Anisnabe Kekendazone Network Environment for Aboriginal Health Research

1 Stewart Street, Room 319
Ottawa, Ontario K1N 6N5
Telephone: 1 613 562 5393
Fax: 1 613 562 5392
E-mail: neahr-iph@ciet.org

Aboriginal research approach and methods

At AK-NEAHR, we aim to build capacity for health research and planning in Aboriginal communities across Canada. To accomplish this goal, we carry out and support projects built around strong community leadership and participation.  We also encourage reflection, discussion, and publications on ethical and methodological issues stemming from participatory research efforts.

Building on these foundations, the work of our team members, fellows and grantees shares some common features:

  • Communities choose their research priorities and own the research process – local people frame the issues and decide how to participate. Researchers propose and develop initiatives in this context.
  • Community members lead the research process; researchers give scientific support and act as facilitators. Engagement of community-based researchers, service workers, and other community members builds skills for research and planning and ties research to action from the onset.
  • Our research focuses on community strengths - including spirituality, oral traditions, identity, and support networks - that allow them to protect themselves and their members, overcome inequalities, and continue to develop.
  • We put the stress on primary prevention, looking upstream for sources of individual and collective resilience.
  • We seek to build bridges between traditional knowledge and modern scientific practices, without marginalizing and destroying indigenous cultures.
  • Principles of cultural safety guide every step of our research approach.

An article by Andersson, Shea, Archibald, Wong, Barlow and Sioui (below) covers many of the above features in a detailed description of the Aboriginal Resilience to AIDS (ACRA) project, which is currently underway in Western Canada. Edwards, Lund, Andersson and Mitchell discuss the role of community-based researchers in community engagement for research and planning.

Those overarching principles have also influenced our theoretical and methodological developments. The articles listed below include discussions on culturally safe epidemiology; resilience measurement tools; research networks and interdisciplinary collaboration in rural and remote areas; and the use of an intersectionality paradigm to improve nursing in Aboriginal communities.

Publications

Pace R, Pluye P, Bartlett G, Macaulay AC, Salsberg J, Jagosh J, Seller R.. Testing the reliability and efficiency of the pilot Mixed Methods Appraisal Tool (MMAT) for systematic mixed studies review. International Journal of Nursing Studies, Available online 10 August 2011.
BACKGROUND: Systematic literature reviews identify, select, appraise, and synthesize relevant literature on a particular topic. Typically, these reviews examine primary studies based on similar methods, e.g., experimental trials. In contrast, interest in a new form of review, known as mixed studies review (MSR), which includes qualitative, quantitative, and mixed methods studies, is growing. In MSRs, reviewers appraise studies that use different methods allowing them to obtain in-depth answers to complex research questions. However, appraising the quality of studies with different methods remains challenging. To facilitate systematic MSRs, a pilot Mixed Methods Appraisal Tool (MMAT) has been developed at McGill University (a checklist and a tutorial), which can be used to concurrently appraise the methodological quality of qualitative, quantitative, and mixed methods studies.
OBJECTIVES:
The purpose of the present study is to test the reliability and efficiency of a pilot version of the MMAT.
METHODS:
The Center for Participatory Research at McGill conducted a systematic MSR on the benefits of Participatory Research (PR). Thirty-two PR evaluation studies were appraised by two independent reviewers using the pilot MMAT. Among these, 11 (34%) involved nurses as researchers or research partners. Appraisal time was measured to assess efficiency. Inter-rater reliability was assessed by calculating a kappa statistic based on dichotomized responses for each criterion. An appraisal score was determined for each study, which allowed the calculation of an overall intra-class correlation.
RESULTS:
On average, it took 14 minutes to appraise a study (excluding the initial reading of articles). Agreement between reviewers was moderate to perfect with regards to MMAT criteria, and substantial with respect to the overall quality score of appraised studies.
CONCLUSION:
The MMAT is unique, thus the reliability of the pilot MMAT is promising, and encourages further development.

