landscape and make recommendations.

RESULTS

Participants agree that Indigenous health is important, but our data reveal an uneven landscape for addressing the Calls to Action. Curriculum was limited though we noted modest positive change. On the whole, the non-Indigenous (white) professoriate still needs to educate themselves while not all see the need to do so. Many deflected responsibility. Yet anecdotally, there is desire among CGPHP students who are already unsettling themselves to see such competency in their training.

CONCLUSION

It is a settler evasion to claim lack of expertise, to express a desire to limit the burden on Indigenous academics, and to stand on the sidelines of institutional inertia. Our findings are a call to CGPHPs to do better.

Toward intersectional and culturally relevant sex and gender analysis in health research

Current institutional frameworks in sex- and gender-based analysis (SGBA) are promising, but significant gaps remain in their relation to recent developments in research praxis. In this paper we draw from our own experiences with a national health research funding agency, the Canadian Institutes of Health Research (CIHR), to critically examine the uptake and implementation of its current frameworks and practices of sex and gender analysis in health research. We conducted semi-structured interviews with a cohort of 18 health researchers alongside an institutional policy analysis to show how sex and gender have been understood, integrated, and addressed within the agency and initiative. Our findings reveal that attention to date has focused on representation (human and data) while deeper justice issues that are attentive to intersectionality, positionality and reflexivity-remain ambiguous. Finally, we discuss possible strategies for institutions to improve the uptake of knowledge, training, and policy to better support intersectional and culturally-relevant frameworks across the diverse research community.

Governmental Fiduciary Failure in Indigenous Environmental Health Justice: The Case of Pictou Landing First Nation

From 1967 until 2020, [Community] has had 85 million litres of pulp and paper mill effluent dumped every day into an estuary that borders the community. Despite long-term concerns about cancer in the community, a federal government appointed Joint Environmental Health Monitoring Committee, mandated to oversee the health of the community, has never addressed [Community] concerns. In this study we accessed the 2013 Canadian Cancer Registry microfile data, and using the standard geographical classification code, accessed the cancer data for [Community], and provided comparable data for all Nova Scotia First Nations, as well as the county, provincial, and national population level data. We determined that digestive organ cancers, respiratory organ cancers, male genital organ cancers, and urinary tract cancers are higher in [Community] than at all comparable levels. Female breast and genital organ cancers are lowest in [Community] than at all other comparable levels. We note the limitation of this study as not being able to capture cancer data for off-reserve members at the time of diagnosis and the lapse in availability of up-to-date CCR data. This study demonstrates that cancer data can be compiled for First Nation communities using the standard geographic code, and although not a comprehensive count of all diagnoses for the registered members of [Community], it is the first study to provide data for those who lived in [Community] at the time of diagnosis. Moreover, it highlights the lack of capacity (or will) by Joint Environmental Health Monitoring Committee to uphold their fiduciary duty.

“We all know each other”: A Strengths-based Approach to Understanding Social Capital in Pictou Landing First Nation

With over three decades of attention drawn to the health of Indigenous peoples in Canada and around the world, an outpouring of health research has been undertaken, much of which has emphasized the experience of disparity at the expense of recognizing strengths. In this case study, we challenge the damage-centred rhetoric of mainstream health research by reporting the findings of 20 qualitative interviews on community strength and health with members of Pictou Landing First Nation, a Mi’kmaw nation located in Nova Scotia, Canada. We then relate and compare these findings with the emerging conceptualization of Indigenous social capital, which is a concept that has been associated with positive health outcomes in a variety of contexts. Our findings indicate that Pictou Landing First Nation is strengthened by qualities of familiarity, reciprocity, safety, and solidarity, which are rooted in the value of family and embedded within a broader Mi’kmaw worldview. The nature of these strengths aligns in part with the concept of Indigenous social capital, which we suggest may be better harnessed to be a means for conducting strengths-based health research. To this end, our findings support the need for reworking social capital conceptualizations to more strongly centralize cultural identities and worldviews in order to authentically and comprehensively affirm Indigenous and decolonizing health research practices.

The public health emergency of climate change: how/are Canadian post-secondary public health sciences programs responding?

