Anishinabek sources of strength: Learning from First Nations people who have experienced mental health and substance use challenges.

We report on the system of care and sources of strength and resilience for mental health among First Nations People experiencing the impacts of historical and contemporary colonization. Aamjiwnaang First Nation, a vibrant community of approximately 2400 members in southwestern Ontario, Canada, partnered in research to reveal sources of strength and resilience among community members with lived experiences (PWLE) with mental health and/or substance use challenges. A thematic content analysis was done using qualitative data collected as part of two complementary studies. In the first study called the "Five Views on a Journey" study, interviews with PWLE and family members of PWLE were conducted to better understand strengths and deficits in the system of care for mental health and substance use. In the second study entitled "A Strengths-Based Approach to Understanding How First Nations People Cope with Stress and Trauma," Photovoice was used to examine sources of strength and resilience among PWLE. Combined, these studies revealed that mental health supports and services that are trustworthy, open, and confidential are foundational to healing, helping PWLE find pathways to wellness by engendering feelings of hope, self-worth and pride. The integral roles of Anishinaabe culture and cultural identity as well as strong connections with family and community were key sources of strength and resilience. Our findings are discussed in the context of Aamjiwnaang's informal and formal systems of care, culture as wellness, inner strength, and the Truth and Reconciliation Commission of Canada's Calls to Action.

Understanding Social Determinants of First Nations Health Using a Four-Domain Model of Health and Wellness Based on the Medicine Wheel: Findings from a Community Survey in One First Nation.

We examined the explanatory roles of social determinants of health (SDOH) for First Nations people using a four-domain model of health and wellness based on the Medicine Wheel (i.e., physical, mental, emotional, and spiritual health), including colonial-linked stressors (i.e., historical trauma, childhood adversities, racial discrimination) and cultural resilience factors (i.e., cultural strengths, traditional healing practices, social support). Data were collected in partnership with a First Nation in Ontario, Canada in 2013 through a community survey (n = 194). For each outcome (physical, mental, emotional, and spiritual health), a modified Poisson regression model estimated prevalence ratios for the SDOH, adjusting for age, sex, education, and marital status. Negative associations were found for historical trauma with physical, mental, emotional, and spiritual health; for childhood adversities with mental health; and for racial discrimination with physical, mental, and emotional health. Positive associations were found for cultural strengths with physical, mental, and emotional health and for social support with physical, mental, emotional, and spiritual health. We observed negative associations between use of traditional healing practices and mental and emotional health. Our findings suggest that these SDOH may play important roles in relation to wellness through associations with the domains of health modelled by the Medicine Wheel.

Buffering effects of social support for Indigenous males and females living with historical trauma and loss in 2 First Nation communities.

Globally, Indigenous mental health research has increasingly focused on strengths-based theory to understand how positive factors influence wellness. However, few studies have examined how social support buffers the effects of trauma and stress on the mental health of Indigenous people. Using survey data from 207 males and 279 females in 2 Ontario First Nations we examined whether social support diminished the negative effects of perceived racism, historical trauma and loss on depression and/or anxiety. Among females, having more social supports was significantly related to a lower likelihood of depression/anxiety, whereas greater perceived racism and historical losses were associated with a greater likelihood of depression/anxiety. For both males and females, childhood adversity was significantly related to a greater likelihood of depression/anxiety. Among females, a significant interaction was found between social support and childhood adversities. For females with low social support, depression/anxiety was significantly higher among those who had experienced childhood adversities versus those with none; however, for those with high level of social support, the association was not significant. The same relationships were not found for males. Possible reasons are that males and females might experience depression/anxiety differently, or the social support measure might not adequately capture social support for First Nations males.

Perspectives on enhancing physical activity and diet for health promotion among at-risk urban UK South Asian communities: a qualitative study.

OBJECTIVES: To explore perspectives on enhancing physical activity and diet among South Asians in urban deprived communities at high risk of chronic disease and to inform development of culturally appropriate health promotion intervention. DESIGN: Qualitative study using semistructured one-to-one and family group interviews with thematic analysis of data. SETTING: Urban disadvantaged communities in the East Midlands of the UK. PARTICIPANTS: 45 respondents, including 34 people of South Asian origin (16 at-risk individuals, six family groups involving 18 relatives), of mainly Pakistani and Indian origin, including 16 non-English speakers; and 11 health professionals working locally with communities of concern. RESULTS: South Asian participants underlined the challenges of requiring family members across generations to engage in modifying dietary behaviours, and the central role of communal eating of traditional 'Asian' food in their cultural lives. Barriers to increasing physical activity included cost, personal safety and lack of time outside of long working hours and carer commitments. However, increasing walking activity was regarded as feasible by both community and health professional participants. Respondents emphasised using a social approach for potential interventions, undertaking activity with family or friends and with bilingual community peers to facilitate engagement, motivation and support. Spoken content and delivery of interventions was favoured, including personal stories and multilingual audio-visual information; within local informal rather than provider settings, including the home; and aided by pedometers for self-monitoring. CONCLUSIONS: Focusing on physical activity by increasing walking may hold promise as health promotion in this deprived South Asian community context. Further intervention development, with exploration of feasibility and acceptability of the social approach and elements suggested, is merited.

Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention.

BACKGROUND: The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. METHODS/DESIGN: A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6-22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. DISCUSSION: The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.