Health and well-being needs of Indigenous adolescents: a protocol for a scoping review of qualitative studies.

INTRODUCTION: Improving the health of Indigenous adolescents is central to addressing the health inequities faced by Indigenous peoples. To achieve this, it is critical to understand what is needed from the perspectives of Indigenous adolescents themselves. There have been many qualitative studies that capture the perspectives of Indigenous young people, but synthesis of these has been limited to date. METHODS AND ANALYSIS: This scoping review seeks to understand the specific health needs and priorities of Indigenous adolescents aged 10-24 years captured via qualitative studies conducted across Australia, Aotearoa New Zealand, Canada, the USA, Greenland and Sami populations (Norway and Sweden). A team of Indigenous and non-Indigenous researchers from these nations will systematically search PubMed (including the MEDLINE, PubMed Central and Bookshelf databases), CINAHL, Embase, Scopus, the Informit Indigenous and Health Collections, Google Scholar, Arctic Health, the Circumpolar Health Bibliographic Database, Native Health Database, iPortal and NZresearch.org, as well as specific websites and clearinghouses within each nation for qualitative studies. We will limit our search to articles published in any language during the preceding 5 years given that needs may have changed significantly over time. Two independent reviewers will identify relevant articles using a two-step process, with disagreements resolved by a third reviewer and the wider research group. Data will then be extracted from included articles using a standardised form, with descriptive synthesis focussing on key needs and priorities. This scoping review will be conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. ETHICS AND DISSEMINATION: Ethics approval was not required for this review. Findings will be disseminated via a peer-reviewed journal article and will inform a broader international collaboration for Indigenous adolescent health to develop evidence-based actions and solutions.

A population-based study on health and living conditions among Sámi in Sweden: the SámiHET study.

The aim of this paper was to describe the study design, data collection procedure and participation of the population-based study "Sámi Health on Equal Terms" (SámiHET) conducted among the Sámi in Sweden in 2021. A Sámi sample was constructed, drawing from three pre-existing-registers: the Sámi electoral roll, the reindeer mark register and the "Labour statistics based on administrative sources" register to identify reindeer herding businesses. All identified persons aged 18-84 were invited to participate during February-May 2021. Among the 9,249 invitations, 3,779 answered the survey (participation rate of 40.9%). More women than men participated, and the age group 45-64 was the most common in both sexes. Around 10% of participants were in the youngest group. A majority of participants were residents of Norrbotten (48%), while almost one fourth were living outside Sápmi (22%). SámiHET has been demonstrated to be a feasible and cost-effective way of investigating health and living conditions among the Sámi in Sweden, providing information easy to compare with Swedish data. The knowledge to be produced may be used to inform policy to guide and improve Sámi health, thus contributing to realising the equal health rights of the Indigenous Sámi in Sweden.

"Mapping suicide prevention initiatives targeting Indigenous Sámi in Nordic countries".

BACKGROUND: Suicide is a major public health issue among Indigenous Sámi in Nordic countries, and efforts to prevent suicide in the Sámi context are increasing. However, there is no literature on suicide prevention initiatives among Sámi. The aim of the study was to map suicide prevention initiatives targeting Sámi in Norway, Sweden, and Finland during 2005-2019. METHOD: Initiatives were identified and described through utilizing networks among stakeholders in the field of suicide prevention among Sámi, acquiring documentation of initiatives and utilizing the authors first-hand experiences. The described initiatives were analyzed inspired by the "What is the problem represented to be?" (WPR)-approach. RESULTS: Seventeen initiatives targeting Sámi were identified during 2005-2019, including nine in Sweden, five in Norway, one in Finland and two international initiatives. Analysis with the WPR-approach yielded 40 problematizations regarding how to prevent suicide among Sámi, pertaining to shortcomings on individual (5), relational (15), community/cultural (3), societal (14) and health systems levels (3). All initiatives were adapted to the Sámi context, varying from tailor-made, culture-specific approaches to targeting Sámi with universal approaches. The most common approaches were the gatekeeper and mental health literacy training programs. The initiatives generally lacked thorough evaluation components. CONCLUSION: We argue that the dominant rationales for suicide prevention were addressing shortcomings on individual and relational levels, and raising awareness in the general public. This threatens obscuring other, critical, approaches, such as broadening perspectives in prevention planning, improving health systems for Sámi, and promoting cultural empowerment among Sámi. Nevertheless, the study confirms considerable efforts have been invested into suicide prevention among Sámi during the last 15 years, and future initiatives might include a broader set of prevention rationales. To improve evaluation and identify the most promising practices, increased support regarding development of plans and implementation of evaluation components is needed.

"We are like lemmings": making sense of the cultural meaning(s) of suicide among the indigenous Sami in Sweden.

BACKGROUND: Suicide is a widespread problem among indigenous people residing in the circumpolar Arctic. Though the situation among the indigenous Sami in northern Scandinavia is better than among some other indigenous people, suicide is still regarded as a major public health issue. To adapt prevention strategies that are culturally attuned one must understand how suicide is understood within context. That is, the cultural meaning(s) of suicide. OBJECTIVE: To explore and make sense of the cultural meaning(s) of suicide among Sami in Sweden. DESIGN: Open-ended focus group discussions (FGDs) on the topic "suicide among Sami" were carried out in 5 Sami communities in Sweden, with in total 22 strategically selected Sami participants. FGDs were recorded, transcribed verbatim and analyzed through employing content analysis. RESULTS: From the FGDs 4 themes emerged including "The Sami are fighting for their culture and the herders are in the middle of the fight," "Suicide as a consequence of Sami losing (or having lost) their identity," "A wildfire in the Sami world" and "Difficult to get help as a Sami." CONCLUSIONS: Findings indicate that Sami in Sweden make sense of suicide in relation to power and identity within a threatened Sami cultural context. Suicide is then understood as an act that takes place and makes sense to others when a Sami no longer has the power to maintain a Sami identity, resulting in being disconnected from the Sami world and placed in an existential void where suicide is a solution. The findings are useful in development of culturally attuned suicide prevention among Sami in Sweden.