Indigenous Health Research Monitoring, July 2025

Just Published

New scientific publications and articles

Cachagee (Omushkego Mushkegowuk), M., Poirier, B., Cachagee (Omushkego Mushkegowuk), C., Jamieson, L., and Neufeld, H. (2025). Nurturing roots: A scoping review on Indigenous acts of resistance through Land-based healing practices. AlterNative: An International Journal of Indigenous Peoples, 21(2).

De Waard, A., Heris, C., Barrett, E. M., Rickard, E., Cohen, R., Brinckley, M.-M., Kennedy, M., Calma, T., Lyons, L., O’Brien, M., Thurber, K. A., and Maddox, R. (2025). Longitudinal study of Indigenous children: Adolescent never smoking and associations with individual, social, and environmental factors. Health Promotion International, 40(2). 

Holl, K., Fejo-King, C., Frederico, M., and MacLean, S. (2025). Aboriginal Australians’ perceptions of non-Aboriginal social workers: Challenges and solutions. Australian Social Work, 1–14.

Milroy, T., Frayne, J., Smith, K., and Bessarab, D. (2025). A scoping review and environmental scan of health literacy and resources related to menstrual health for Aboriginal women in Australia. Health Promotion Journal of Australia, 36(2), e70036. 

O’Keefe, V. M., Maudrie, T. L., Grubin, F., Gonzalez, M. B., Ullrich, J. S., Crouch, M., White, E., Desjardins, M. M., Martin, L., Lewis, M., HorseChief, M., Fernandez, A., Keryte, A. P., and Walls, M. L. (2025). “Someday, I’ll be an ancestor”: Understanding Indigenous intergenerational connectedness through qualitative research to inform measure development. American Journal of Community Psychology, 1–11. 

Oré, C. E., Loerzel, E., Marziale, E., and Parker, M. (2025). Developing Indigenous-centered healing, health, and wellness frameworks to strengthen Indigenous health systems, decolonize public health, and achieve health equity. American Journal of Public Health, 115(5), 726–731. 

Peach, L., Patterson, K., Skene, D., Perchak, S., Skinner, K., and Neufeld, H. (2025). Lessons from an evaluation of an urban Indigenous food sharing initiative in Southwestern Ontario: “I feel like I’m nourishing my spirit.” Canadian Journal of Public Health. 

Rankin, A., Baumann, A., Downey, B., Valaitis, R., Montour, A., and Bearskin, D. B. (2025). A multi‑site qualitative study to explore and understand barriers and enablers Indigenous community members experience when accessing health and social services: Perspectives of Indigenous patient navigators and Indigenous community members in Canada. International Journal of Indigenous Health, 20(2).

Article Summaries: Subject Areas

Social inequalities and determinants of health

Health-related stigma among Indigenous Peoples in Canada: A scoping review

Rourke, L., Damant, R., Kung, J. Y., and Widney, C. (2025). Health-related stigma among Indigenous Peoples in Canada: A scoping review. PLoS One, 20(4), e0318618.

Context

Stigma may explain some care-avoidance behaviours by patients, including a reluctance to get tested, adhere to treatments or confide in others. Stigma is defined as an attribute that predisposes one to disdain and includes factors such as labelling, stereotyping, status loss and discrimination. It is associated with numerous health issues. 

Indigenous communities in Canada are disproportionately affected by various health problems that are compounded by stigma. While Indigenous beliefs and practices are not homogenous, trends exist in how members of those communities experience health-related stigma. 

Objective

Determine the scope of research into health-related stigma among Indigenous Peoples in Canada, more specifically:

• First Nations, Inuit and Métis communities;
• The range of health problems related to stigma;
• Types of stigma experienced by people facing various health issues;
• Their strategies for dealing with stigma.

