Cultural Adaptation of a Substance Abuse Prevention Program as a Catalyst for Community Change

The aim of the current paper is to discuss the use of Outcome Mapping as a tool for evaluating community and stakeholder changes that occurred when a prevention program was culturally adapted and delivered through a community-university partnership. To the authors’ knowledge, this paper represents the first account of using Outcome Mapping as an evaluation tool in a Canadian Indigenous context. Changes in the behavior, actions, activities, and relationships of five boundary partners were retrospectively documented using the tool. Data demonstrated positive impact on Elders and students; growing community investment in and support for the Maskwacis Life Skills Training program’s cultural components; progressive increases in community ownership of the program; and growth in the community-university partnership. Overall, Outcome Mapping provided a systematic method for understanding peripheral changes that are often overlooked in conventional research and evaluation, but that nonetheless indicate progress toward community changes and long-term impact

A Community-University Approach to Substance Abuse Prevention

In response to high rates of substance abuse in their communities, members of the Maskwacis four Nations invited university researchers to partner in culturally adapting, implementing, and evaluating an evidence-based substance abuse and violence prevention program, the Life Skills Training program (Botvin & Griffin, 2014). This project used a community-based participatory research (Israel, Schulz, Parker, & Becker, 1998; Minkler & Wallerstein, 2003) approach, and was carried out by university and First Nation community partners. To evaluate the impact of the adapted program, students completed pre and post questionnaires, and community members participated in focus groups. The adapted Maskwacis Life Skills Training program was delivered in schools for three years. Students’ knowledge increased significantly during program delivery, and strong support was documented from community members. This project demonstrates the impact that can be facilitated by culturally adapting and delivering a prevention program, and by forming a community-university partnership

Community-based participatory research with Aboriginal children and their communities: Research principles, practice and the social determinants of health

Conventional health and social science research has contributed to advances in public well-being over the past century. Despite these advances, a significant gap exists in the health of Aboriginal children as compared to non-Aboriginal children in Canada. This has occurred, in part, as a result of the failure of conventional research to acknowledge the worldview of First Nations, Inuit, and Métis peoples, to fully take into account their experience of the social determinants of health (SDOH) and to address the intergenerational impact of colonization. In this article we review and discuss the social determinants of health (SDOH) with a specific focus on Aboriginal children and youth. Motivated by our experience in carrying out community based participatory research (CBPR) with children and families from First Nations and Métis communities in Alberta, Canada we review how use of CBPR) approach to research with Aboriginal children and communities can serve to enhance research results, resulting in greater relevance to community identified questions. We will address these issues in the context not only of good research practice but as an aspect of “wise practices” (Wesley-Esquimaux & Calliou, 2010) occurring within an “ethical space of engagement” (Ermine, 2007). We conclude that CBPR allows for meaningful and equitable research partnerships to occur in an ethical space without reinforcing colonial processes of knowledge construction and translation while marginalizing Indigenous knowledge

Culturally Competent Care for Aboriginal Women: A Case for Culturally Competent Care for Aboriginal Women Giving Birth in Hospital Settings

Increasing numbers of Aboriginal women are using urban hospital settings to give birth. Culturally competent care, including an understanding of cultural, emotional, historical, and spiritual aspects of Aboriginal Peoples’ experience and beliefs about health and healthcare, is important to the provision of quality care. While there is a body of literature on culturally competent care, no models specific to Aboriginal women giving birth in hospital settings exist. This article explores Aboriginal peoples’ historical experience with western health care systems, worldviews and perspectives on health and healing, and beliefs regarding childbirth. Some of the existing models of culturally competent care that emphasize provision of care in a manner that shows awareness of both patients’ cultural backgrounds as well as health care providers’ personal and professional culture are summarized. Recommendations for the development of cultural competency are presented.Acquisition of knowledge, self-awareness and development of skills are all necessary to ensure quality care. It is essential that - at both systemic and individual levels - processes are in place to promote culturally competent healthcare practices. Recommendations include: partnering with Aboriginal physicians, nurses, midwives and their representative organizations; conducting community-based research to determine labour and delivery needs; identifying and describing Aboriginal values and beliefs related to childbirth and its place in the family and community; and following Aboriginal women’s birth experiences in hospital settings with the overarching goal of informing institutional practices

Integrating preventive dental care into general Paediatric practice for Indigenous communities: paediatric residents’ perceptions

This qualitative study aimed to explore paediatric residents’ perceptions of the feasibility of incorporating preventive dental care into a general paediatric outreach clinic for a First Nations community. Four focus groups were conducted with paediatric residents and attending paediatricians. Interviews were recorded, transcribed verbatim and analysed using a basic interpretive qualitative approach. Three major themes emerged from the data: advantages of integration, barriers to integration and strategies for integration. Comprehensive care and service delivery were the two identified advantages of integration. Three categories of barriers emerged including patient and caregiver-related, resident-related and setting-related barriers. Training and practice, patient education, support and policy were the suggested strategies for successful integration. Providers were found to be open to integrating preventive dental care into their practice. However, barriers impeded the success of this integration. Multiple strategies including oral health care training for medical providers, office support and policy changes would facilitate successful integration

