Indigenous Health Research Monitoring, October 2020

In this issue:

Descriptive Section

 List of scientific publications and articles

Analytical Section

Methodologies and knowledge

Research methodology and community participation: A decade of Indigenous social science research in Canada

Context

In Canada, social science research has been regulated by the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS) since 1998. Research ethics policies promote the use of methods involving the participation of communities often excluded from spheres of power, such as Indigenous communities.
Participatory research requires a sharing of power between researchers and the community. There may, however, be tensions between the objectives of the two parties. Researchers must deal with institutional barriers pertaining to participatory research, while Indigenous communities have an interest in upholding their active participation and validating their knowledge and epistemologies.

Objectives

This study aims to shed light on the relationship between research policies, theoretical frameworks, methods employed and community participation in social science publications in Canada.

Methodology and data

A search for documents listed in university social science databases and websites identified a body of peer-reviewed scientific articles published between 2005 and 2015. Of those documents, 497 sources were retained. The analysis looked at the methodology and epistemological paradigms used, the degree of Indigenous participation, whether or not the project was initiated and led by Indigenous persons, and the declared identity of the authors (Indigenous or otherwise).

What was learned?

Of the 497 sources retained, less than half included interaction with Indigenous individuals, with those studies being conceptual or theoretic in nature. A very small number of studies (4.8% or 24 out of 497) met the definition of research led by Indigenous communities.
The authors established a correlation between 1) Indigenous participation, measured by the level of community participation, community-led research and Indigenous authors, and 2) the incorporation of Indigenous epistemologies, data sources and more participatory analysis methods. Moreover, the study clearly demonstrates that most research is led by non-Indigenous researchers.
Research involving interaction with Indigenous participants could therefore go beyond the minimum requirements of TCPS/TCPS 2 in order to expand and support significant participation by Indigenous individuals.

Limitations

The authors point out the irony of having used an approach to classification and analysis based on Western epistemology. They selected only articles written in English and adopted peer review—a very academic approach to knowledge sharing that is not necessarily coherent with the principles and values of Indigenous communities. They also specify that unpublished results and applied research by governments and nongovernmental organizations were excluded.

Dion, M.L., Díaz Ríos, C., Leonard, K. and Gabel, C. (2020). Research Methodology and Community Participation: A Decade of Indigenous Social Science Research in Canada. Canadian Review of Sociology/Revue canadienne de sociologie, 57, 122-146.

Mental health and wellbeing

Intersectionality of resilience: A strengths-based case study approach with Indigenous youth in an urban Canadian context

Context

Many researchers studying Indigenous health are interested in the concepts of wellbeing and resilience as factors that can improve the ability of individuals and communities to adapt and even flourish in the face of adversity. To fill the gap in research combining the concept of intersectionality with a strengths‑based approach, the authors developed a new theoretical framework—the intersectionality of resilience—in order to encourage a holistic understanding of the factors involved in the resilience process.

Objectives

This research explores possible interactions among individual, community and structural factors that foster resilience and wellbeing for urban Indigenous youth in Saskatchewan by mobilizing the theoretical framework of the intersectionality of resilience and Indigenous methodologies.

Methodology and data

The authors combine Indigenous methodologies (close collaboration with participants and the community, sharing circles, participant observations, etc.) with the case study approach (Stake, 1995) in analyzing the experiences of Indigenous youth. This association, described as “two eyes seeing,” makes it possible to combine Indigenous frameworks and methodologies with Western constructivist methods. The authors compared data collected through four sharing circles, 38 conversational interviews, four photovoice series, and participant observation of 28 youth over a one-year period to better understand the influence of various factors on youth resilience and wellbeing. The case studies are based on the experience of six youth who participated in all research activities. The youth and representatives of partner organizations collaborated in all research phases at regular intervals.

What was learned?

The youth describe resilience as a strong determination to self-develop throughout their lives, be it through education, managing problems, assuming responsibility or exerting a positive influence on others. The resilience expressed by these young people was supported by a safe place to get away to or a positive aspect to focus on. In their eyes, resilience also means being engaged in social or community activities, such as volunteering and cultural projects.
The life stories of the young people are presented around three encompassing themes: a) strengthening cultural identity and family relationships; b) engaging in social groups by taking care of oneself and the community; c) practising artistic expression and developing a positive outlook on life. The authors suggest investing in the development of programs focusing on culture and artistic expression to encourage Indigenous youth to take the path to resilience.

Limitations

The authors identify certain criticisms of the concept of intersectionality, such as a risk of confusion by attempting to pool a large number of factors. In addition, what the youth had to say may have been nuanced by the participants’ support workers or families.

Njeze, C., Bird-Naytowhow, K., Pearl, T., & Hatala, A. R. (2020). Intersectionality of Resilience: A Strengths-Based Case Study Approach With Indigenous Youth in an Urban Canadian Context. Qualitative Health Research.

Risk factors associated with developing anxiety in Inuit adolescents from Nunavik

Context

The scientific literature points to risk factors associated with anxiety in young people. Clinical levels of anxiety in young people are associated with emotional distress, poor quality of life and difficulty functioning in social, family and school settings. The prevalence of anxiety among the Inuit population in Canada is poorly documented. Some studies identify this population as being at risk given the difficult living conditions faced by many Inuit. The suicide rate among Inuit youth is 11 times higher than the Canadian average.
In addition to socioeconomic factors, environmental contaminants—specifically mercury, PCBs and lead—could have an impact on the risks of developing anxiety. The potential role played by exposure to environmental contaminants has not yet been examined, and Arctic communities are the most exposed to heavy metals and organochlorine compounds, which are found in the region’s food chain.