OBJECTIVE

The Intergovernmental Panel on Climate Change recently issued a statement that the fate of human society and human health is at serious risk of catastrophic impacts unless we take bold action to keep global warming under 1.5 °C. In 2015, the Canadian Public Health Association noted emerging efforts to embrace intersectoral approaches to global change in public health research and practice. In this study, we question the extent to which Canadian Graduate Public Health Sciences Programs have kept pace with these efforts to see climate change surface as a new frontier for training the next generation of researchers and practitioners.

METHODS

Semi-structured interviews (19) were conducted with Department Heads (or equivalents) of graduate-level Public Health Sciences Programs at 15 Canadian universities concerning the place of climate change in their respective curricula. Interviews were designed to elicit participants' institutional perspectives on the importance of climate change in the Public Health Sciences and identify perceived challenges and opportunities.

RESULTS

Despite wide recognition among participants that climate change is a public health "crisis", very few reported having substantive curricular engagement on the topic. Key challenges identified were lack of resources, organizational issues, and political barriers. Key opportunities to adapt curricula to address this new frontier in Public Health were faculty interest and expertise, cross-disciplinary collaboration, and pressure from the institution.

CONCLUSION

Our findings provide evidence for post-secondary Public Health Sciences Programs to understand the need to address their own sluggishness when what is needed are bold, even radical, shifts to existing curricula.

If only they had accessed the data: Governmental failure to monitor pulp mill impacts on human health in Pictou Landing First Nation

For over fifty years, Pictou Landing First Nation (PLFN), a small Mi'kmaw community on the northern shore of mainland Nova Scotia, Canada, has been told by a Joint Environmental Health Monitoring Committee (JEHMC) mandated to oversee the health of the community that their health has not been impacted by exposure to 85 million litres of pulp mill effluent dumped every day into what was once a culturally significant body of water bordering their community. Yet, based on lived experience, the community knows otherwise, and despite countless dollars spent on government and industry-sponsored research, their concerns have not gone away. Using biopolitical theory, we explore why JEHMC never fully implemented its mandate. We will use a Mi'kmaw environmental 'theoretical' framework to demonstrate that indicators of a relational epistemology and ontology that have been consistently and persistently overlooked in Indigenous environmental health research demands that Indigenous connections to the air, land and water must be taken into consideration to get a full understanding of environmental health impacts. Guided by the principle of Etuaptmumk (Two-Eyed Seeing), which brings together the strengths of both western and Indigenous knowledge, and employing a community-based participatory research approach, we use data that could have been accessed by the JEHMC that might have signaled that human health studies were warranted. Further, we developed an environmental health survey that more appropriately assesses the impacts on the community. Finally, we will discuss how an Indigenous-developed framework can adequately assess the impacts of land displacement and environmental dispossession on the health of Indigenous communities and illustrate how our framework can serve as a guide to others when exploring Indigenous environmental health more broadly.

Are the natural sciences ready for truth, healing, and reconciliation with Indigenous peoples in Canada? Exploring 'settler readiness' at a world-class freshwater research station

The Experimental Lakes Area in Northwestern Ontario, Canada, is a globally prominent freshwater research facility, conducting impactful whole-of-lake experiments on so-called 'pristine' lakes and watersheds. These lakes are located in traditional Anishinaabe (Indigenous) territory and the home of 28 Treaty #3 Nations, something rarely acknowledged until now. Indeed, Indigenous peoples in the area have historically been excluded from the research facility's governance and research. Shortly after it changed hands in 2014-from the federal government to the not-for-profit International Institute of Sustainable Development (IISD)-the Truth and Reconciliation Commission (TRC) of Canada released its Calls to Action to all Canadians. The newly named International Institute of Sustainable Development-Experimental Lakes Area (IISD-ELA) began to respond with a number of initiatives aimed to develop relationships with local Indigenous peoples and communities. In this paper, from the perspectives of IISD-ELA staff members, we share findings from an exploratory study into the relationships beginning to develop between IISD-ELA and Treaty #3 Nations. We used semi-structured interviews (n = 10) to identify how staff perceived their initial efforts and contextualize those with the current literature on meaningfully engagement in reconciliation. Our analysis highlights perceived barriers, including time, resources, and funding constraints, as well as an acknowledged lack of cultural awareness and sensitivity training. Participants also recognized the need to engage Indigenous knowledge holders and embrace their ways of knowing at the research station. While the study is small in scale, as an international leader in freshwater science, transparency in the IISD-ELA's journey in reconciliation has the potential to inform, influence, and 'unsettle' settler-colonial scientists, field stations, and institutions across the country and beyond.

Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study

BACKGROUND

Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada.

METHODS

Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis.

FINDINGS

The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (-1·4 score, 95% CI -2·5 to -0·3; p=0·01), trust between neighbours (-0·7, -1·2 to -0·3; p=0·003), higher education level (-1·9, -2·9 to -0·8, p<0·001), and higher social support (-1·1, -2·0 to -0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score.

INTERPRETATION

Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing.

FUNDING

Heart and Stroke Foundation of Canada, Canadian Partnership Against Cancer, Canadian Institutes for Health Research.

Awareness as a dimension of health care access: exploring the case of rural palliative care provision in Canada

Objectives

In Canada, the rural elderly population is increasing in size, as is their need for palliative care services in these settings. This analysis aims to identify awareness-associated barriers to delivering rural palliative care services, along with suggestions for improving service delivery from the perspective of local health care providers.

Methods

A total of 40 semi-structured interviews with various formal and informal health care providers were conducted in four rural and/or remote Canadian communities with limited palliative care resources. Interview data were thematically coded using Penchansky and Thomas’ five dimensions of access (i.e. availability, (geographic) accessibility, accommodation, acceptability and affordability). Saurman’s recently added sixth dimension of access – awareness – was also identified while coding and subsequently became the primary focus of this analysis.

Results

Identified barriers to palliative care awareness and suggestions on how to enhance this awareness, and ultimately palliative care delivery, corresponded with three key themes arising from the data: limited palliative care knowledge/education, communication and coordination. Participants recognized the need for more palliative care education, open lines of communication and better coordination of palliative care initiatives and local resources in their communities.

Conclusions

These findings suggest that identifying the barriers to palliative care awareness in rural communities may be foundational to addressing barriers to the other five dimensions of access. A thorough understanding of these three areas of awareness knowledge, communication and coordination, as well as the connections between them, may help enhance how rural palliative care is delivered in the future.

Predictors of medical student interest in Indigenous health learning and clinical practice: a Canadian case study

BACKGROUND

Including content on Indigenous health in medical school curricula has become a widely-acknowledged prerequisite to reducing the health disparities experienced by Indigenous peoples in Canada. However, little is known about what levels of awareness and interest medical students have about Indigenous peoples when they enter medical school. Additionally, it is unclear whether current Indigenous health curricula ultimately improve students' beliefs and behaviours.

METHODS

A total of 129 students completed a 43-item questionnaire that was sent to three cohorts of first-year medical students (in 2013, 2014, 2015) at one undergraduate medical school in Canada. This survey included items to evaluate students' sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. The survey also assessed students' perceived importance of learning about Indigenous peoples in medical school, and their interest in working in an Indigenous community, which were examined as outcomes. Using principal component analysis, survey items were grouped into five independent factors and outcomes were modelled using staged multivariate regression analyses.

RESULTS

Generally, students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in an Indigenous community. When controlling for age and gender, the strongest predictors of perceived importance of learning about Indigenous health were positive sociopolitical attitudes about Indigenous peoples and knowledge about colonization and its links to Indigenous health inequities. Significant predictors for interest in working in an Indigenous community were positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community.

CONCLUSIONS

Students' positive sociopolitical attitudes about Indigenous peoples is the strongest predictor of both perceived importance of learning about Indigenous health and interest in working in Indigenous communities. In addition to teaching students about the links between colonization, health inequities and other knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula and include opportunities for experiential learning to shape students' future behaviours and ultimately improve physician relationships with Indigenous patients.

