Indigenous Health Research Monitoring, April 2025

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Scoping review of outdoor and land-based prevention programs for Indigenous youth in the United States and Canada

Price, F. M., Weaselhead-Running Crane, T. D., and Weybright, E. H. (2025). Scoping review of outdoor and land-based prevention programs for Indigenous youth in the United States and Canada. International Journal of Environmental Research and Public Health, 22(2), Article 183.

Context

Many Indigenous communities implement a range of programs aimed at revitalizing culture‑based lifestyles. Land-based interventions are often designed by communities and integrate traditional knowledge. While such interventions are culturally appropriate, there is little data concerning their design, implementation, characteristics and effects. 

Objectives

Examine the scope of the literature on prevention programs focused on nature- or land-based activities for Indigenous youth in the United States and Canada in order to answer the following questions:

  • What are the characteristics of these programs?
  • Among the studies evaluated, what methods and tools are used and what effects have been identified?

Methods

This scoping review was conducted under guidelines of the Joanna Briggs Institute and included peer-reviewed articles and grey literature published in English between 2000 and 2023. The interventions described had to have taken place outdoors and been either adventure therapy (a term used in the general literature on outdoor activities) or land-based (a term specific to Indigenous contexts). The study objective had to concern health and general wellbeing prevention or promotion. Finally, the target population had to have been Indigenous youth aged 10 to 25 living in the United States or Canada. 

Among the selected documents, program characteristics and evaluation methods were analyzed using frequencies and a thematic analysis developed by the authors.

What was learned? 

A total of 98 documents were selected (51 peer-reviewed articles and 47 documents from the grey literature), a majority of which were published in the last 10 years. The articles describe 153 projects, 28 of which were evaluated.

Concerning program design and objectives, more than three quarters of the programs identified were developed by the communities where they were implemented. Generally speaking, the programs were aimed at promoting general wellbeing by adopting a strength-based perspective. About three studies in ten emphasized the prevention of substance use and/or suicide prevention among young people.

As for the activities implemented, cultural and recreational activities involving Elders stood out in the program descriptions. All but four programs included cultural dimensions, such as survival skills (e.g. building a shelter), knowledge sharing by Elders, spiritual practices, Indigenous languages or activities at a sacred site. About eight programs in ten involved recreational activities such as games, sports or activities like camping and canoeing.

Finally, program evaluations included a variety of specifications (quantitative, qualitative and mixed). The 22 evaluations that were quantitative or mixed primarily used measurement tools validated by Indigenous peoples. Generally, the evaluations reported various positive effects, including personal development and building relationships with the culture and the community. Moreover, some studies incorporated holistic measurements of wellbeing, including physical, mental, emotional and spiritual health.

Limitations

The authors point out the possibility that some programs were not captured in the selection process. In addition, it was difficult to determine what proportion of a program spent in a natural environment was sufficient to merit selecting a given study. In this regard, the authors preferred leaning towards inclusion, selecting a study when even just one component of an activity was conducted outdoors. Moreover, the inclusion of studies from the grey literature increased the number of programs selected, but the descriptions in those studies offered fewer details. It should be noted that the quality of the selected studies was not assessed. The results presented concerning effectiveness must therefore be interpreted with caution.

Measuring wellness through Indigenous partnerships: A scoping review

Mad Plume, L., Carroll, D., Nadeau, M., and Redvers, N. (2024). Measuring wellness through Indigenous partnerships: A scoping review. International Journal of Environmental Research and Public Health, 22(1), Article 43.

Context

Many governments and organizations use indicators to measure the wellness of populations and to monitor their health. However, those indicators do not always adequately reflect Indigenous concepts of health and wellness, which are closely linked to identity, culture and ways of life. For this reason, identifying measurements of wellbeing that are relevant in Indigenous contexts would improve the consistency and quality of health assessments.

Objectives

Survey the literature on designing measurements of wellness in partnership with Indigenous populations, more specifically:

  • Identify measurements of wellness designed in partnership
  • Describe the participatory and community-based design processes
  • Ascertain gaps in research on the subject.

Methods

This scoping review was conducted in accordance with the Arksey and O’Malley Methodological Framework. A search of the scientific and grey literature published up until October 2024 was conducted using the following keywords: Indigenous, wellness and Indigenous partnerships. Documents were selected by agreement among a team of Indigenous and non-Indigenous researchers, and a thematic analysis was conducted of their content. 

What was learned? 

Eighteen documents were selected from Australia, Canada, New Zealand and the United States. Only one project included a more global perspective of wellbeing measurement initiative. The other 17 documents present studies involving a partnership with a specific Indigenous Nation or community.

