Integrative review protocol for Indigenous youth participation in health equity promotion.

INTRODUCTION: Indigenous youth participation in decision-making is internationally recognised as a pathway to promote health equity, decolonisation and social inclusion. Hearing Indigenous youth voices and actively involving them in decisions that affect their lives and their communities has the potential to address disproportionate health and social challenges they encounter. Yet the existing evidence-base on participatory approaches remains fragmented and vast leading to a lack of integration. METHODS AND ANALYSIS: An integrative review methodology will be used to conduct a comprehensive, multidisciplinary review of the literature about Indigenous youth participation in health equity promotion. The literature search is anticipated to be carried out in July-August 2022. We will search online databases Scopus, Ovid MEDLINE, Embase and PsycINFO along with several interdisciplinary databases indexed in EBSCOhost and ProQuest. Key Indigenous research journals not consistently indexed in the online databases will be examined to identify additional journal articles. We will employ a blinded, dual-reviewer two-step selection process with established inclusion/exclusion criteria and limit data to English-language publications related to Indigenous populations in Canada, USA, Aotearoa New Zealand and Australia. Focusing on qualitative empirical and theoretical studies, they will undergo quality appraisal and Covidence software will be used to manage the review. Data will be sorted, extracted and analysed. We will codify data for descriptive reporting and conduct a narrative synthesis to identify a common conceptualisation for Indigenous youth participatory approaches across disciplines, its barriers and facilitators, and knowledge gaps. ETHICS AND DISSEMINATION: Ethical review is not required for the integrative review. The review will be shared through various publication and non-academic platforms as well as our university and community research networks. Findings will have broad relevance for those seeking to involve Indigenous youth to be active decision-makers across a range of fields, but with specific implications for health equity.

Land and nature as sources of health and resilience among Indigenous youth in an urban Canadian context: a photovoice exploration.

BACKGROUND: Population and environmental health research illustrate a positive relationship between access to greenspace or natural environments and peoples' perceived health, mental health, resilience, and overall well-being. This relationship is also particularly strong among Canadian Indigenous populations and social determinants of health research where notions of land, health, and nature can involve broader spiritual and cultural meanings. Among Indigenous youth health and resilience scholarship, however, research tends to conceptualize land and nature as rural phenomena without any serious consideration on their impacts within urban cityscapes. This study contributes to current literature by exploring Indigenous youths' meaning-making processes and engagements with land and nature in an urban Canadian context. METHODS: Through photovoice and modified Grounded Theory methodology, this study explored urban Indigenous youth perspectives about health and resilience within an inner-city Canadian context. Over the course of one year, thirty-eight in-depth interviews were conducted with Indigenous (Plains Cree First Nations and Métis) youth along with photovoice arts-based and talking circle methodologies that occurred once per season. The research approach was also informed by Etuaptmumk or a "two-eyed seeing" framework where Indigenous and Western "ways of knowing" (worldviews) can work alongside one another. RESULTS: Our strength-based analyses illustrated that engagement with and a connection to nature, either by way of being present in nature and viewing nature in their local urban context, was a central aspect of the young peoples' photos and their stories about those photos. This article focuses on three of the main themes that emerged from the youth photos and follow-up interviews: (1) nature as a calming place; (2) building metaphors of resilience; and (3) providing a sense of hope. These local processes were shown to help youth cope with stress, anger, fear, and other general difficult situations they may encounter and navigate on a day-to-day basis. CONCLUSIONS: This study contributes to the literature exploring Indigenous youths' meaning-making process and engagements with land and nature in an urban context, and highlights the need for public health and municipal agencies to consider developing more culturally safe and meaningful natural environments that can support the health, resilience, and well-being of Indigenous youth within inner-city contexts.

"Just because they aren't human doesn't mean they aren't alive": The methodological potential of photovoice to examine human-nature relations as a source of resilience and health among urban Indigenous youth.

Photovoice has been widely used as a participatory visual research methodology within the social sciences and health research. Given photovoice's critical and pedagogical potential, its advancement within Indigenous resilience and health research has been particularly prevalent. However, it has largely failed to problematize the concept of 'voice' to the extent of theorizing and engaging with the 'voices' of other kinds of life with consequences for theory and method. In this paper we re-examine the methodological potential and utility of photovoice methods to include other-than-human 'voices' during the empirical study of place-making, human-nature relations, and resilience and health. We analyze photo-narratives from a community-based, participatory research project involving Indigenous youth in Saskatoon, Saskatchewan in order to revisit 1) what we did to produce those images and 2) what we saw and heard in images. Our results suggest that when photovoice methods consider a relational and affective understanding of subjective reality during research practice, they have the capacity to capture and handle other-than-human 'voices'. Accordingly, we discuss future directions when adapting photovoice methods for the study of environmental repossession and dispossession within contested contexts of and encounters with methodological complexity, uncertainty, and emergence.

Re-imagining miyo-wicehtowin: Human-nature relations, land-making, and wellness among Indigenous youth in a Canadian urban context.

Relationships to land and nature have long been recognized globally as a central Indigenous determinant of health. As more Indigenous peoples migrate to larger urban centers, it is crucial to better understand how these relationships are maintained or function within urban spaces. This article outlines the results of a year-long collaborative study that qualitatively explored Indigenous young peoples' connections between "land," nature, and wellness in an urban Canadian context. Thirty-eight semi-structured interviews were conducted with 28 Cree and Métis Indigenous youth living within Saskatoon, Saskatchewan. A strength based analysis focused on re-imagining miyo-wicehtowin; that is, the processes of youths' self-determination and agency that build positive human-nature relationships and enact "land-making" amidst their urban spaces. This research critically engages environmental dispossession and repossession to more readily consider decolonizing land-based approaches to health and wellness among urban contexts. Future empirical and methodological directions for exploring human-nature relationships in urban health research are also offered.

Hospitalization for mental health related ambulatory care sensitive conditions: what are the trends for First Nations in British Columbia?

BACKGROUND: Indigenous peoples globally experience a disproportionate burden of mental illness due to forced policies and practices of colonization and cultural disruption. The objective of this study was to provide a baseline profile of hospitalization rates for mental health-related Ambulatory Care Sensitive Conditions among First-Nations living both on and off reserve in British Columbia, Canada, and explore the relationship between local access to health services and mental health-related hospitalization rates. METHODS: A population-based time trend analysis of mental health-related Ambulatory Care Sensitive Conditions hospitalizations was conducted using de-identified administrative health data. The study population included all residents eligible under the universal British Columbia Medical Services Plan and living on and off First Nations reserves between 1994/95 and 2009/10. The definition of mental health-related Ambulatory Care Sensitive Conditions included mood disorders and schizophrenia, and three different change measures were used to operationalize avoidable hospitalizations: 1) rates of episodes of hospital care, 2) rates of length of stay, and 3) readmission rates. Data were analyzed using generalized estimating equations approach, controlling for age, sex, and socio-economic status, to account for change over time. RESULTS: Our findings show that First Nations living on reserve have higher hospitalization rates for mental disorders compared to other British Columbia residents up until 2008. Those living off reserve had significantly higher hospitalization rates throughout the study period. On-reserve communities served by nursing stations had the lowest rates of hospitalization whereas communities with limited local services had the highest rates. Compared to other British Columbia residents, all First Nations have a shorter length of stay and lower readmission rates. CONCLUSIONS: This study suggests that despite reduced rates of hospitalization for mental-health related Ambulatory Care Sensitive Conditions over time for First Nations, gaps in mental health care still exist. We argue greater investments in primary mental health care are needed to support First Nations health. However, these efforts should place equal importance on prevention and the social determinants of health.