Using codesign to develop a culturally tailored, behavior change mHealth intervention for indigenous and other priority communities: A case study in New Zealand.

The obesity rate in New Zealand is one of the highest worldwide (31%), with highest rates among Maori (47%) and Pasifika (67%). Codesign was used to develop a culturally tailored, behavior change mHealth intervention for Maori and Pasifika in New Zealand. The purpose of this article is to provide an overview of the codesign methods and processes and describe how these were used to inform and build a theory-driven approach to the selection of behavioral determinants and change techniques. The codesign approach in this study was based on a partnership between Maori and Pasifika partners and an academic research team. This involved working with communities on opportunity identification, elucidation of needs and desires, knowledge generation, envisaging the mHealth tool, and prototype testing. Models of Maori and Pasifika holistic well-being and health promotion were the basis for identifying key content modules and were applied to relevant determinants of behavior change and theoretically based behavior change techniques from the Theoretical Domains Framework and Behavior Change Taxonomy, respectively. Three key content modules were identified: physical activity, family/whanau [extended family], and healthy eating. Other important themes included mental well-being/stress, connecting, motivation/support, and health literacy. Relevant behavioral determinants were selected, and 17 change techniques were mapped to these determinants. Community partners established that a smartphone app was the optimal vehicle for the intervention. Both Maori and Pasifika versions of the app were developed to ensure features and functionalities were culturally tailored and appealing to users. Codesign enabled and empowered users to tailor the intervention to their cultural needs. By using codesign and applying both ethnic-specific and Western theoretical frameworks of health and behavior change, the mHealth intervention is both evidence based and culturally tailored.

Reshaping Policies to Achieve a Strategic Plan for Indigenous Engagement in Nursing Education.

Canadian universities are developing strategies to address the Truth and Reconciliation Commission (TRC) Calls to Action. There has been much attention paid to the positivist, individualistic and Eurocentric foundations of nursing and its educational curricula, but limited focus on assessing organizational structures or engaging with stakeholders. Without both approaches, the success of new initiatives may be limited. The College of Nursing at the University of Saskatchewan implemented a "Learn Where You Live" model that demonstrated a sense of place by providing access and opportunity in rural, remote and northern regions of the province. Key to this initiative was the creation of the position of Strategist for Outreach and Indigenous Engagement, whose role it is to develop strategic initiatives designed to interpret and influence socio-political and policy-level system changes. This paper shares how adding a political scientist to nursing education created an interprofessional team by introducing new ways of thinking and being that have cultural relevance and understanding for a sustainable future.

Development and Use of Health-Related Technologies in Indigenous Communities: Critical Review.

BACKGROUND: Older Indigenous adults encounter multiple challenges as their age intersects with health inequities. Research suggests that a majority of older Indigenous adults prefer to age in place, and they will need culturally safe assistive technologies to do so. OBJECTIVE: The aim of this critical review was to examine literature concerning use, adaptation, and development of assistive technologies for health purposes by Indigenous peoples. METHODS: Working within Indigenous research methodologies and from a decolonizing approach, searches of peer-reviewed academic and gray literature dated to February 2016 were conducted using keywords related to assistive technology and Indigenous peoples. Sources were reviewed and coded thematically. RESULTS: Of the 34 sources captured, only 2 concerned technology specifically for older Indigenous adults. Studies detailing technology with Indigenous populations of all ages originated primarily from Canada (n=12), Australia (n=10), and the United States (n=9) and were coded to four themes: meaningful user involvement and community-based processes in development, the digital divide, Indigenous innovation in technology, and health technology needs as holistic and interdependent. CONCLUSIONS: A key finding is the necessity of meaningful user involvement in technology development, especially in communities struggling with the digital divide. In spite of, or perhaps because of this divide, Indigenous communities are enthusiastically adapting mobile technologies to suit their needs in creative, culturally specific ways. This enthusiasm and creativity, coupled with the extensive experience many Indigenous communities have with telehealth technologies, presents opportunity for meaningful, culturally safe development processes.

A tertiary approach to improving equity in health: quantitative analysis of the Maori and Pacific Admission Scheme (MAPAS) process, 2008-2012.