Kimberley A Van Herk.  Identity Matters: Aboriginal Mothers' Experiences of Accessing Care. Contemporary Nurse 2011; Vol 37, No 1.
This paper reports on research examining how service providers’ perceptions of Aboriginal women`s identities contributes to their experiences of accessing preventive care during pregnancy and parenting in an urban setting. An intersectionality paradigm was adopted to conduct a secondary analysis of purposively selected transcripts of exploratory interviews with Aboriginal women. Findings indicate that how Aboriginal women’s identity as mothers was perceived by service providers was the focal point at which women’s described positive or negative experiences of accessing care. These conclusions challenge nurses’ understandings of developing therapeutic relationships with marginalized populations and highlight the necessity of examining how perceptions of identity shape issues of oppression and discrimination within therapeutic relationships.

Kimberley A Van Herk, Dawn Smith and Caroline Andrew. Examining our privileges and oppressions: incorporating an intersectionality paradigm into nursing.  Nursing Inquiry 2011; 18: 29–39.

An intersectionality paradigm is a means by which nurses can attend to issues of oppression and privilege within their practice and profession. Intersectionality is introduced as an essential theory to help debunk the hegemony of the ‘white, middle class’ perspective that often directs nursing research, practice, and education. The values and benefits of using an intersectionality paradigm in nursing are shown through recent research done with Aboriginal women. These findings contribute to an increased understanding of the importance and necessity of attending to the power relations that dominate nursing care encounters and influence the way nurses provide care. By acknowledging and responding to the presence of privilege and oppression and the associated power dynamics within the therapeutic encounter, nursing can strive further in helping to alleviate social injustices and health disparities that arise from unequal power relations.

J Jagosh, P Pluye, AC Macaulay, J Salsberg, J Henderson, E Sirett, PL Bush, R Seller, G Wong, T Greenhalgh, M Cargo, CP Herbert, SD Seifer, LW Green. Assessing the Outcomes of Participatory Research: Protocol for Identifying, Selecting and Appraising the Literature for Realist Review. Implementation Science 2011; 6(24). 2011
Participatory Research (PR) entails the co-governance of research by academic researchers and end-users. End-users are those who are affected by issues under study (e.g., community groups or populations affected by illness), or those positioned to act on the knowledge generated by research (e.g., clinicians, community leaders, health managers, patients, and policy makers). Systematic reviews assessing the generalizable benefits of PR must address: the diversity of research topics, methods, and intervention designs that involve a PR approach; varying degrees of end-user involvement in research co-governance, both within and between projects; and the complexity of outcomes arising from long-term partnerships.

Cameron M, Andersson N, McDowell I, Ledogar RJ. Culturally Safe Epidemiology: Oxymoron or Scientific Imperative.  Pimatisiwin. 2010 Fall; 8(2): 89–116.
Since the early 20th Century, epidemiological research has brought benefits and burdens to Aboriginal communities in Canada. Many First Nations, Métis, and Inuit continue to view Western research with distrust; quantitative methods are perceived as especially inconsistent with indigenous ways of knowing. There is increasing recognition, however, that rigorous epidemiological research can produce evidence that draws attention and resources to pressing health issues in Aboriginal communities. We present a framework for culturally safe epidemiology, from the identification of research priorities, through fieldwork and analysis, to communication and use of evidence. Modern epidemiology and indigenous knowledge are not inherently discordant; many public health opportunities arise at this interface and good science must begin here too.

D. Parry, J. Salsberg, AC. Macaulay. A Guide to Researcher and Knowledge-User Collaboration in Health Research. Canadian Institutes of Health Research (CIHR) 2009.
Learning objectives: 1) understand the history of knowledge translation at CIHR; 2) understand the differences between end of grant knowledge translation (KT) and integrated knowledge translation (IKT); 3) learn how IKT is supported by the principles of participatory research; 4) understand basic principles of participatory research; 5) know when IKT is not appropriate.