Chemical and microbial characteristics of municipal drinking water supply systems in the Canadian Arctic

Drinking water in the vast Arctic Canadian territory of Nunavut is sourced from surface water lakes or rivers and transferred to man-made or natural reservoirs. The raw water is at a minimum treated by chlorination and distributed to customers either by trucks delivering to a water storage tank inside buildings or through a piped distribution system. The objective of this study was to characterize the chemical and microbial drinking water quality from source to tap in three hamlets (Coral Harbour, Pond Inlet and Pangnirtung-each has a population of <2000) on trucked service, and in Iqaluit (population ~6700), which uses a combination of trucked and piped water conveyance. Generally, the source and drinking water was of satisfactory microbial quality, containing Escherichia coli levels of <1 MPN/100 mL with a few exceptions, and selected pathogenic bacteria and parasites were below detection limits using quantitative polymerase chain reaction (qPCR) methods. Tap water in households receiving trucked water contained less than the recommended 0.2 mg/L of free chlorine, while piped drinking water in Iqaluit complied with Health Canada guidelines for residual chlorine (i.e. >0.2 mg/L free chlorine). Some buildings in the four communities contained manganese (Mn), copper (Cu), iron (Fe) and/or lead (Pb) concentrations above Health Canada guideline values for the aesthetic (Mn, Cu and Fe) and health (Pb) objectives. Corrosion of components of the drinking water distribution system (household storage tanks, premise plumbing) could be contributing to Pb, Cu and Fe levels, as the source water in three of the four communities had low alkalinity. The results point to the need for robust disinfection, which may include secondary disinfection or point-of-use disinfection, to prevent microbial risks in drinking water tanks in buildings and ultimately at the tap.

Linking Inuit Knowledge and Public Health for Improved Child and Youth Oral Health in NunatuKavut

The oral health of Inuit children in Canada has been identified as a public health crisis. Although efforts are being made to identify and address ways to deal with this crisis, current policy and program approaches are largely entrenched within the prevailing paradigm of dental science to the exclusion of Indigenous people's understandings of health. This article reports qualitative findings of a larger study aimed at identifying, understanding, and addressing rates of oral disease among children living in NunatuKavut, a cluster of small, coastal Inuit communities located in southern Labrador, Canada. Through 18 focus groups with youth (n = 86), caregivers (n = 22), and interviews with key informant (n = 13), this study begins to elucidate southern Inuit understandings of oral health. Theorized using Two-Eyed Seeing, an Indigenous approach to balancing both Indigenous and non-Indigenous understandings of the world, the findings reported here reveal 3 themes, each of which is crosscut by historical and contemporary dimensions: 1) (w)holistic conceptualizations of health are essential to good oral health, 2) achieving optimal oral health is prohibitive for Inuit communities, and 3) community-engaged oral health service delivery is needed. Our recommendations have implications for improved oral public health service delivery for Inuit communities, in that the inclusion of Inuit perspectives on oral health should form an instrumental element of oral public health service delivery. Knowledge Transfer Statement: The results of this study may be used by clinicians and oral health educators to inform approaches to oral health service delivery within the context of Indigenous communities. It may also be used by policymakers to recognize how historical and contemporary issues of colonization relate to the formation of oral health-related policies.

"Put It Near the Indians": Indigenous Perspectives on Pulp Mill Contaminants in Their Traditional Territories (Pictou Landing First Nation, Canada)

BACKGROUND

Pictou Landing First Nation (PLFN), a small Mi'kmaw community on the Canadian east coast, has had a relationship with a tidal estuary known as A'se'k for millennia. In the 1960s, it became the site of effluent disposal from a nearby pulp mill. Almost immediately, health concerns regularly and consistently reverberated throughout the community.

OBJECTIVES

The Pictou Landing Native Women's Group (PLNWG) formed a community-based participatory research (CBPR) partnership with an academic team to conceptualize community well-being in the context of environment and human health connections. This paper documents Mi'kmaw Elders' stories of A'se'k before it became contaminated.

METHODS

Using narrative inquiry vis-à-vis oral histories, we carried out conversational interviews with 10 Elders from PLFN. These interviews were thematically analyzed and 're-storied' through a process of (w)holistic content analysis.

RESULTS

Our findings present four broad story layers, recounting the themes that emerged through analysis and presenting a broad Mi'kmaw narrative of A'se'k. These story layers share: what A'se'k originally provided, the historical/cultural context of PLFN, changes to land and health after the mill was put in, and reflections on the past and future of A'se'k.

CONCLUSIONS

Our research offers a novel contribution to the literature by showing how Mi'kmaw perspectives on the pollution at A'se'k reveal the close connection between Mi'kmaw livelihood, local ecologies, and health and well-being. Our research also provides insights into the way the research relationship developed between the PLNWG and the academic team, providing a pathway for others seeking to decolonize the research landscape.