INTRODUCTION: Achieving health equity for indigenous and ethnic minority populations requires the development of an ethnically diverse health workforce. This study explores a tertiary admission programme targeting Maori and Pacific applicants to nursing, pharmacy and health sciences (a precursor to medicine) at the University of Auckland (UoA), Aotearoa New Zealand (NZ). Application of cognitive and non-cognitive selection tools, including a Multiple Mini Interview (MMI), are examined. METHODS: Indigenous Kaupapa Maori methodology guided analysis of the Maori and Pacific Admission Scheme (MAPAS) for the years 2008-2012. Multiple logistic regression models were used to identify the predicted effect of admission variables on the final MAPAS recommendation of best starting point for success in health professional study i.e. 'CertHSc' (Certificate in Health Sciences, bridging/foundation), 'Bachelor' (degree-level) or 'Not FMHS' (Faculty of Medical and Health Sciences). Regression analyses controlled for interview year, gender and ancestry. RESULTS: Of the 918 MAPAS interviewees: 35% (319) were Maori, 58% (530) Pacific, 7% (68) Maori/Pacific; 71% (653) school leavers; 72% (662) females. The average rank score was 167/320, 40-80 credits below guaranteed FMHS degree offers. Just under half of all interviewees were recommended 'CertHSc' 47% (428), 13% (117) 'Bachelor' and 38% (332) 'Not FMHS' as the best starting point. Strong associations were identified between Bachelor recommendation and exposure to Any 2 Sciences (OR:7.897, CI:3.855-16.175; p < 0.0001), higher rank score (OR:1.043, CI:1.034-1.052; p < 0.0001) and higher scores on MAPAS mathematics test (OR:1.043, CI:1.028-1.059; p < 0.0001). MMI stations had mixed associations, with academic preparation and career aspirations more consistently associated with recommendations. CONCLUSIONS: Our findings raise concerns about the ability of the secondary education sector to prepare Maori and Pacific students adequately for health professional study. A comprehensive tertiary admissions process using multiple tools for selection (cognitive and non-cognitive) and the provision of alternative entry pathways are recommended for indigenous and ethnic minority health workforce development. The application of the MMI within an equity and indigenous cultural context can support a holistic assessment of an applicant's potential to succeed within tertiary study. The new MAPAS admissions process may provide an exemplar for other tertiary institutions looking to widen participation via equity-targeted admission processes.

Taima (stop) TB: the impact of a multifaceted TB awareness and door-to-door campaign in residential areas of high risk for TB in Iqaluit, Nunavut.

BACKGROUND: The incidence rate of active tuberculosis (TB) disease in the Canadian Territory of Nunavut has shown a rising trend over the past 10 years. In 2010 it was 60 times greater than the national incidence rate. The objective of the Taima (translates to "stop" in Inuktitut) TB study was to implement and evaluate a public health campaign to enhance existing TB prevention efforts in Nunavut. METHODS: A TB awareness campaign followed by a door-to-door screening campaign was carried out in Iqaluit, Nunavut. The aim of the campaign was to raise awareness about TB, and to provide in-home screening and treatment for people living in residential areas at high risk for TB. Screening was based on geographic location rather than on individual risk factors. RESULTS: During the general awareness campaign an increase in the number of people who requested TB testing at the local public health clinic was observed. However, this increase was not sustained following cessation of the awareness campaign. Targeted TB screening in high risk residential areas in Iqaluit resulted in 224 individuals having TSTs read, and detection of 42 previously unidentified cases of latent TB, (overall yield of 18.8% or number needed to screen = 5.3). These cases of latent TB infection (LTBI) were extra cases that had not been picked up by traditional screening practices (34% relative increase within the community). This resulted in a 33% relative increase in the completion of LTBI treatment within the community. The program directly and indirectly identified 5/17 new cases of active TB disease in Iqaluit during the study period (29.5% of all incident cases). CONCLUSIONS: While contact tracing investigations remain a cornerstone of TB prevention, additional awareness, screening, and treatment programs like Taima TB may contribute to the successful control of TB in Aboriginal communities.

"Poppies are democracy!" A critical geopolitics of opium eradication and reintroduction in Turkey.

Historical scholarship in traditional geopolitics often relied on documents authored by states and by other influential actors. Although much work in the subfield of critical geopolitics thus far has addressed imbalances constructed in official, academic, and popular media due to a privileging of such narratives, priority might also be given to unearthing and bringing to light alternative geopolitical perspectives from otherwise marginalized populations. Utilizing the early-1970s case of the United States' first "war on drugs," this article examines the geopolitics of opium-poppy eradication and its consequences within Turkey. Employing not only archival and secondary sources but also oral histories from now-retired poppy farmers, this study examines the diffusion of U.S. antinarcotics policies into the Anatolian countryside and the enduring impressions that the United States and Turkish government created. In doing so, this research gives voice to those farmers targeted by eradication policies and speaks more broadly to matters of narcotics control, sentiments of anti-Americanism, and notions of democracy in Turkey and the region, past and present.

The two worlds of race revisited: a meditation on race in the age of Obama.