Objectives

This research on Inuit adolescents in Nunavik examines the relationship between anxiety and various risk factors that may have long-term observable or persistent effects. Based on a series of longitudinal studies, this research measures objective biomarkers associated with psychosocial phenomena and exposure to toxic environmental contaminants from the prenatal period to adolescence.

Methodology and data

The study had 89 participants (mean age = 18.4 years; range = 16.2 to 21.9 years) from 14 coastal villages in Nunavik. Anxiety was assessed using the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the State-Trait Anxiety Inventory (STAI). The data presented comes from a sub-study conducted in a neuroimaging laboratory in Montréal. The adolescent volunteers stayed in Montréal with a parent for three days. The tests were conducted in English, and statistical analyses were produced using the SPSS 22 software.
The potential risk factors associated with developing anxiety were documented at birth, 11 years of age and 18 years of age. They include blood levels of chemical products (mercury, lead and PCBs) and nutrients, age, sex, estimated IQ, drug and alcohol use, bullying, exposure to domestic violence, food insecurity, overpopulation and socioeconomic status.

What was learned?

The results demonstrate a high level of anxiety among Inuit adolescents, who generally score above the clinical threshold for SCARED (53.49%) and for STAI (39.29%). Girls are more likely to present with anxiety, and having experienced bullying within the past year is associated with chronic anxiety. A lower IQ is also linked with a higher level of anxiety. These results concur with the literature on the subject.
Food insecurity, blood mercury level and nutritional deficiencies are significant risk factors for developing anxiety. The data presented in this study shows the complex balance between the risks and benefits of the traditional diet of the Inuit (who struggle with food insecurity), a diet that is an important source of iron and vitamins A, C and E.
Data concerning a link between the presence of mercury in the blood and anxiety among the Inuit is not conclusive, but hypotheses associate mercury with neurotoxic effects in key brain regions associated with processing emotions. It is to be hoped that further research will clarify the conditions and mechanisms involved in this issue.

Limitations

The authors considered confounding factors but state that it is impossible to take into consideration all such factors having an impact on risk factors. For example, the study did not take into account adverse events that may have occurred during the year preceding the investigation. Furthermore, quality of sleep and level of physical activity were not analyzed as factors protecting against the development of anxiety.
They authors underline that the tests and questionnaires are based on the Western medical model and were conducted in English. The Inuit conception of mental health, a unique individual transitory state, distinct from the person and associated with an overall context, also differs widely from the Western concept, which links it to personal identity. Finally, being in Montréal away from their region may have had a positive or negative influence on the anxiety level of the participants.

Lamoureux-Tremblay, V., Muckle, G., Maheu, F., Jacobson, S. W., Jacobson, J. L., Ayotte, P., Bélanger, R. E. & Saint-Amour D. (2020). Risk factors associated with developing anxiety in Inuit adolescents from Nunavik. Neurotoxicology and Teratology, 81.

Prevention and health promotion programs and approaches

Closing the gap between rhetoric and practice in strengths‑based approaches to Indigenous public health: A qualitative study

Context

This article presents the results of a research project that examines the relevance of a strengths-based approach adopted by Indigenous public health programs in Australia. This approach emerged in the early 2000s in Indigenous environments in Australia and was aimed at getting away from a deficit discourse in which Indigenous health was viewed as a problem to be solved.
The authors qualify the presence of the strengths-based approach in the Indigenous health literature as “epidemic.” They also observe a lack of consistency in its definition and applications.

Objectives

This qualitative research project revisits the Indigenous conceptualization of the strengths-based approach through analysis of what community support workers at an Australian Indigenous organization have to say.

Methodology and data

Semi-directed interviews were conducted with 12 community support workers, seven of whom are women. Eleven participants self-identify as Indigenous, and ten self-identify as belonging to a participating community. Participants were recruited using the “snowball” method. The interviews were conducted by two researchers and recorded. The verbatim interviews were transcribed and coded to analyze 1) the definition of the participants’ approach (theoretical conception) and 2) how the approach was operationalized within the organization (practical expression). The analysis was made with the help of the theoretical framework of Martin and Mirraboopa (2003) in accordance with Indigenous principles of research and ontology.

What was learned?

For the community support workers interviewed, the strengths-based approach is rooted in common sense. It is a way of being and the only way to do Indigenous health work. The client and support worker are seen to have equal roles in a relationship of mutual learning, where each is part of both the problem and the solution. Rooted in the community and possessing experiential knowledge of the structural conditions underlying social and health inequality issues affecting the community, the participants describe the strengths-based approach as a meaningful engagement in the relationship with the individual, with the certainty that “being Indigenous is something wonderful.”
The authors warn the reader against the public health stance—rooted in power—recommending that oppressed peoples “stay strong” while ignoring the underlying causes of social inequality pertaining to health. By focusing on surveillance indicators, diseases and the perception of Indigenous health as a problem to be solved, public health monitors and measures the gap between Indigenous and non‑Indigenous populations. The authors suggest that more interest be taken in redistributing control over Indigenous health and in assessing the weight of stereotypes versus the value assigned Indigenous knowledge and expertise.

Limitations

The authors do not identify the limitations of their study. The scientific knowledge presented must therefore be interpreted with caution.

Askew, D.A., Brady, K., Mukandi, B., Singh, D., Sinha, T., Brough, M. and Bond, C.J. (2020). Closing the gap between rhetoric and practice in strengths‐based approaches to Indigenous public health: a qualitative study. Australian and New Zealand Journal of Public Health, 44, 102-105. Available here: PDF

The information selected expresses the opinion of the authors quoted and not that of the INSPQ. The methodology for monitoring research into Indigenous health is available here.

The French version is entitled Veille scientifique en santé des Autochtones.
Translation by Services d’édition Guy Connolly.