Increasing Response Rates on Face-to-Face Surveys with Indigenous Communities in Canada: Lessons from Pictou Landing

BACKGROUND

Designing an effective survey for gathering primary health data using a community-based participatory research (CBPR) approach in Indigenous communities in Canada has its challenges. Yet, the Pictou Landing First Nation (PFLN) Native Women's Group (NWG) and academic research partners achieved a 59% response rate.

OBJECTIVES

To share lessons learned with both campus and community-based research teams engaged in CBPR involving Indigenous communities on the process of team development, and particularly survey development and execution, as well as the factors that led to a reliable and valid household level environmental health survey that achieved a 59% response rate.

METHODS

Multiple debriefings conducted over the course of the 12-month data collection period allowed us to modify our protocol to fit with community oscillations.

RESULTS/LESSONS LEARNED

Unique aspects of CBPR allowed for the development of a culturally appropriate survey protocol and culturally relevant variables that reflected the concerns of the NWG, and presenting preliminary data to the community also encouraged community buy-in to participate.

CONCLUSIONS

Sharing lessons learned in this project are intended to have positive implications for future CBPR projects wanting to collect primary health survey data involving Indigenous communities.

Revisiting the use of 'place' as an analytic tool for elucidating geographic issues central to Canadian rural palliative care

In 2010, Castleden and colleagues published a paper in this journal using the concept of 'place' as an analytic tool to understand the nature of palliative care provision in a rural region in British Columbia, Canada. This publication was based upon pilot data collected for a larger research project that has since been completed. With the addition of 40 semi-structured interviews with users and providers of palliative care in four other rural communities located across Canada, we revisit Castleden and colleagues' (2010) original framework. Applying the concept of place to the full dataset confirmed the previously published findings, but also revealed two new place-based dimensions related to experiences of rural palliative care in Canada: (1) borders and boundaries; and (2) 'making' place for palliative care progress. These new findings offer a refined understanding of the complex interconnections between various dimensions of place and palliative care in rural Canada.

Palliating inside the lines: The effects of borders and boundaries on palliative care in rural Canada

We draw lines to divide our world into specific places, territories, and categories. Although borders and boundaries are dynamic and socially constructed, their existence creates many broad impacts on our lives by geographically distinguishing between groups (e.g., us/them; here/there; inside/outside) at various scales from the national down to the personal spaces of the individual. Particularly, borders and boundaries can be used to define a variety of differing spaces such as the familial, social, economic, political, as well as issues of access - including access to health services. Despite the implicit connection between borders, boundaries, and health, little research has investigated this connection from a health geography perspective. As such, this secondary thematic analysis contributes to addressing this notable gap by examining how borders and boundaries are experienced and perceived to impact access to palliative care in rural Canada from the perspectives of the formal and informal providers of such care. Drawing upon data from qualitative interviews (n = 40) with formal and informal palliative caregivers residing in four different rural Canadian communities, five forms of borders and boundaries were found to directly impact care delivery/receipt: political; jurisdictional; geographical; professional; and cultural. Implicitly and explicitly, participants discussed these borders and boundaries while sharing their experiences of providing palliative care in rural Canada. We conclude by discussing the implications of our findings for palliative care in rural Canada, while also emphasizing the need for more health geography, and related social science, researchers to recognize the significance of borders and boundaries in relation to health and healthcare delivery. Lastly, we emphasize the transferability of these findings to other health sectors, geographical settings, and disciplines.

Asthma Prevention and Management for Aboriginal People: Lessons From Mi'kmaq Communities, Unama'ki, Canada, 2012

Background

Asthma affects at least 10% of Aboriginal children (aged 11 or younger) in Canada, making it the second most common chronic disease suffered by this demographic group; yet asthma support strategies specific to Aboriginal peoples have only begun to be identified.

Community Context

This research builds on earlier phases of a recent study focused on identifying the support needs and intervention preferences of Aboriginal children with asthma and their parents or caregivers. Here, we seek to identify the implications of our initial findings for asthma programs, policies, and practices in an Aboriginal context and to determine strategies for implementing prevention programs in Aboriginal communities.