Nearly fifty years ago, the American Academy organized a conference and two issues of its journal "Daedalus" on the topic of "The Negro American." The project engaged top intellectuals and policy-makers around the conflicts and limitations of mid-1960s liberalism in dealing with race. Specifically, they grappled with the persistent question of how to integrate a forced-worker population that had been needed but that was socially undesirable once its original purpose no longer existed. Today, racism has been discredited as an idea and legally sanctioned segregation belongs to the past, yet the question the conference participants explored -- in essence, how to make the unwanted wanted -- still remains. Recent political developments and anticipated demographic shifts, however, have recast the terms of the debate. Gerald Early, guest editor for the present volume, uses Barack Obama's election to the presidency as a pretext for returning to the central question of "The Negro American" project and, in turn, asking how white liberalism will fare in the context of a growing minority population in the United States. Placing his observations alongside those made by John Hope Franklin in 1965, Early positions his essay, and this issue overall, as a meditation on how far we have come in America to reach "the age of Obama" and at the same time how far we have to go before we can overcome "the two worlds of race."

New series for agricultural prices in London, 1770­1914.

New annual series for the prices of major agricultural commodities sold in London markets between 1770 and 1914 are presented. These series are based on bimonthly observations drawn from newspaper market reports. The products covered are wheat, barley (grinding and malting), oats, potatoes, hay, butter, beef, mutton, and pork. Annual prices are calculated for both calendar and production years. The new series are compared to existing series.

Accounting for the contribution of vitamin B to Canada's WWII effort.

Canada began to fortify its flour and bread with vitamin B when it entered the Second World War. The decision was informed by the biology of vitamin B and therefore I suggest that the complexity of this political maneuver can best be understood by considering the specificity of the biochemistry of vitamin B. In this paper I will show that the specific biology of vitamin B allowed the Canadian government the possibility of a healthier population under wartime conditions but also allowed the government a variety of means by which to develop and organize food processing practices to this end.

Towards a holistic review of Pan-Africanism: linking the idea and the movement.

This article explores two general approaches to defining Pan-Africanism. Traditional Pan-Africanism reflects definitions of Pan-Africanism that begin with the assumption that distinctions must be made between early "ideas" of group identification with Africa versus modern organizational activities. However, holistic approaches emphasize the interconnectivity of Pan-African ideas and concrete activities. This discussion explores these approaches and their implications for contemporary analyses of Pan-Africanism. The essay concludes that the holistic line is best suited for developing a new model in Pan-Africanism.

The potato in Ireland's evolving agrarian landscape and agri-food system.

The scale, structure and impacts of food systems in Ireland have changed dramatically over the last several hundred years, predominantly since the mechanisation and intensification of farming began in the late nineteenth century. The transformation of the potato production system, which for the preceding century had dominated the Irish diet, was particularly dramatic. The time from the introduction of the potato c. 1600 to its catastrophic decline in the mid-1800s, represented a period of Irish agriculture distinctly at odds with what came before and after, involving as it did complete dependence on a single crop system. Despite devastating crop losses suffered in the nineteenth century and particularly associated with the Great Famine, the potato remained agriculturally significant in Ireland. From the late 1800s onwards the system underwent a transition towards the highly mechanised, specialised, intensive and market-oriented agri-industrial food systems of today. This new high input-high output system was accompanied by an expansion in environmental impacts extending from local to global scales. This article addresses that transition in the role and impacts of the potato in Ireland, from its introduction to the present day.

Linking traditional knowledge and environmental practice in Ontario.

Beginning in the late 1980s with the release of Our Common Future by the World Commission on Environment and Development, followed by the development of international accords such as the 1992 Convention on Biological Diversity, international pressure to resolve Indigenous rights issues has been steadily mounting. Successive Canadian governments have been striving increasingly to recognize and incorporate Aboriginal traditional knowledge into resource management planning. Following more than a decade of such efforts, the question of how to achieve such incorporation appropriately remains inadequately answered. This essay contributes to the resolution of this issue by first clarifying some key differences between Aboriginal and non-Aboriginal definitions of "traditional knowledge." Then, three Ontario case studies are briefly described that highlight the most and least successful aspects of previous undertakings. Among the lessons learned are the need to value traditional knowledge on a par with Western science while recognizing the particular capabilities of each system, and the requirement that Aboriginal peoples and their knowledge participate on a mutually respectful basis.

["Galli vocant istvm morbvm morbvm eius cvivs est.": another designation for the French disease]. / "Galli vocant istvm morbvm morbvm eius cvivs est.": otra designación para el "mal francés."

Berengario da Carpi, in "Anatomiam Mundini Commentarius" (1521) writes "morbus eius cuius est" as equivalent of "Morbus Gallicus." We aim to understand this expression in its morphology as well as in the way the medical profession considered this illness at his time.