Moffitt, P., Murdoch, E., Wells, C., Martin-Misener, R., McDonagh, M., & Edge, D. From sea to shining sea: Making collaborative rural research work. International Journal of Rural and Remote Research 2009.
Rural researchers collaborate on many levels to collect and analyze data, develop research reports and disseminate findings. While this collaboration is critical, there is a dearth of literature about research team collaboration within all stages of the research process. The purpose of this article is to discuss the research experience of 10 rural researchers scattered across Canada who participated in the study "Health Research: Accessible, Applicable and Useable for Rural Communities and Practitioners". Using focused ethnography, one aim of this study was to discover how research is utilized in rural and remote settings. The necessity of establishing networks to collect and manage data, and jointly analyze 72 qualitative transcripts from different geographical sites led to innovations and unexpected lessons learned. The research design provided significant opportunities to mentor undergraduate, masters and doctoral nursing students and to enhance the development of newly graduated doctoral nurses. These opportunities are crucial in the development of new researchers and in creating ongoing interest in rural health research. In this article, we discuss how the research process evolved, the mentoring process used, the barriers identified related to collaboration across vast distances, and the strategies employed to enhance the study’s trustworthiness. We also consider the advantages and challenges of using ElluminateTM, a web application, as an interactive forum for this qualitative health research.

Andersson N, Ledogar RJ. The CIET Aboriginal Youth Resilience Studies: 14 Years of Capacity Building and Methods Development in Canada. Pimatisiwin. 2008 Summer; 6(2): 65–88.
CIET started supporting Canadian Aboriginal community-based researchers of resilience in 1995. An evolving approach to Aboriginal resilience used a combination of standard instruments and questionnaires of local design. Over the years, CIET measured personal assets like sense of coherence, spirituality, knowledge, pride in one's heritage, mastery or self-efficacy, self-esteem, low levels of distress, involvement in traditional ways and activities, and church attendance. Other indicators reflected the social dimension of resilience: feeling supported; parental care and support; parental monitoring, attitudes, and example; peer support; and support from the wider community. Pride in one's heritage, self-esteem, low distress, and mastery were measurable personal assets of resilient Aboriginal youth in a variety of cultures and circumstances. Early efforts to link resilience with specific features of culture or spirituality did not meet with success - largely reflecting failure to ask the right questions. Parental care and support, parental monitoring, parental attitudes, and parental example clearly supported the resilient Aboriginal youth in most settings. But peers are an even stronger influence, critical in relation to different types of behaviour from smoking to drinking to substance abuse to violence, unsafe sex, and suicidal tendencies. More generally, having someone to confide in, to count on in times of crisis, someone to give advice and someone who makes one feel cared for are important factors in youth resilience. This is something that communities can help to provide even where the family is not the support it should be and where peers are more of a hindrance than a help. CIET currently supports three resilience research projects involving Aboriginal youth in Canada: suicide prevention, reduction of HIV risk, and reduction of domestic violence. The latest resilience measurement tools include enculturation and revised approaches to Aboriginal spirituality.

Andersson N, Shea B, Archibald C, Wong T, Barlow K, Sioui G. Building on the Resilience of Aboriginal People in Risk Reduction Initiatives Targeting Sexually Transmitted Infections and Blood-Borne Viruses: The Aboriginal Community Resilience to AIDS (ACRA) Pimatisiwin. 2008 Summer; 6(2): 89–110.
There is evidence that Aboriginal people may be at increased risk of HIV infection; they also experience higher rates of other blood-borne viral (BBV) and sexually transmitted infections (STI). This project will provide insights into the role of resilience and its impact on the health and well-being of Aboriginal youth, especially as it relates to sexual and injecting behaviour. The primary recipients of this information will be agencies that provide risk education related to BBVs and STIs. The project involves several phases. First, the framework for the research will be established, with Aboriginal leadership and involvement at every level. Next, both qualitative and quantitative methodologies will be used to identify factors that protect Aboriginal youth against blood-borne viral and sexually transmitted infections and their transmission within local communities. Finally, results from this project will be used to develop interventions and appropriate frameworks for their evaluation in Aboriginal communities. An important component of this project will involve the building of capacity within participating communities, with the goal of identifying strategies related to resilience that can be incorporated into public health and clinical practice. The project will run for five years.

