Cultural adaptation of an appropriate tool for mental health among Kanien'kehá:ka: a participatory action project based on the Growth and Empowerment Measure.

We present a cultural adaptation of the Growth and Empowerment Measure (GEM) from the Kanien'kehá:ka people of Quebec (Canada). Our aim was to develop a culturally competent and safe tool to assess and promote well-being among this population. We followed a qualitative, collaborative, and participatory method that sought to benefit Indigenous participants and communities, while honouring their culture and philosophies. Twelve adults from health and community services of Kahnawà:ke participated in total five focus group meetings. We carried out a thematic analysis of the data collected through an advisory group that led a revision of the cultural and conceptual relevance of the tool and its content. The group integrated socio-culturally relevant elements and restructured the tool so that it reflected local well-being factors and showed its versatility of being an assessment tool and therapeutic support. A narrative and empowerement-driven approach, culturally based intervention, cultural safety and flexibility when using the instrument were considered successful strategies to improve wellness. This project provides valuable information about the perspectives of local Indigenous communities regarding mental health and factors of empowerment. Mutual understanding and integration of psychological and traditional knowledge can create a beneficial program to improve emotional, mental, spiritual, and physical well-being for the local population. It remains to be tested whether the Kanien'kehá:ka Growth and Empowerment Measure (K-GEM) is clinically useful in psychological and psychiatric intervention, and social and community services.

Depression or resilience? A participatory study to identify an appropriate assessment tool with Kanien'kéha (Mohawk) and Inuit in Quebec.

PURPOSE: We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec. METHODS: We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information. RESULTS: The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner. CONCLUSION: This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.

Psychometric validation of the Growth and Empowerment Measure (GEM) applied with Indigenous Australians.

OBJECTIVE: Empowerment is a complex process of psychological, social, organizational and structural change. It allows individuals and groups to achieve positive growth and effectively address the social and psychological impacts of historical oppression, marginalization and disadvantage. The Growth and Empowerment Measure (GEM) was developed to measure change in dimensions of empowerment as defined and described by Aboriginal Australians who participated in the Family Well Being programme. METHOD: The GEM has two components: a 14-item Emotional Empowerment Scale (EES14) and 12 Scenarios (12S). It is accompanied by the Kessler 6 Psychological Distress Scale (K6), supplemented by two questions assessing frequency of happy and angry feelings. For validation, the measure was applied with 184 Indigenous Australian participants involved in personal and/or organizational social health activities. RESULTS: Psychometric analyses of the new instruments support their validity and reliability and indicate two-component structures for both the EES (Self-capacity; Inner peace) and the 12S (Healing and enabling growth, Connection and purpose). Strong correlations were observed across the scales and subscales. Participants who scored higher on the newly developed scales showed lower distress on the K6, particularly when the two additional questions were included. However, exploratory factor analyses demonstrated that GEM subscales are separable from the Kessler distress measure. CONCLUSION: The GEM shows promise in enabling measurement and enhancing understanding of both process and outcome of psychological and social empowerment within an Australian Indigenous context.

The healing journey: empowering Aboriginal communities to close the health gap.

OBJECTIVES: This paper presents two arguments relevant to both past and present efforts to improve Indigenous health. It advocates for ways of thinking about and doing health promotion that begin with empowerment to help people gain a greater level of control over their lives and circumstances. CONCLUSION: A combination of the strengths of different approaches is in fact an empowering, dialectical view that can be achieved by considering Aboriginal people not as children in need, but as capable and efficacious individuals.

Promoting traditions: an evaluation of a wilderness activity among First Nations of Canada.