Methods

Five focus groups were conducted with 22 recruited community health care professionals and school personnel in 5 Mi’kmaq communities in Unama’ki (Cape Breton), Nova Scotia, Canada, through a community-based participatory research design. Each focus group was first introduced to findings from a local “social support for asthma” intervention, and then the groups explored issues associated with implementing social support from their respective professional positions.

Outcome

Thematic analysis revealed 3 key areas of opportunity and challenges for implementing asthma prevention and management initiatives in Mi’kmaq communities in terms of 1) professional awareness, 2) local school issues, and 3) community health centers.

Interpretation

Culturally relevant support initiatives are feasible and effective community-driven ways of improving asthma support in Mi’kmaq communities; however, ongoing assistance from the local leadership (ie, chief and council), community health directors, and school administrators, in addition to partnerships with respiratory health service organizations, is needed.

Water systems, sanitation, and public health risks in remote communities: Inuit resident perspectives from the Canadian Arctic

Safe drinking water and wastewater sanitation are universally recognized as critical components of public health. It is well documented that a lack of access to these basic services results in millions of preventable deaths each year among vulnerable populations. Water and wastewater technologies and management practices are frequently tailored to local environmental conditions. Also important, but often overlooked in water management planning, are the social, cultural and economic contexts in which services are provided. The purpose of this qualitative case study was to identify and understand residents' perceptions of the functionality of current water and wastewater sanitation systems in one vulnerable context, that of a remote Arctic Aboriginal community (Coral Harbour, Nunavut), and to identify potential future water related health risks. Semi-structured interviews were conducted with 28 Inuit residents and 9 key informants in 2011 and 2012. Findings indicate that the population's rapid transition from a semi-nomadic hunting and gathering lifestyle to permanent settlements with municipally provided utilities is influencing present-day water usage patterns, public health perceptions, and the level of priority decision-makers place on water and wastewater management issues. Simultaneously environmental, social and cultural conditions conducive to increased human exposure to waterborne health risks were also found to exist and may be increasing in the settlements. While water and wastewater system design decisions are often based on best practices proven suitable in similar environmental conditions, this study reinforces the argument for inclusion of social, cultural, and economic variables in such decisions, particularly in remote and economically challenged contexts in Canada or elsewhere around the world. The results also indicate that the addition of qualitative data about water and wastewater systems users' behaviours to technical knowledge of systems and operations can enhance the understanding of human-water interactions and be valuable in risk assessments and intervention development.

Contemporary programs in support of traditional ways: Inuit perspectives on community freezers as a mechanism to alleviate pressures of wild food access in Nain, Nunatsiavut

Rapid socio-cultural, economic, and environmental changes are challenging wild food access and thus food security for Inuit in the Canadian Arctic. In response to the continued value and practice of harvesting wild foods, communities are establishing "wild food support" initiatives. This study evaluated how one such initiative, a community freezer, in Nain, Nunatsiavut supported wild food access for community members. Data were collected through: interviews and focus groups with users, freezer managers, and active harvesters; participant observation; and document analysis. Results indicated that the community freezer supported socio-cultural, economic and local access to wild foods. However, there were issues associated with supply, dependency, social exclusion, and tension between feasibility and traditional values and practices. Communities, governments, and policymakers are urged to consider social and physical location as factors when investing in and monitoring such initiatives. The Nunatsiavut Government and the Nain Inuit Community Government have since worked together to modify this early freezer initiative due, in part, to this study's findings.

Municipal water quantities and health in Nunavut households: an exploratory case study in Coral Harbour, Nunavut, Canada

Background

Access to adequate quantities of water has a protective effect on human health and well-being. Despite this, public health research and interventions are frequently focused solely on water quality, and international standards for domestic water supply minimums are often overlooked or unspecified. This trend is evident in Inuit and other Arctic communities even though numerous transmissible diseases and bacterium infections associated with inadequate domestic water quantities are prevalent.

Objectives

Our objective was to explore the pathways by which the trucked water distribution systems being used in remote northern communities are impacting health at the household level, with consideration given to the underlying social and environmental determinants shaping health in the region.

Methods

Using a qualitative case study design, we conducted 37 interviews (28 residents, 9 key informants) and a review of government water documents to investigate water usage practices and perspectives. These data were thematically analysed to understand potential health risks in Arctic communities and households.

