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Background: There is a widespread commitment to implementing anti-Indigenous racism with health organizations in Canada by introducing cultural safety staff training. In partnership with a public health unit in Ontario, Canada, we developed an evaluation tool to assess the performance of staff who completed an online Indigenous cultural safety education course. Aims: To develop an accountability checklist that could be used for annual employee performance reviews to assess the use and level of knowledge received in professional cultural safety training. Intervention: We co-created a professional development accountability checklist. Five areas of interest were identified: terminology, knowledge, awareness, skills, and behaviours. The checklist comprises of 37 indicators linked to our community collaborators’ intended goals as defined in our partnership agreement. Outcomes: The Indigenous Cultural Safety Evaluation Checklist (ICSEC) was shared with public health managers to use during regularly scheduled staff performance evaluations. The public health managers provided feedback on the design, checklist items, and useability of the ICSEC. The pilot of the checklist is in the preliminary stage and data is unavailable about effectiveness. Implications: Accountability tools are important to sustain the long-term effects of cultural safety education and prioritize the wellbeing of Indigenous communities. Our experience can provide guidance to health professionals in creating and measuring the efficacy of Indigenous cultural safety education to foster an anti-racist work culture as well as improved health outcomes among Indigenous communities.

In the Spring of 2021, a research team from the Dalla Lana School of Public Health completed environmental scans on nine key health-related topics to develop an anti-Indigenous racism strategy for health systems in Toronto, Ontario, Canada. To ensure we (Indigenous and non-Indigenous researchers) were respecting First Nations, Inuit, and Métis peoples, cultures, worldviews, and research methods, we weaved three frameworks of Indigenous values and principles together to create a conceptual foundation for undertaking the environmental scans. In discussions with First Nations Elders, Métis Senators, and our research team, we chose the Seven Grandfather Teachings (Anishinaabe, a specific First Nation's life values), Inuit Qaujimajatuqangit (Inuit societal values), and the Métis Principles of Research. Further discussions provided insights for each of these guiding principles used in research projects with Indigenous peoples. Through this research, we created a weaved framework reflecting the three distinct Indigenous cultures in Canada; First Nations, Métis, and Inuit. The Weaved Indigenous Framework for Research was created for researchers to use as a guiding document as they embark upon health research with Indigenous communities. Inclusive, culturally responsive research frameworks are needed within Indigenous health research to ensure each culture can be respected and honored. •Weaved Indigenous Framework for Research was developed as a wholistic framework that encompassed First Nations, Métis and Inuit ways of knowing and being.•Existing First Nations, Métis and Inuit research principles and guidelines exist–OCAP, NAHO’s Six Principles of Métis Health Research and Inuit Qaujimajatuqangit but are often not used together to ensure each group's ways of knowing and being are incorporated.•We provide an overview of First Nations, Métis and Inuit principles and teachings as we weave them together.•Each of these principles is based on interconnectedness, holism, and doing work in a good way.•The importance of a value-centric approach allows data to be collected, analyzed and disseminated respecting distinct Indigenous worldviews.

There is growing evidence on the observed and expected consequences of climate change on population health worldwide. There is limited understanding of its consequences for child health inequalities, between and within countries. To examine these consequences and categorize the state of knowledge in this area, we conducted a review of reviews indexed in five databases (Medline, Embase, Web of Science, PsycInfo, Sociological Abstracts). Reviews that reported the effect of climate change on child health inequalities between low- and high-income children, within or between countries (high- vs low–middle-income countries; HICs and LMICs), were included. Twenty-three reviews, published between 2007 and January 2021, were included for full-text analyses. Using thematic synthesis, we identified strong descriptive, but limited quantitative, evidence that climate change exacerbates child health inequalities. Explanatory mechanisms relating climate change to child health inequalities were proposed in some reviews; for example, children in LMICs are more susceptible to the consequences of climate change than children in HICs due to limited structural and economic resources. Geographic and intergenerational inequalities emerged as additional themes from the review. Further research with an equity focus should address the effects of climate change on adolescents/youth, mental health and inequalities within countries.