“Why Do I Need to Sign it? Issues in Carrying Out Child Assent in School-Based Prevention Research Within a First Nation Community

The practice of and procedures for obtaining child assent in research involving children are based in Western conceptions of individual decision-making rights, free from any form of coercion including that of parents. In the context of obtaining assent for children involved in research in an Alberta First Nation, the issue can become more complex given respect for ethical frameworks based in collective decision-making and the responsibility of Elders and families to protect children in interactions with Western institutions. This article explores the results of a focus group held to discuss our experience with child assent in research taking place with a community-initiated and culturally-adapted substance abuse prevention program being taught in the community school. In this case the process of being asked to sign written individual assent in the classroom was perceived as bearing extrinsic risk. Given collective cultural norms, the communities past experiences with the safety of signatures, and the proper roles of Elders and family, the children asked “Why do I have to sign it” when asked to sign their assent for participation in the project. A process that involved gathering child assent with children surrounded by family and community was recommended. Greater researcher and REB responsiveness to the issue of non-malfeasance is needed, in this case, by not asking researchers and community members to act in ways that violate culturally-based ethical norms and protocol all of which are important to community continuity, self-determination, and well-being

“Why Do I Need to Sign it? Issues in Carrying Out Child Assent in School-Based Prevention Research Within a First Nation Community

The practice of and procedures for obtaining child assent in research involving children are based in Western conceptions of individual decision-making rights, free from any form of coercion including that of parents. In the context of obtaining assent for children involved in research in an Alberta First Nation, the issue can become more complex given respect for ethical frameworks based in collective decision-making and the responsibility of Elders and families to protect children in interactions with Western institutions. This article explores the results of a focus group held to discuss our experience with child assent in research taking place with a community-initiated and culturally-adapted substance abuse prevention program being taught in the community school. In this case the process of being asked to sign written individual assent in the classroom was perceived as bearing extrinsic risk. Given collective cultural norms, the communities past experiences with the safety of signatures, and the proper roles of Elders and family, the children asked “Why do I have to sign it” when asked to sign their assent for participation in the project. A process that involved gathering child assent with children surrounded by family and community was recommended. Greater researcher and REB responsiveness to the issue of non-malfeasance is needed, in this case, by not asking researchers and community members to act in ways that violate culturally-based ethical norms and protocol all of which are important to community continuity, self-determination, and well-being. Keywords: child assent; First Nations children; research ethics; community-based participatory research; Indigenous research; research ethics boards

Complementary and Alternative Medicine: A Survey of Its Use in Pediatric Oncology

Background. The use of complementary and alternative medicine (CAM) is high among children and youths with chronic illnesses, including cancer. The objective of this study was to assess prevalence and patterns of CAM use among pediatric oncology outpatients in two academic clinics in Canada. Procedure. A survey was developed to ask patients (or their parents/guardians) presenting to oncology clinics at the Stollery Children’s Hospital in Edmonton and the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa about current or previous use of CAM products and practices. Results. Of the 137 families approached, 129 completed the survey. Overall CAM use was 60.5% and was not significantly different between the two hospitals. The most commonly reported reason for not using CAM was lack of knowledge about it. The most common CAM products ever used were multivitamins (86.5%), vitamin C (43.2%), cold remedies (28.4%), teething remedies (27.5%), and calcium (23.0%). The most common CAM practices ever used were faith healing (51.0%), massage (46.8%), chiropractic (27.7%), and relaxation (25.5%). Many patients (40.8%) used CAM products at the same time as prescription drugs. Conclusion. CAM use was high among patients at two academic pediatric oncology clinics. Although most respondents felt that their CAM use was helpful, many were not discussing it with their physicians.Peer Reviewe

Wicubami: Honoring Alexis Nakota Sioux Ish?awimin through Kinship, Language, Spirit, and Research

This essay is meant to serve as an honor song for the Ish?awimin (Elders) from the Alexis Nakota Sioux Nation, without whose blessings and teachings our learning and research would not have been possible, particularly Bella Alexis, Rosalie Alexis, Stanley Alexis, Angela Jones, Effie Kootenay, Helen Letendre, and Nancy and Paul Potts. We describe their contributions to a community-based participatory research project on substance abuse prevention for the doshgamin (children) at the community school. The involvement of the Ish?awimin was grounded in the values and responsibilities they carry with them. Our purpose is to wicubami, to honor the Ish?awimin highly, to honor them, as in an honor song. We honor the purpose and vision embedded in the spirit, wisdom, and leadership they carry with them. We illustrate here how the teachings and blessings of the Ish?awimin affected the research experience. They deepened the meaning of the schoolbased substance abuse prevention program, culturally adapted by the Ish?awimin and delivered to the doshgamin who participated in this study