Development and Initial Validation of the Transportation Support Scale.

IMPORTANCE: Driving cessation affects older drivers and, possibly, also care partners (most of whom tend to be women). Although tools exist to assess the effects on family and friends of providing informal care to someone who needs assistance, no tool is available to clinicians that specifically focuses on the effects of driving cessation. OBJECTIVE: To develop the Transportation Support Scale (TSS) to measure care partners' responses-both negative and positive-to driving cessation and assuming transportation responsibilities. DESIGN: We developed a list of 98 items to capture the impact on care partners of providing transportation to older adults who have stopped driving. In Phase 1, we pretested the items qualitatively with a small sample of care partners. In Phase 2, we reduced the number of items and examined several psychometric properties of the TSS with a larger sample. SETTING: Community. PARTICIPANTS: Two convenience samples of care partners who provide transportation (Phase 1, n = 11; Phase 2, n = 66). RESULTS: The initial pool of items was reduced from 98 to 22. The final TSS has an internal consistency of .88 (Cronbach's α). Thirty-five percent of care partners' scores fell above the middle possible score; these care partners were likely experiencing a high negative impact related to providing transportation after driving cessation. CONCLUSIONS AND RELEVANCE: The TSS demonstrated adequate preliminary psychometric properties. We need additional research to further evaluate the psychometric properties of the TSS (e.g., test-retest reliability). A fully validated TSS may be useful to clinicians and researchers. What This Article Adds: The TSS has the potential to help clarify the perspective of care partners as well as inform the development and evaluation of services for care partners who are providing transportation to former drivers.

Outcomes from a collaborative project developing and evaluating a community rehabilitation worker program for Northwestern Ontario First Nations.

INTRODUCTION: Major inequities exist in levels of health and wellbeing, availability, and access to healthcare services between seniors of Indigenous and non-Indigenous background in Ontario. First Nations elders are 45-55% more frail than the average senior in Ontario. Additionally, needed rehabilitation services are not easily accessible or available in the first language of most First Nations elders within their home communities. A literature review demonstrated community-based rehabilitation assistant models had been successfully developed and implemented in regions facing similar equity and access challenges. Building on these findings, a needs assessment was conducted to capture unique needs and requirements in Northwestern Ontario relating to rehabilitation among First Nations elders. METHODS: The needs assessment resulted in four First Nations, three Indigenous health organizations, three rehabilitation health organizations, and two academic institutions iteratively developing and evaluating curriculum for a Community Rehabilitation Worker (CRW) program in treaty territories 5, 9, and Robinson-Superior. The goal of the program is to train local CRWs, familiar with local languages and cultures, to provide rehabilitative services that support ageing in place, health, wellbeing, and quality of life for First Nations elders. The study employed a community participatory action research approach aligning with the OCAP® (Ownership, Control, Access, and Possession) framework for working with Indigenous populations. Seventeen community partners were active participants in the program development, evaluation, and adaptation of the CRW curriculum. Feedback was received through advisory committee meetings, surveys, and individual and group interviews. RESULTS: All 101 participants agreed, across all curriculum modules, that (1) the time allotment was realistic; (2) instructional materials, activities, and resources were appropriate and easy to understand; (3) evaluation activities accurately measured learning; and (4) participants identifying as Indigenous felt that Indigenous culture was adequately reflected. The qualitative findings highlighted the importance of incorporating culture, spirituality, traditions, local language use, and reintegration of First Nations elders into traditional activities and community activities for both the CRW curriculum and rehabilitation efforts. The need for locally available First Nations, elder-focused mental health support, transportation options, and gathering spaces such as those commonly seen in urban areas was also highlighted. CONCLUSION: The process of iteratively developing and evaluating a CRW program resulted in a Northwestern Ontario college welcoming the first cohort of students to the CRW program in March 2022. The program is co-facilitated with a First Nations Elder and includes components of local culture, language, and the reintegration of First Nations elders into community as part of the rehabilitation efforts. In addition, to appropriately support the quality of life, health, and wellbeing of First Nations elders, the project team called upon provincial and federal governments to work with First Nations to make available dedicated funding to address inequities in resources available to First Nations elders in Northwestern Ontario urban and First Nations remote communities. This included elder-focused transportation options, mental health services, and gathering places. The program implementation will be evaluated with the first cohort of CRWs for further adaptations considering potential scale and spread. As such, the project and findings may also represent a resource for others wishing to pursue similar development using participatory approaches in rural and remote communities both nationally and internationally.