In Canada, Indigenous and racialized patients have been shown to have worse access to health care, receive poorer care and have worse outcomes than White people. A recent conceptmapping study found that Indigenous and racialized patients often feel belittled by clinicians and report that their symptoms are not taken seriously. In health care, racism faced by Indigenous and Black patients has been extensively documented in key reports and postmortem investigations. Although race is a social construct that uses perceived physical differences to create and maintain power differentials and the existence of discrete racial groups has not been shown to have any biological basis, perceived race influences how people are treated by individuals and institutions. Having data on race available for analysis can facilitate the measurement of racial inequities in health care, help to hold organizations and governments accountable for addressing these inequities and monitor progress. We discuss health card renewal as a potentially efficient and effective way of collecting race and Indigenous identity data in Canada and highlight the key preconditions to the collection, governance and use of such data that would facilitate positive action on racism in health care in Canada.

Background Indigenous populations have remained strong and resilient in maintaining their unique culture and values, despite centuries of colonial oppression. Unfortunately, a consequential result of facing years of adversity has led Indigenous populations to experience a disproportionate level of poorer health outcomes compared to non-Indigenous populations. Specifically, the rate of Indigenous chronic disease prevalence has significantly increased in the last decade. Many of the unique issues Indigenous populations experience are deeply rooted in their colonial history and the intergenerational traumas that has subsequently impacted their physical, mental, emotional and spiritual well-being. With this, to better improve Indigenous health outcomes, understanding the local context of their challenges is key. Studies have begun to use modes of community engagement to initiate Indigenous partnerships and design chronic disease-based interventions. However, with the lack of a methodological guideline regarding the appropriate level of community engagement to be used, there is concern that many interventions will continue to fall short in meeting community needs. Objective The objective of this study was to investigate the how various community engagement strategies have been used to design and/or implement interventions for Indigenous populations with chronic disease. Methods A scoping review guided by the methods outlined by Arksey and O’Malley was conducted. A comprehensive search was completed by two reviewers in five electronic databases using keywords related to community engagement, Indigenous health and chronic disease. Studies were reviewed using a descriptive-analytical narrative method and data was categorized into thematic groups reflective of the main findings. Results We identified 23 articles that met the criteria for this scoping review. The majority of the studies included the use a participatory research model and the procurement of study approval. However, despite the claimed use of participatory research methods, only 6 studies had involved community members to identify the area of priority and only five had utilized Indigenous interview styles to promote meaningful feedback. Adapting for the local cultural context and the inclusion of community outreach were identified as the key themes from this review. Conclusion Many studies have begun to adopt community engagement strategies to better meet the needs of Indigenous Peoples. With the lack of a clear guideline to approach Indigenous-based participatory research, we recommend that researchers focus on 1) building partnerships, 2) obtaining study approval and 3) adapting interventions to the local context.

Cardiovascular disease is a leading cause of death worldwide, with disproportionate impacts on Indigenous Peoples in Canada. In Spring 2022, a land-based learning program was piloted and evaluated as an Indigenous cultural safety training for professionals at a cardiac care centre and university in a large urban city. Baseline and endline surveys showed an increase in knowledge of Indigenous histories, cultures, and practices; increased reflection on positionality and intention to create change; and strengthened relationships with the land. Future work should explore the long-term effects of land-based cultural safety training on participant behaviours, and health outcomes for Indigenous Peoples.

The overincarceration of Indigenous peoples and its impacts on individual and community health is a growing concern across Canada and the United States. Federally run Healing Lodges in Canada are an example of support services for incarcerated and previously incarcerated Indigenous peoples to reintegrate into community and support their healing journey. However, there is a need to synthesise research which investigates these programmes. We report a protocol for a scoping review that is guided by the following research question: What is known about culturally informed programmes and services available to incarcerated and previously incarcerated Indigenous peoples in Canada and the US? This scoping review will follow guidelines published by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. This review will only identify programmes that are guided by Indigenous ways of being and knowing in order to best serve Indigenous communities and our community partners. The results of this review will support the development of programmes that are necessary for understanding and addressing the diverse needs of incarcerated and previously incarcerated Indigenous peoples.