Results

Each resident receives an average of 110 litres of municipal water per day. Fifteen of 28 households reported experiencing water shortages at least once per month. Of those 15, most were larger households (5 people or more) with standard sized water storage tanks. Water shortages and service interruptions limit the ability of some households to adhere to public health advice. The households most resilient, or able to cope with domestic water supply shortages, were those capable of retrieving their own drinking water directly from lake and river sources. Residents with extended family and neighbours, whom they can rely on during shortages, were also less vulnerable to municipal water delays.

Conclusions

The relatively low in-home water quantities observed in Coral Harbour, Nunavut, appear adequate for some families. Those living in overcrowded households, however, are accessing water in quantities more typically seen in water insecure developing countries. We recommend several practical interventions and revisions to municipal water supply systems.

Identifying gaps in asthma education, health promotion, and social support for Mi'kmaq families in Unama'ki (Cape Breton), Nova Scotia, Canada

INTRODUCTION

Asthma is the most common chronic condition affecting Aboriginal youth aged 8 to 12 years in Canada. Research investigating psychosocial challenges associated with asthma is limited. This study examines support resources, support-seeking strategies, support and education needs, and intervention preferences of Aboriginal youth with asthma and their caregivers in an effort to encourage community-wide, health-promoting behaviors.

METHODS

We employed a community-based participatory research design to conduct interviews with 21 youths aged 8 to 12 years and 17 caregivers from 5 Mi'kmaq communities in Unama'ki (Cape Breton) Nova Scotia, Canada. After conducting interviews that explored existing and desired social, educational, and health support in participating communities, we held a 2-day asthma camp to engage participants in asthma education, social support networking, and cultural activities. At the camp, we collected data through participant observation, sharing circles, focus groups, and youth drawings of their experiences living with asthma.

RESULTS

Our study yielded 4 key findings: 1) asthma triggers included household mold, indoor smoking, pets, season change, strenuous exercise, extreme cold, and humidity; 2) social and educational support is lacking in Mi'kmaq communities despite a strong desire for these services; 3) cultural, linguistic, and geographic barriers to accessing support exist; and 4) family members are primary support resources.

CONCLUSION

Improved support and educational resources are needed to foster effective Mi'kmaq asthma support networks. Future asthma interventions for marginalized populations must be culturally meaningful and linguistically accessible to those using and providing asthma support.

Researchers' perspectives on collective/community co-authorship in community-based participatory indigenous research

Ethical tensions exist regarding the value and practice of acknowledging Indigenous contributions in community-based participatory research (CBPR). Semistructured phone interviews with researchers documented their perspectives on authorship in the scholarly dissemination of their community-based participatory Indigenous research. Thematic analysis resulted in four key ideas: (1) current practices regarding methods of acknowledging community contributions; (2) requirements for shared authorship with individual versus collective/community partners; (3) benefits to sharing authorship with collective/community partners; and (4) risks to sharing authorship with collective/community partners. Findings suggest an emerging but inconsistent practice.

'Heated political dynamics exist ...': examining the politics of palliative care in rural British Columbia, Canada

Palliative care is delivered by a number of professional groups and informal providers across a range of settings. This arrangement works well in that it maximizes avenues for providing care, but may also bring about complicated 'politics' due to struggles over control and decision-making power. Thirty-one interviews conducted with formal and informal palliative care providers in a rural region of British Columbia, Canada, are drawn upon as a case study. Three types of politics impacting on palliative care provision are identified: inter-community, inter-site, and inter-professional. Three themes crosscut these politics: ownership, entitlement, and administration. The politics revealed by the interviews, and heretofore underexplored in the palliative literature, have implications for the delivery of palliative care. For example, the outcomes of the politics simultaneously facilitate (e.g. by promoting advocacy for local services) and serve as a barrier to (e.g. by privileging certain communities/care sites/provider) palliative care provision.