Methods

The authors searched different databases for articles published between 1963 (the year seminal works on stigma were published) and September 2024. They searched for publications in which participants describe stigma as one aspect of their experience with a health problem. Only primary data was included. Studies were excluded if participants’ experiences of stigma derived from characteristics other than their health status (e.g. profession, sexual orientation, gender and cultural or ethnic identity).

What was learned? 

Study population

A total of 25 studies with 1,187 Inuit, Métis and First Nations participants met the inclusion criteria. Participants were from Alberta, British Columbia, Manitoba, Nunavut, Ontario, Québec and Saskatchewan. Communities in the Atlantic Provinces, Yukon and Northwest Territories were not represented. 

Health conditions 

The number of health problems represented in the studies was limited. Stigma was reported by patients living with human immunodeficiency virus (HIV), sexually transmitted or blood-borne infections (STBBI), mental health issues, tuberculosis, type 2 diabetes, arthritis, physical disabilities, asthma, substance use disorders, and fetal alcohol syndrome disorder.

Forms of stigma 

Participants described four forms of health-related stigma: enacted, anticipated, self and secondary.

Enacted stigma was the most common (17 of 25 studies). It took several forms, including social distancing, as participants reported losing close relationships after disclosing their condition. Physical distancing was also common for those with a contagious disease. Other forms of enacted stigma included being blamed for the condition, stereotyping and the trivialization of symptoms.

Anticipated stigma was the second most common form (15 of 25 studies). Unlike enacted stigma, this form of stigma refers to expected rather than experienced behaviour. Such anticipation was rooted in discriminatory behaviour observed towards others with the same medical condition.

The final two forms were self stigma, where participants blamed themselves for their illness (n = 9), and secondary stigma, in which family members of those with a health condition experienced stigma (2 of 25 studies).

Response to stigma

When participants experienced stigma, their main response was to use various strategies to conceal their health condition. They withheld their health status from family, friends and acquaintances, withdrew socially or avoided presenting publicly for treatment. All of these responses may explain the reluctance to be screened and treated.

Limitations

The authors note that the selected literature sample is too small and exploratory in nature to draw inferences for use in practice.

Promotion of wellbeing and mental health

Developing self-efficacy and ‘communities of practice’ between community and institutional partners to prevent suicide and increase mental health in under-resourced communities: Expanding the research constructs for upstream prevention

Wexler, L., White, L., Ginn, J., Schmidt, T., Rataj, S., Wells, C. C., Schultz, K., Kapoulea, E. A., McEachern, D., Habecker, P., and Laws, H. (2025). Developing self-efficacy and ‘communities of practice’ between community and institutional partners to prevent suicide and increase mental health in under-resourced communities: Expanding the research constructs for upstream prevention. BMC Public Health, 25(1), 1323. 

Context

The growing rate of suicide among Indigenous youth in Alaska calls for new approaches to prevention. Universal prevention strategies comprise two important dimensions: 1) communities of practice, in which stakeholders from the community (family, caregivers, Elders, etc.) and institutions (teachers, health professionals, etc.) work together in a common interest; and 2) personal self-efficacy in promoting wellness and preventing suicide. In Indigenous communities where access to services is limited (e.g., rural and remote communities), communities of practice could strengthen collaboration between informal and formal networks, which in turn could improve the help offered to young people at risk of suicide. Furthermore, perceived self-efficacy could enhance behaviour modification interventions with young people.

Objective

Explore the relationship between participants’ perception of self-efficacy and their involvement in a community of practice as a predictor of suicide prevention and wellbeing promotion behaviours among young people. 

Methods

The data was derived from baseline measurements used to assess the PC CARES intervention. A convenience sample (n = 398) of participants aged 15 or older living in five remote Indigenous communities in Alaska answered an electronic survey. A longstanding collaboration with a steering committee representing the communities provided direction for this participatory project, and the committee helped develop the questionnaire.