Background: To improve the quality of care for Indigenous patients, local Indigenous leaders in the Northwest Territories, Canada have called for more culturally responsive models for Indigenous and biomedical healthcare collaboration at Stanton Territorial Hospital.Objective: This study examined how Indigenous patients and biomedical healthcare providers envision Indigenous healing practices working successfully with biomedical hospital care at Stanton Territorial Hospital.Methods: We carried out a qualitative study from May 2018 – June 2022. The study was overseen by an Indigenous Community Advisory Committee and was made up of two methods: (1) interviews (n = 41) with Indigenous Elders, patient advocates, and healthcare providers, and (2) sharing circles with four Indigenous Elders.Results: Participants’ responses revealed three conceptual models for Indigenous and biomedical healthcare collaboration: the (1) integration; (2) independence; and (2) revisioning relationship models. In this article, we describe participants’ proposed models and examine the extent to which each model is likely to improve care for Indigenous patients at Stanton Territorial Hospital. By surfacing new models for Indigenous and biomedical healthcare collaboration, the study findings deepen and extend understandings of hospital-based Indigenous wellness services and illuminate directions for future research.

Background: Racism and discrimination are realities faced by Indigenous peoples navigating the healthcare system in Canada. Countless experiences of injustice, prejudice, and maltreatment calls for systemic action to redress professional practices of health care professionals and staff alike. Research points to Indigenous cultural safety training in healthcare systems to educate, train, and provide non-Indigenous trainees the necessary skills and knowledge to work with and alongside Indigenous peoples using cultural safe practices grounded in respect and empathy. Objective: We aim to inform the development and delivery of Indigenous cultural safety training within and across healthcare settings in the Canadian context, through repository of Indigenous cultural safety training examples, toolkits, and evaluations. Methods: An environmental scan of both gray (government and organization-issued) and academic literature is employed, following protocols developed by Shahid and Turin (2018). Synthesis: Indigenous cultural safety training and toolkits are collected and described according to similar and distinct characteristics and highlighting promising Indigenous cultural safety training practices for adoption by healthcare institutions and personnel. Gaps of the analysis are described, providing direction for future research. Final recommendations based on overall findings including key areas for consideration in Indigenous cultural safety training development and delivery. Conclusion: The findings uncover the potential of Indigenous cultural safety training to improve healthcare experiences of all Indigenous Peoples. With the information, healthcare institutions, professionals, researchers, and volunteers will be well equipped to support and promote their Indigenous cultural safety training development and delivery.

With many socially disadvantaged populations experiencing a higher level of illness than the general population, health research has begun to recognize the impact of social determinants on health outcomes. Community-based research has increasingly been used to understand the complexities of the local context. However, given the number of interdependent factors influencing individual well-being, no single methodology can explore this level of complexity alone. To put context into perspective, research processes need to shift from the sole use of Western methodologies and, instead, incorporate collaborative methods from nontraditional research. Specifically, Indigenous methodologies have been developed to better understand the complexity of context within multiple worldviews, but current studies have failed to apply these approaches within other cultural settings. This mixed methods study will use Western and Indigenous methodologies to adapt a digital health program for remote communities in Uganda. Using the principles of community-based research and user-centered design, a 4-phase mixed methods study will be conducted. The Indigenous method of 2-eyed seeing will be used to promote a reflexive engagement strategy throughout all study phases. Phase 1 will focus on partnership building to codevelop the project priorities and study design. Phase 2 will involve a needs assessment to elicit a context-focused understanding of the local clinic and community environment. Phase 3 will involve a series of system adaptations to co-design the program. Phase 4 will consist of a community-based field study to evaluate the usability and cultural relevance of the adapted program. This study was approved by the Makerere University School of Medicine Research and Ethics Committee (Mak-SOMREC-2021-63) and the University Health Network Research Ethics Board (20-6022). This protocol provides a novel strategy leveraging a range of community-based methods to ensure that the contextual significance of each community's challenges is reflected in the design of the Medly Uganda program. Partnership building was initiated in June 2019, and the first stage of data collection in phase 2 began in January 2021. At the time of manuscript submission, phases 1 to 3 have been completed. Phase 4 data analysis is ongoing and expected to be completed in October 2025. Integrating the community's local knowledge into the design of the Medly Uganda program will lead to the development of meaningful interventions that improve health outcomes. DERR1-10.2196/75136.