Edwards K, Lund C, Mitchell S, Andersson N. Trust the Process: Community-based Researcher Partnerships. Pimatisiwin. 2008 Summer; 6(2): 186–199.
In recent years, Aboriginal communities across Canada have begun to seek ways to increase their participation and control of research that affects them. Similarly, academics are seeking new methods to include parallel and complementary knowledge in their research, including traditional knowledge and community experience and expertise. New approaches, theories, and methods related to, or derived from, Indigenous ways of knowing are appearing. Among the approaches that have emerged are community-based participatory research (CBPR), and, closely related, the role of the community-based researcher (CBR). This paper reviews some of the literature that traces the emergence of the role of CBRs as a strategy for community engagement in research. We discuss ethical issues that CBRs encounter in their practice, and some of the lessons we have learned together as a CBPR team.

Caldwell D. The Suicide Prevention Continuum. Pimatisiwin. 2008 SUMMER; 6(2): 145–153.

The suicide prevention continuum illustrates a practical approach to the complex issue of suicide prevention. The continuum evolved from discussions with two Aboriginal communities in Atlantic Canada about suicide and the different types of interventions available. The continuum offers a framework and reference tool to differentiate between the different stages of suicide risk. It illustrates where the Aboriginal Community Youth Resilience Network (ACYRN) fits into suicide prevention and how it contributes to prevention knowledge, capacity building, and policy development.

Barlow K, Loppie C, Jackson R, Akan M, Maclean L, Reimer G. Culturally Competent Service Provision Issues Experienced By Aboriginal People Living With HIV/AIDS Pimatisiwin. 2008 Summer; 6(2): 155–180.
Cultural identity is an important factor in how well Aboriginal people respond to HIV/AIDS prevention or, once diagnosed with HIV or AIDS, how it affects their health care. This study explores the cultural skills among service providers who see Aboriginal people living with HIV/AIDS (APHAs) and the perspectives of APHAs. The purpose is to better understand the wellness needs of APHAs and how culturally competent care affects health service access and use. Data collection included face-to-face semi-structured interviews with APHAs and focus groups/interviews with community-based and primary health professionals in five regions of Canada. Interviews and focus groups were voice-recorded, verbatim transcribed, and coded using Atlas.ti(®) software. Thirty-five APHAs and fifty-two service providers were reached. Two key themes were noticed: Active addictions are a major obstacle to adherence to HIV drug regimes. Half of APHA participants said addictions are a major factor. A similar portion noted intensified substance use was an initial coping strategy when diagnosed. A slightly smaller portion noted that addictions were dealt with soon after diagnosis in order to begin antiretroviral treatment. Service providers who inform, encourage, and support APHAs' choices are viewed as "culturally competent." Addictions and HIV must be "treated together," reflecting a holistic worldview of Aboriginal people. Programs that integrate addiction treatment with HIV/AIDS and service providers who encourage and support APHA's choices are viewed as "wise practice" models by both sets of study participants offering some convergence and a set of five wise practices are identified.

Lessard L. La collaboration interdisciplinaire en région isolée : Le cas de l’Eeyou Istchee.  Mémoire de maîtrise, Université Laval 2005.
Les écrits démontrent que la collaboration interdisciplinaire contribue à l’amélioration des services de santé et à l’efficience des organisations. Cependant, plusieurs études menées en milieu urbain ou rural soulignent qu’elle continue à rencontrer des obstacles majeurs (D’Amour, 1999 ; Clair, 2000 ; Fowler, Hannigan et al., 2000 ; Corser, 1998). La situation pourrait être différente dans les régions isolées où la collaboration semble s’instaurer plus naturellement entre les intervenants du domaine de la santé. Toutefois, les raisons expliquant cette différence sont mal connues. Une étude de cas a donc été réalisée dans le contexte des services de santé de première ligne de la région sociosanitaire Terres-Cries-de- la-Baie-James, afin de décrire le contexte particulier de cet environnement de travail et d’analyser l’influence de ce contexte sur la collaboration interdisciplinaire. Un modèle mixte basé sur la structuration de la collaboration interdisciplinaire (D’Amour et al., 1997, 1999, 2003; Friedberg, 1993) et sur l’influence du contexte (Corser, 1998; Pronovost, 2000; Osmond, 2004; Sicotte, D’Amour et al., 2002) a été utilisé. L’analyse indique que plusieurs caractéristiques contextuelles influencent la structuration la collaboration interdisciplinaire. L’implication de ces influences pour la pratique et la recherche est discutée.

 

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