The authors identify five themes contributing to the definition of wellness measurements in partnership with Indigenous populations: 

  • Building relationships that uphold Indigenous worldviews, genuine commitment and authentic partnerships—for example, recognizing that individual wellness is interconnected with a set of relationships
  • Codeveloping measures to mitigate power imbalances between Indigenous and Western approaches and enable reciprocal learning—for example, using Indigenous methods
  • Being aware of the limitations in measuring wellness within Indigenous contexts—for example, taking into consideration the diversity of Peoples and communities and including the various dimensions of wellness, as well as the limitations of policies developed on the basis of indicators that fail to reflect Indigenous context.
  • Taking into account the specific context of each community—for example, the different types of knowledge, relationships and power dynamics in decision making
  • Valuing wellness indicators based on strengths, self-determination and empowerment—for example, spirituality and culture.

The selected literature points to a two-way or shared learning process to encourage equitable partnerships that combine Indigenous and Western views of wellness. That said, only the Australian studies included Indigenous methods and perspectives. Moreover, few of the studies adopted a participatory community-based approach or integrated the knowledge and perspective of Elders and young people, which can yield a better understanding of current challenges to Indigenous wellness. 

Another significant point concerns the ethical implications of evidence-based approaches in Indigenous contexts aimed at effective wellness promotion activities. Such approaches are increasingly considered to be based on socially constructed evidence and therefore potentially limited for taking into account cultural differences when designing measures that respect and integrate Indigenous knowledge.

Limitations

It should be remembered that the terminology around wellness and Indigenous peoples is vast. Some studies may have been omitted because the use of these concepts, and the notion of Indigenous partnerships yielded a rather restricted pool of literature. The oral tradition of several Indigenous communities may also have limited the publication of projects. Finally, the results of this scoping review may not be applicable to some specific Indigenous contexts.

Implementing a strength-based adverse childhood experiences prevention program for predominantly Indigenous families: A mixed-method process evaluation

Waterman, E. A., Edwards, K. M., Hopfauf, S., Herrington, R., Mullet, N., and Trujillo, P. (2025). Implementing a strength-based adverse childhood experiences prevention program for predominantly Indigenous families: A mixed-method process evaluation. Child Abuse & Neglect, 161, 107230.

Context

Adverse childhood experiences, such as abuse, neglect or exposure to domestic violence, are associated with numerous health consequences as an adult, including diabetes and depression. The Indigenous population in the United States reports a high level of such experiences. Despite this situation, few programs to prevent adverse childhood experiences in Indigenous families have been rigorously evaluated, specifically with respect to their implementation.

In this regard, Tiwahe Wicagwicayapi (“strengthening of families” in the Lakota language) is a strengths-based, family-centred program aimed at preventing adverse childhood experiences by improving family cohesion, communication, emotional regulation, problem solving, parental supervision, and empowerment of children. Cultural components (e.g., prayer, smudging and storytelling) were integrated into the seven sessions led by Indigenous adults and Lakota Elders.

Objective

Evaluate the Tiwahe Wicagwicayapi implementation process by describing program fidelity, attendance levels and barriers to attendance, contamination rates, and program acceptability.

Methods

This study was part of a randomized control trial aimed at evaluating the Tiwahe Wicagwicayapi program. The project took place in a small-sized city close to several rural Indigenous communities in the Great Plains region of the northern United States. The evaluation, which used a mixed methods approach, included multiple sources of data: observations; surveys at the start and end of the program as well as six months afterwards; and participant interviews. 

The sample comprised 124 randomized families on a waiting list (n = 58 families; 145 individuals; 58 parents; 87 children) or in the program (n = 66 families; 173 individuals; 66 parents; 107 children). The term “parent” refers to any adult responsible for a child. To be eligible, children had to be between the ages of 10 and 14, identify as Indigenous (92.7% of participating children) or come from a family living below the poverty line. 

What was learned? 

Four aspects of the implementation process were evaluated: fidelity, attendance, contamination and acceptability. The results point to many successes as well as a few shortcomings.

  • Fidelity: Fidelity refers to implementation of the program as described in the manual in the same way and for all groups. The overall fidelity score was high—an average of 93% and a range from 56% to 100% depending on the session. This indicates that the leaders followed the manual scrupulously. Lower fidelity scores were the result of strong engagement on the part of the participants, who asked many questions and told stories about their culture and the delivery of care. This limited the time available for other activities. A lack of staff and participants being late for sessions also contributed to lower fidelity scores.
  • Attendance: Attendance refers to participation throughout the entire program. Among the 66 parents in the program group, three quarters (n = 50; 75.8%) attended at least one session. On average, parents attended 2.44 sessions. Among children, 79 of 107 (73.8%) attended at least one session, and the average number of sessions attended was 2.24. Barriers to attendance included one-off obstacles such as a personal appointment, medical appointments, including mental health emergencies, births and deaths, as well as transportation issues. The possibility of offering make-up sessions, home visits or transportation services could therefore be explored.
  • Contamination: Contamination refers to the extent to which the control group was exposed to the intervention. Of that group, 87 children (32.6%) and 58 parents (36.2%) reported contamination by friends or family members following the program. This high level of contamination is not surprising given that the study took place in a close-knit community with extended family ties and frequent contact.
  • Acceptability: Acceptability refers to the participants’ perception of the program’s relevance. It was well received by both parents and children. Participants particularly appreciated content related to Lakota culture, traditions and ceremonies. The results of the survey at the end of the intervention suggest learning took place with respect to cultural content and safety. 