Niqivut Silalu Asijjipalliajuq: Building a Community-Led Food Sovereignty and Climate Change Research Program in Nunavut, Canada.

The history of health research in Inuit communities in Canada recounts unethical and colonizing research practices. Recent decades have witnessed profound changes that have advanced ethical and community-driven research, yet much work remains. Inuit have called for research reform in Inuit Nunangat, most recently creating the National Inuit Strategy on Research (NISR) as a framework to support this work. The present study details the process undertaken to create a research program guided by the NISR to address food security, nutrition, and climate change in Inuit Nunangat. Four main elements were identified as critical to supporting the development of a meaningful and authentic community-led program of research: developing Inuit-identified research questions that are relevant and important to Inuit communities; identifying Inuit expertise to answer these questions; re-envisioning and innovating research methodologies that are meaningful to Inuit and reflect Inuit knowledge and societal values; and identifying approaches to mobilizing knowledge that can be applied to support food security and climate change adaptation. We also identify considerations for funding agencies to support the meaningful development of Inuit-led research proposals, including aligning funding with community priorities, reconsidering who the researchers are, and investing in community infrastructure. Our critical reflection on the research program development process provides insight into community-led research that can support Inuit self-determination in research, enhance local ethical conduct of research, privilege Inuit knowledge systems, and align Inuit-identified research priorities with research funding opportunities in health research. While we focus on Inuit-led research in Nunavut, Canada, these insights may be of interest more broadly to Indigenous health research.

Inuit Country Food and Health during Pregnancy and Early Childhood in the Circumpolar North: A Scoping Review.

Inuit communities in the Circumpolar North have experienced a nutrition transition characterized by the decreased intake of culturally important, nutrient-rich traditional food (country food), and an increased intake of market food, resulting in concerns over reduced diet quality and emerging chronic diseases. Nutrition in early life is critical for development, may influence health risks in later life, and is an important concern for Inuit community health. The goal of this scoping review was to characterize the nature, extent, and range of the published literature on Inuit country food and health in pregnancy and childhood. A search string was developed and applied to three databases, followed by title and abstract screening and full text review. Articles published between 1995 and 2019 were included, and data were extracted and summarized descriptively. The number of articles generally increased over time, despite the unequal geographic distribution of articles. The majority of the articles focused on environmental contaminants, and one-quarter described nutrient adequacy. Few articles described food security or food safety in pregnancy, and the most utilized quantitative methods. Gaps in understanding of country food use in pregnancy and early childhood highlight areas of future research to support public health policy for this population. Given the critical role of good nutrition in early life and the important contribution country food makes to diet quality for Inuit, further understanding of this interface is warranted.

Perinatal care experiences of Muslim women in Northwestern Ontario, Canada: A qualitative study.

PROBLEM AND BACKGROUND: Although the number of Muslim women in Canada and northwestern Ontario (NWO) is increasing, few studies have focused on their experiences of perinatal health care. Extant research has highlighted discrimination and care that lacks respect for cultural and religious norms. These factors may limit access to health services and increase unfavorable maternal and child health outcomes. AIM: To explore the perinatal health care experiences of Muslim women in NWO. METHODS: A qualitative, descriptive study used purposive and snowball sampling to recruit a sample of 19 Muslim mothers. Ssemistructured interviews were conducted, audio recorded, transcribed verbatim, and analyzed thematically. FINDINGS: The mothers' experiences were categorized into four themes: women's choices and preferences of health care providers (HCPs); attitudes toward prenatal classes and education; husbands' involvement and support in the birthing process; and challenges to optimal care. DISCUSSION AND CONCLUSION: The findings show that NWO Muslim women's experiences were generally positive and their care choices and preferences were shaped by their religious beliefs and cultural practices. Factors that enhanced their experiences were HCPs' awareness of and respect for the women's religious and cultural beliefs and practices. However, the women lacked personal knowledge of a range of care options and services. Respecting Muslim women's religious and cultural beliefs and practices will enhance their experience of care. Equity in access to quality services, care, and outcomes can be further enhanced if Muslim women are informed about the range of care options and services as early in their pregnancies as possible.

Symposium on "parental education" at the ICCH17.