The analysis looked at associations between independent variables—specifically wellness self‑efficacy, suicide prevention self-efficacy and the presence of communities of practice—and dependent variables, namely behaviours and actions to promote wellness and lower the risk of suicide:

• Working together within families and communities;
• Offering interpersonal support;
• Reducing access to lethal means;
• Reducing the risk of subsequent suicides after one has occurred (postvention). 

The analysis included several statistical tests: regressions, analyses of variance and post hoc analyses. 

What was learned? 

Participants were grouped into four roles:

1. Community members (e.g., parents or Elders; 53%)
   1. People with an institutional role (e.g., caregivers or teachers; 5%)
   2. People who are community members and who also have an institutional role (11%)
   3. Other (e.g., students; 30%) 

Perceived self-efficacy in promoting wellness and behaviours associated with working together, offering support and reducing access to lethal means varied among the groups. The “Other” group generally scored lower than other groups.

Perceived self-efficacy in promoting wellness was significantly associated with working together and interpersonal support. Perceived suicide prevention self-efficacy was associated with interpersonal support, reducing access to lethal means and postvention actions. Involvement with a community of practice was significantly associated with working together and postvention actions.

According to the authors, these results offer ideas to consider regarding approaches to suicide prevention in rural and remote communities. They suggest investing in the development of communities of practice that involve individuals with institutional roles, community members and stakeholders committed to the interests of young people, so as to strengthen the social safety net and create new opportunities for action.

Limitations

The authors point out that the data is cross-sectional and represents a single moment in time. It is therefore impossible to establish causal relationships, directionality or a temporal sequence in the found associations. Another limitation concerns the sample’s lack of representativeness. Moreover, the categorization of participants according to their “community” and “institutional” role is based on what they reported. It may not reflect nuances in how the participants actually perceive their roles.

Culturally adapted approaches to research and intervention

Childhood adversity and coping among Indigenous university students in Canada: Considerations when examining adverse childhood experiences

Luther, A. W., Skinner, K., Anthony, K., and Mielke, J. G. (2025). Childhood adversity and coping among Indigenous university students in Canada: Considerations when examining adverse childhood experiences. Psychological Trauma: Theory, Research, Practice, and Policy.

Context

Adverse childhood experiences (ACEs) have lifelong repercussions on health and wellbeing. One example is the adoption of risky behaviours such as substance abuse. Generally, ACEs are grouped into seven domains (physical, emotional and sexual abuse, domestic violence, substance abuse in the home, mental disorder experienced by a family member, and incarceration of someone in the household) on which standard data collection surveys are based. However, as it is true of other populations, Indigenous Peoples may experience childhood adversities that are not well reflected in surveys, which therefore fail to provide a full picture of the complexity of their experiences.

Objectives

• Examine domains of childhood adversity experienced by Indigenous Peoples that, according to Indigenous university students and employees, could be added to standard surveys.
• Identify factors that might contribute to reducing the repercussions of ACEs for Indigenous Peoples living in Canada.

Methods

The study combined the principles of discussion groups and First Nations sharing circles. Indigenous university students and employees aged 18 or older at two postsecondary institutions in a city in Ontario were recruited through purposive and snowball sampling. Semi-structured interviews or a discussion group were conducted with the 16 participants. A thematic analysis was performed in collaboration with an Indigenous Student Advisory Committee. Students and employees were invited to join the committee to collaborate on the research project.

What was learned? 

The participants, who were all Métis or First Nations aged 21 to 28, shared five additional domains of ACEs.

• All the participants underscored experiences associated with historical traumas, such as child welfare policies, oppression, cultural disruption, poverty and waves of suicide.
• A lack of quality public services and public infrastructure was mentioned as a factor aggravating ACEs. This included a lack of access to drinking water and poor quality or overcrowded housing.
• Participants also discussed household dysfunction, a theme that overlapped closely with adversities reported in standard surveys: exposure to someone with addiction issues, neglect, sudden loss of a family member and exposure to serious crime.
• Another aspect mentioned by the interview subjects concerns issues of gender-based violence, for example, sexual assault, domestic violence, and the high number of missing and murdered Indigenous women. One female student emphasized that the repercussions of the high rate of sexual violence against Indigenous women represents a constant threat and trauma in their lives.
• Participants also described many experiences of racial discrimination: prejudice, public encounters of racism and the devaluing of Indigenous identities.