Reversing the gaze: constructing European race discourse as modern witchcraft practice.

In keeping with the challenge of (African American) historian of religions Charles Long to develop a mode of postcolonial encounter that is a process of mutual hermeneusis, I am proposing in this article to think "race" in terms of "indigenous ritual." At the very least it is an effort to relativize the western scientific paradigm and the universalizing humanities discourses that have nestled close to that paradigm. It is not an attempt to repudiate such an episteme but, rather-to borrow a jazz term-to "swing" it, to put it in antiphonal and improvisational circulation. More specifically, this article will trace a thought experiment, probing the historical emergence of white supremacist practice as a kind of modernist embodiment of "witchcraft discourse," which functions-in the institutional grammar it has left on deposit in contemporary social practice and the "intention to consume" (the substance of others) that it "rationalizes"-very much like the "primitive superstitions" it seeks to name and repudiate in positing its own rationalizing superiority. In such an enterprise, witchcraft, I am arguing, can be "good to think with" as a mode of communicative action, signifying with a kind of "boomerang effect" in the intercultural space of rupture between the West and the rest.

Healing the body and the soul through visualization: a technique used by the Community Healing Team of Cape Dorset, Nunavut.

As Alice Kimiksana indicated, the Healing Circle or Healing Teams evolved to help First Nations people who attended residential schools deal with the aftermath of the abuse many of them suffered there. They use a variety of interventions, some traditional and some more Western in origin, for an innovative approach to a very serious problem. One technique developed by Western psychology, but very useful and adaptable in other cultural settings, is guided imagery or visualization. Often used for performance enhancement in sports, it is also applicable to other situations from medical settings to mental health treatment. In this presentation, Novaliinga Kingwatsiaq of Kingnait (Cape Dorset) led the audience through a modified version of a visualization used by her Community Healing Team. (During visualization one assumes a relaxed state with one's eyes closed and imagines oneself in the context of a story told by the person guiding the imagery.) The imagery she chose is both symbolically and culturally appropriate. Most audience members were unfamiliar with the process of visualization, and several indicated that they were intrigued by the experience. Kumaarjuk Pii introduced Novaliinga Kingwatsiaq and translated for her.

Music as knowledge in Shamanism and other healing traditions of Siberia.

Several presenters made the point that one cannot look at narrative alone, without taking into account the music, dance, and drumming that, in many settings, go along with it. One of these presenters was Marilyn Walker, who has had the good fortune to work with healers in Siberia. Although academic in approach, Marilyn's paper also recognizes the importance of experiential ways of knowing. In her Quebec City presentation, she shared some of this experiential dimension by showing and commenting on videotaped segments featuring three Siberian healers. Walker's paper discusses healing at several levels. In addition to several healing dimensions that she lists at the end of her paper, she mentions the physiological effects of music, dance, and drumming. Current research is leading to a better understanding of how trauma affects the brain and the body, and ways that various therapies, including new therapies focusing on sensorimotor effects, can promote healing. Along with these developments has come a greater appreciation and understanding among some mental health practitioners of some of the neuropsychological processes by which traditional practices such as narrative, singing, drumming, and dancing, may bring about healing.

Diving down: ritual healing in the tale of The Blind Man and the Loon.

Some stories enjoy a very widespread distribution in the North. Anthropologists and folklorists have long collected and analyzed these stories, and scrutinized their regional variants. Craig Mishler taps into this longstanding scholarly tradition as he looks at the widespread story of "The Blind Man and the Loon." However, he goes beyond analyzing the form of this tale to explore what gives it healing properties. He wants to know why this story has become part of virtually every Native storyteller's repertoire throughout the Arctic and Subarctic. One answer is that the main character and events of the story evoke the undeserved suffering that shapes the human condition everywhere. Much of the story's power stems from its depiction of a ritual for healing the handicapped, thereby becoming a medicinal oral text. Additional power comes from the wide range of local and regional forms that adapt it to local sensibilities.

The transformative power of story for healing.

One of our goals in this session was, not just to talk about the healing power of narrative, but to experience it as well. Louise Profeit-LeBlanc is one of the presenters we invited specifically because of her skills as a storyteller. She has been heavily involved for several years as both an organizer and a participant in the Yukon Storytelling Festival, held every year in late May in Whitehorse. Woven into her presentation is a useful framework for differentiating various kinds of stories. As she tells us a series of stories, she takes us through a wide range of emotions from grief and loss to laughter and awe. For each of her stories, she gives us some personal contextual information that adds to the story's meaning and helps us appreciate its significance. Her final story, in particular, is the kind of traditional story that has probably existed for a very long time. Such stories may be told with slightly different emphases, depending on the occasion, but they carry wisdom and value for every generation that hears them.