Providers' perceptions of Aboriginal palliative care in British Columbia's rural interior

Aboriginal Canadians experience a disproportionate burden of ill-health and have endured a history of racism in accessing and using health care. Meanwhile, this population is rapidly growing, resulting in an urgent need to facilitate better quality of living and dying in many ways, including through enhancing (cultural) access to palliative care. In this article, we report the findings from a qualitative case study undertaken in rural British Columbia, Canada through exploring the perceptions of Aboriginal palliative care in a region identified as lacking in formal palliative care services and having only a limited Aboriginal population. Using interview data collected from 31 formal and informal palliative care providers (May-September 2008), we thematically explore not only the existing challenges and contradictions associated with the prioritisation and provision of Aboriginal palliative care in the region in terms of (in)visibility but also identify the elements necessary to enhance such care in the future. The implications for service providers in rural regions are such that consideration of the presence of small, and not always 'visible', populations is necessary; while rural care providers are known for their resilience and resourcefulness, increased opportunities for meaningful two-way knowledge exchange with peers and consultation with experts cannot be overlooked. Doing so will serve to enhance culturally accessible palliative care in the region in general and for Aboriginal peoples specifically. This analysis thus contributes to a substantial gap in the palliative care literature concerning service providers' perceptions surrounding Aboriginal palliative care as well as Aboriginal peoples' experiences with receiving such care. Given the growing Aboriginal population and continued health inequities, this study serves to not only increase awareness but also create better living and dying conditions in small but incremental ways.

Visioning for secondary palliative care service hubs in rural communities: a qualitative case study from British Columbia's interior

Background

As the populations of many developed nations continue to age at rapid rates it is becoming increasingly important to enhance palliative care service delivery in order to meet anticipated demand. Rural areas face a number of challenges in doing this, and thus dedicated attention must be given to determining how to best enhance service delivery in ways that are sensitive to their particular needs. The purposes of this article are to determine the vision for establishing secondary palliative care service hubs (SPCH) in rural communities through undertaking a case study, and to ascertain the criteria that need to be considered when siting such hubs.

Methods

A rural region of British Columbia, Canada was selected for primary data collection, which took place over a five-month period in 2008. Formal and informal palliative care providers (n = 31) were interviewed. A purposeful recruitment strategy was used to maximize occupational and practice diversity. Interviews were conducted by phone using a semi-structured guide. Interviews were audio recorded and transcribed verbatim. Data were managed using NVivo8™ software and analyzed thematically, using investigator triangulation to strengthen interpretation.

Results

Four themes emerged from the dataset: (1) main SPCH features; (2) determining a location; (3) value-added outcomes; and (4) key considerations. It was found that participants generally supported implementing a SPCH in the rural region of focus. Several consistent messages emerged, including that: (1) SPCHs must create opportunities for two-way information exchange between specialists and generalists and communities; (2) SPCHs should diffuse information and ideas throughout the region, thus serving as a locus for education and a means of enhancing training opportunities; and (3) hubs need not be physical sites in the community (e.g., an office in a hospice or hospital), but may be virtual or take other forms based upon local needs.

Conclusion

Visioning innovation in the provision of palliative care service in rural communities can be enhanced by consultation with local providers. Interviews are a means of determining local concerns and priorities. There was widespread support for SPCH coupled with some uncertainty about means of implementation.

"We listen to our Elders. You live longer that way": examining aquatic risk communication and water safety practices in Canada's North

This paper examines ways in which Aboriginal residents of Taloyoak, Nunavut and Tuktoyaktuk, Northwest Territories perceive aquatic-based risk communication, and how this information could be used to improve water safety. We argue that aquatic risk communication with northern Aboriginal populations can be improved by identifying and accounting for the consequences of colonialism in the context of aquatic risk communication and, in turn, decolonizing water safety programs north of the 60th parallel-Canada's North.

Modifying Photovoice for community-based participatory Indigenous research

Scientific research occurs within a set of socio-political conditions, and in Canada research involving Indigenous communities has a historical association with colonialism. Consequently, Indigenous peoples have been justifiably sceptical and reluctant to become the subjects of academic research. Community-Based Participatory Research (CBPR) is an attempt to develop culturally relevant research models that address issues of injustice, inequality, and exploitation. The work reported here evaluates the use of Photovoice, a CBPR method that uses participant-employed photography and dialogue to create social change, which was employed in a research partnership with a First Nation in Western Canada. Content analysis of semi-structured interviews (n=45) evaluated participants' perspectives of the Photovoice process as part of a larger study on health and environment issues. The analysis revealed that Photovoice effectively balanced power, created a sense of ownership, fostered trust, built capacity, and responded to cultural preferences. The authors discuss the necessity of modifying Photovoice, by building in an iterative process, as being key to the methodological success of the project.