Finally, four thematic categories of factors that can contribute to reducing the repercussions of ACEs emerged from the analysis: addressing trauma (e.g., by supporting and helping others); improving cultural connections (e.g., traditional practices and spending time with Elders); strengthening social networks (e.g., being part of a caring community); developing skills and knowledge (e.g., personal attributes such as a quest for continuous improvement).

Limitations

The authors point out that the participants recruited all live in an urban setting. Involving Indigenous individuals living in areas more or less distant from a large city could offer different perspectives. Furthermore, they note that, as is the case with any analysis of qualitative data, the interpretation is subject to the personal bias of those conducting the research.

“No one ever comes back and asks us how could we do it better”: Findings from First Nations community panels about ways to keep First Nations peoples safe from COVID‑19

Crooks, K., Taylor, K., Hansen, J., Savo, J., Campbell, S., Miller A., Massey, P. D., Andrews, R. M., and Degeling, C. (2025). “No one ever comes back and asks us how could we do it better”: Findings from First Nations community panels about ways to keep First Nations peoples safe from COVID‑19. AlterNative: An International Journal of Indigenous Peoples, 21(2). 

Context

Wide-scale public health measures aimed at limiting the spread of infectious diseases, such as physical distancing and quarantine, do not necessarily take the unique situation and experiences of First Nations into consideration. Moreover, generalized approaches that are neither targeted nor culturally appropriate can be seen as a modern form of colonization. A better understanding of First Nations realities helps to guide public health measures from an equity perspective in preparing for and responding to pandemics.

Objective

Encourage Australian First Nations to participate in decision making about how public health authorities and governments can support families and communities during the COVID-19 pandemic.

Methods

The study was based on democratic methods and Indigenous epistemologies. Community panels were convened to deliberate and make decisions in three regions with distinct geographic and demographic contexts. The participants, who were recruited through local community networks, were invited to attend a virtual presentation followed by a question period. They then received a booklet (“Yarning with the Mob”) to facilitate discussions with their family and friends. A few days later, they met online for a second session to deliberate and target their priorities.

What was learned? 

A total of 22 people sat on the panels: 16 women and 6 men. All the participants were members of the local community and included Elders and community leaders. Generally, participants found the community panels an appropriate setting for sharing experiences and learning more about those of other people. It should be noted that although data collection concerned three themes related to COVID-19—1) actions to keep families safe, 2) education settings, and 3) communication and governance—, the deliberations may apply to other infectious disease emergencies. Here are a few examples of the many recommendations that emerged from the analysis: 

• Concerning public health communications, set up an information hub directed by First Nations to counter disinformation and ensure that the measures implemented are well understood by the population, the goal being to build trust and reduce confusion.
• To support education during the pandemic, offer families Internet access, digital tools (such as laptops) and support for learning in the home.
• Work with schools to offer local activities.
• Showcase community success stories in order to share learning and promote collaboration among different organizations.
• Prioritize culturally safe healthcare and services.
• Encourage the recruitment and retention of Indigenous staff in various public health positions to offer holistic support to families and communities, including through funding.
• To enhance governance and build trust, actively involve First Nations members in making decisions that concern them. In addition, call on trusted individuals to deliver messages to families and communities.
• Ensure the cultural relevance of measures implemented to prevent infectious diseases by prioritizing approaches led by and for communities.
• Develop local action plans for pandemic preparedness.

Limitations

The authors remind us that the perspectives collected cannot represent all First Nations in Australia. Given that the study took place during the first year of the COVID-19 pandemic, some recommendations may have changed. Finally, in-person meetings would have been preferable to foster greater engagement. 

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.