Limitations

The authors mention encountering problems in contacting a quarter of the families invited, who didn’t attend any sessions. In addition, the participants interviewed at the end of the project had developed a relationship with the facilitators, which may have positively biased their feedback. Social desirability and researchers’ expectations are other potential limitations.

Revitalising strong cultural connections and resilience: Co‑designing a pilot Elder-led mentorship program for Indigenous mothers in a remote northern community in Alberta, Canada

Montesanti, S., Fitzpatrick, K. M., Verstraeten, B. S. E., Tourangeau, B., Albert, L., and Oster, R. T. (2025). Revitalising strong cultural connections and resilience: Co-designing a pilot Elder-led mentorship program for Indigenous mothers in a remote northern community in Alberta, Canada. Global Public Health, 20(1), 2457109.

Context   

In Canada, colonial policies such as residential schools and the removal of children from their families by youth protection services disrupted the reproductive and parenting practices of Indigenous women. This disruption affected family ties, intergenerational cultural transmission and involvement in community life. The intergenerational transmission of parental knowledge is essential to the wellbeing of Indigenous mothers and their children. 

A pilot mentorship program by female Elders was developed, implemented and evaluated in Fort Chipewyan, a small remote Indigenous community in northern Alberta. Families living in Fort Chipewyan are geographically isolated from obstetric services, including those provided by midwives.

Objectives   

  • Reinforce relationships between female Elders and both mothers and pregnant women in order to promote cultural reconnection and resilience.
  • Understand the need for perinatal support for Indigenous women living in remote regions.
  • Evaluate the social, cultural and personal benefits of the pilot project for Indigenous mothers and pregnant women.

Methods  

The community of Fort Chipewyan collaborated with researchers in adapting to their needs and context a pilot mentorship program led by female Elders through a research partnership with members of the Fort Chipewyan community and an Elders Advisory Committee. The project was guided by the principles of participatory community research and relational approaches aimed at decolonizing research.

Twelve workshops led by female Elders featured traditional activities, knowledge sharing about identity and cultural values, storytelling, and cultural instruction concerning pregnancy, delivery, childcare and parenting skills. Nine mothers and pregnant women self‑identifying as Métis or First Nations were recruited for the program by the snowball sampling method, including five who attended more than 6 of the 12 workshops.

A survey about past experiences in accessing pregnancy or family services was completed by the participants before the workshops. A virtual sharing circle with the advisory committee and Elder workshop leaders was held after the workshops, as were individual interviews with the mothers. A qualitative analysis was used to explore how the project influenced the understanding of the role of female Elders as mentors and Indigenous mothers’ need for care.

What was learned?   

In the survey, the mothers identified the limited availability of perinatal services, transportation and access childcare services, as well as professional responsibilities and social anxiety as barriers to accessing perinatal services. The three services most often cited as essential during the perinatal period were: food coupons, traditional activities and training on becoming a parent.

Four themes emerged from the qualitative analysis of the sharing circle and interviews with the mothers:

  • The meaningful role of Elder mentorship for mothers and pregnant women: The Elders emphasized that active listening, the transmission of traditional knowledge, compassion and setting an example helped them to build solid relationships with the mothers. The mothers pointed out the essential role of Elders in transmitting cultural traditions and knowledge. The teaching they received improved their confidence and parenting skills.
  • The workshops provided a safe space to develop relationships: It was reported that some mothers do not have a positive role model in their community. The relationship with Elders helped fulfill this need. The mothers said that the workshops provided a safe space for sharing and building relationships with other mothers, strengthening their sense of belonging to the community and fostering social support.
  • Participation in workshop activities fostered positive coping skills and improved self-esteem: The Elders noticed that self-esteem, the ability to adapt and parenting skills were underdeveloped among the community’s young mothers. One mother noted herself that her participation in the workshops made her a better parent. The Elders reported feeling a deep sense of pride about the changes observed in the mothers.
  • Cultural connection and transference of traditional knowledge to younger generations: All the mothers reported that the mentoring by Elders had strengthened their connection to their culture. They described how cultural teachings had encouraged them to transmit traditions to their own? children. Some mothers did not have anyone in their lives to teach them about customary practices in their Indigenous culture.

Limitations   

It should be noted that participation in the workshops was not consistent. The participants noted that family circumstances, program logistics, and a lack of transportation and daycare services were obstacles to attending. In addition, the Elders felt that the group framework could be intimidating for some participants and heighten their anxiety.

If you are experiencing emotional distress, you can call the Hope for Wellness Help Line (1‑855‑242‑3310) or chat online. This service is available 24/7 for Indigenous people in Canada.

For other available services, see the list of Centres d’Écoute par région (regional support lines).

The inclusion of articles presented in this monitoring newsletter does not represent their endorsement by the Institut. Professional judgment remains essential in assessing the value of these articles for your work. You can also consult the Methodology for Indigenous Health Research Monitoring.