This symposium report provides a brief overview of the six programmes and studies on parental education and maternal health services within the circumpolar region presented in the symposium "parental education" at the 17th International Congress of Circumpolar Health in Copenhagen, Denmark, August 2018.

"Double culturedness": the "capital" of Inuit nurses.

BACKGROUND: The health and educational systems in Greenland and Nunavut are reflections of those in Denmark and Southern Canada, with the language of instruction and practise being Danish and English. This places specific demands on Inuit studying nursing. OBJECTIVE: This paper discusses the experiences of Inuit who are educated in nursing programmes and practise in healthcare systems located in the Arctic but dominated by EuroCanadian and Danish culture and language. DESIGN: Research was qualitative and ethnographic. It was conducted through 12 months of fieldwork in 5 Greenlandic and 2 Nunavut communities. METHODS: Observation, participant observation, interviews, questionnaires and document review were used. The analytical framework involved Bourdieu's concepts of capital and habitus. RESULTS: Participants experienced degrees of success and well-being in the educational systems that are afforded to few other Canadian and Greenlandic Inuit. This success appeared to be based on nurses and students possessing, or having acquired, what I call "double culturedness"; this makes them able to communicate in at least 2 languages and cultures, including the ability to understand, negotiate and interact, using at least 2 ways of being in the world and 2 ways of learning and teaching. CONCLUSION: There continues to be a critical need for Inuit nurses with their special knowledge and abilities in the healthcare systems of the Arctic. Inuit nurses' experiences will help inform the education and healthcare systems and point to areas in need of support and change in order to increase recruitment and retention of nursing students and practitioners.

Women's perspectives on illness when being screened for cervical cancer.

BACKGROUND: In Greenland, the incidence of cervical cancer caused by human papillomavirus (HPV) is 25 per 100,000 women; 2.5 times the Danish rate. In Greenland, the disease is most frequent among women aged 30-40. Systematic screening can identify women with cervical cell changes, which if untreated may cause cervical cancer. In 2007, less than 40% of eligible women in Greenland participated in screening. OBJECTIVE: To examine Greenlandic women's perception of disease, their understanding of the connection between HPV and cervical cancer, and the knowledge that they deem necessary to decide whether to participate in cervical cancer screening. STUDY DESIGN: The methods used to perform this research were 2 focus-group interviews with 5 Danish-speaking women and 2 individual interviews with Greenlandic-speaking women. The analysis involved a phenomenological-hermeneutic approach with 3 levels of analysis: naive reading, structural analysis and critical interpretation. RESULTS: These revealed that women were unprepared for screening results showing cervical cell changes, since they had no symptoms. When diagnosed, participants believed that they had early-stage cancer, leading to feelings of vulnerability and an increased need to care for themselves. Later on, an understanding of HPV as the basis for diagnosis and the realization that disease might not be accompanied by symptoms developed. The outcome for participants was a life experience, which they used to encourage others to participate in screening and to suggest ways that information about screening and HPV might reach a wider Greenlandic population. CONCLUSION: Women living through the process of cervical disease, treatment and follow-up develop knowledge about HPV, cervical cell changes, cervical disease and their connection, which, if used to inform cervical screening programmes, will improve the quality of information about HPV, cervical cancer and screening participation. This includes that verbal and written information given at the point of screening and diagnosis needs to be complemented by visual imagery.

Tales about tuberculosis and colonization: the socio-cultural experience of tuberculosis in Nunavut.

OBJECTIVE: To examine how Inuit in Nunavut experience and make meaning of TB, its history, protocols and regimes, and how this and the effects of historical and continuing colonization in Nunavut influence current levels of TB in Nunavut. DESIGN AND METHODS: The study was qualitative, conducted through seven months of fieldwork in two Nunavut communities utilising ethnographic methods including 42 taped interviews, casual conversations, participant observation and document review. RESULTS: Inuit participants include explanations other than biomedical when making meaning of TB, and health and disease generally. Also, Inuit participants express a preference for methods of health education different from those presently employed. Lastly, and perhaps more importantly, this study suggests that the history of colonization and continuing colonization play a significant role in how some Inuit experience TB, other disease, and health, and in the high incidence of TB in Nunavut. CONCLUSION: In order to decrease incidence of TB and increase levels of health in Nunavut decolonizing measures are necessary.