Integrating knowledge and action: learnings from an implementation program for food security and food sovereignty with First Nations communities within Canada.

BACKGROUND: Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research, program development, and implementation with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning and action from key learnings and successes on scaling-up of the Learning Circles (LC) model vertically in Haida Nation, British Columbia (BC), and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. The application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. METHODS: A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from interviews (n = 55) and meeting reports (n = 37) was thematically analyzed to inform the development of guiding principles. Community sense-making of findings informed applicability in a new community context embarking on food systems work. RESULTS: Emergent guiding principles for participatory food system planning and action are described within four main areas: (1) create safe and ethical spaces for dialog by establishing trust and commitment from the ground up, (2) understand the context for change through community engagement, (3) foster relationships to strengthen and sustain impact, and (4) reflect and embrace program flexibility to integrate learnings. CONCLUSIONS: Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community protocols and perspectives in support of Indigenous self-determined priorities.

Indigenous Community Perspectives of Food Security, Sustainable Food Systems and Strategies to Enhance Access to Local and Traditional Healthy Food for Partnering Williams Treaties First Nations (Ontario, Canada).

In partnership with communities of the Williams Treaties First Nations in southern Ontario (Canada), we describe an approach to work with communities, and highlight perspectives of food security and sustainability, including priorities and opportunities to revitalize local food systems as a pathway to food security and food sovereignty. The objectives of our project were: (1) to build a shared understanding of food security and sustainability; and (2) to document community priorities, challenges and opportunities to enhance local food access. Utilizing an Indigenous methodology, the conversational method, within the framework of community-based participatory research, formative work undertaken helped to conceptualize food security and sustainability from a community perspective and solidify interests within the four participating communities to inform community-led action planning. Knowledge generated from our project will inform development of initiatives, programs or projects that promote sustainable food systems. The community-based actions identified support a path towards holistic wellbeing and, ultimately, Indigenous peoples' right to food security and food sovereignty.

Predictors of household food insecurity and relationship with obesity in First Nations communities in British Columbia, Manitoba, Alberta and Ontario.

OBJECTIVE: To further understandings of household food insecurity in First Nations communities in Canada and its relationship with obesity. DESIGN: Analysis of a cross-sectional dataset from the First Nations Food, Nutrition and Environment Study representative of First Nations communities south of the 60th parallel. Multivariate logistic regression was used to assess associations between food insecurity and sociodemographic factors, as well as the odds of obesity among food-insecure households adjusting for sociodemographic characteristics. SETTING: Western and Central Canada. PARTICIPANTS: First Nations peoples aged ≥19 years. RESULTS: Forty-six percent of First Nations households experienced food insecurity. Food insecurity was highest for respondents who received social assistance; had ≤10 years of education; were female; had children in the household; were 19-30 years old; resided in Alberta; and had no year-round road access into the community. Rates of obesity were highest for respondents residing in marginally food-insecure households (female 56·6 %; male 54·6 %). In gender-specific analyses, the odds of obesity were highest among marginally food-insecure households in comparison with food-secure households, for both female (OR 1·57) and male (OR 1·57) respondents, adjusting for sociodemographic variables. For males only, those in severely food-insecure (compared with food-secure) households had lower odds of obesity after adjusting for confounding (OR 0·56). CONCLUSIONS: The interrelated challenges of food insecurity and obesity in First Nations communities emphasise the need for Indigenous-led, culturally appropriate and food sovereign approaches to food security and nutrition in support of holistic wellness and prevention of chronic disease.

"You don't have anorexia, you just want to look like a celebrity": perceived stigma in individuals with anorexia nervosa.

BACKGROUND: Minimal research has been conducted on how individuals with Anorexia nervosa (AN) undergoing treatment perceive public stigma. AIM: Explore how affected individuals with AN believe the general public perceives AN. METHOD: Using thematic analysis, 19 participants with AN were interviewed at the beginning of treatment. RESULTS: Three interrelated themes were ascertained: (1) AN is not an illness; (2) eating disorder behaviours are volitional and the public endorses a socio-cultural explanation for the disorder; 3) affected individuals delay disclosing their illness and experience shame engaging in intensive treatment for AN as a result of their perception of stigma. CONCLUSIONS: Individuals with AN viewed the public as trivializing AN by viewing behaviours as within their control and by attributing eating disorder behaviours solely to socio-cultural factors. Participants believed that the public minimizes the challenges associated with treatment. Findings suggest that clinical interventions targeting stigma are required to counteract perceptions held by service users regarding how others view their illness. "Mental health literacy" interventions are needed for health professionals working with high risk groups likely to avoid seeking help due to fears of stigmatization.