OBJECTIVES: Several native American communities face serious social problems brought about by the loss of culture. Many First-Nation communities organize traditional activities in a wilderness setting to promote culture and prevent social problems, among them suicide. The activities evaluated in this study were organized by the Atikamek community of Manawan (Quebec, Canada) for adolescents aged between 14 and 17 years. The main goals of these activities were to increase self-esteem, re-establish cultural continuity, encourage pro-social behaviours among the participants and ultimately empower and mobilize the community. METHODS: Within the context of an honours thesis project, this research assessed the process and the effects of these traditional activities on a group of First-Nation youth. The evaluation used a mixed methodology consisting of two self-esteem scales and participatory observation. The results of this evaluative study show that this type of traditional activity is an innovative tool to increase cultural pride, foster pro-social behaviour and empower First-Nation youth. CONCLUSIONS: Obstacles met during the course of this research project highlight the importance of developing methodologies able to capture the rich and specific outcomes of traditional activities in an Aboriginal context.

Listening, sharing understanding and facilitating consumer, family and community empowerment through a priority driven partnership in Far North Queensland.

OBJECTIVES: This paper provides an example of a mental health research partnership underpinned by empowerment principles that seeks to foster strength among community organizations to support better outcomes for consumers, families and communities. It aims to raise awareness among researchers and service providers that empowerment approaches to assist communities to address mental health problems are not too difficult to be practical but require long-term commitment and appropriate support. METHODS: A collaborative research strategy that has become known as the Priority Driven Research (PDR) Partnership emerged through literature review, consultations, Family Wellbeing Program delivery with community groups and activities in two discrete Indigenous communities. Progress to date on three of the four components of the strategy is described. RESULTS: The following key needs were identified in a pilot study and are now being addressed in a research-based implementation phase: (i) gaining two-way understanding of perspectives on mental health and promoting universal awareness; (ii) supporting the empowerment of carers, families, consumers and at-risk groups through existing community organizations to gain greater understanding and control of their situation; (iii) developing pathways of care at the primary health centre level to enable support of social and emotional wellbeing as well as more integrated mental health care; (iv) accessing data to enable an ongoing process of analysis/sharing/planning and monitoring to inform future activity. CONCLUSION: One of the key learnings to emerge in this project so far is that empowerment through partnership becomes possible when there is a concerted effort to strengthen grassroots community organizations. These include social health teams and men's and women's groups that can engage local people in an action orientation.

Everyday ethics of participation: a case study of a CBPR in Nunavik.

INTRODUCTION: Multiple reports highlight the need for community-based family-oriented prevention services for Aboriginal peoples in order to address important health and social inequalities. Participatory, empowerment-based approaches are generally favoured for these means. Faced with important social issues, in a context of colonisation and complex power dynamics, we question how community members experience participation, as well as the everyday dynamics that take place when attempting to create community-level change. CONTEXT: The initial steps of this community-based participatory research (CBPR) took place over a two-year period in a community of Nunavik, a large northern region of the province of Quebec. The objective of the CBPR was to develop a community-driven project aimed at supporting families to be able to keep children within their homes or communities, rather than having to be placed under child welfare services. METHOD: We participated in, and documented, various group meetings, community workshops, informal reflexive discussions, and formal interviews with community partners to explore their everyday experiences of participation in community-based change. RESULTS: We describe some of the initial actions taken in this project. We describe how certain social and power dynamics infiltrated into the process of participation leading to various tensions, personal and interpersonal experiences and needs. DISCUSSION: We discuss how these experiences led to everyday ethical dilemmas regarding participation. We conclude that although participatory approaches towards community change may be effective, they are also ethically challenging and at times disempowering for those who participate. We describe some of the approaches used to work with these ethical challenges.

Promoting the health of Aboriginal Australians through empowerment: eliciting the components of the family well-being empowerment and leadership programme.

Most policies addressing Aboriginal health in Australia promote initiatives that are based on empowerment principles. Articulated programme components are necessary to support personal and group empowerment and to assist individuals in gaining the sense of control and purposefulness needed to exert their political and personal power in the face of the severe stress and powerlessness faced by the Australian Aboriginal people. This paper aims to provide a detailed description of the mechanisms underpinning a 'bottom-up' empowerment initiative, the Family well-being empowerment and leadership programme (FWB), and to analyze how the programme supports empowerment. The five stages of FWB were described and the validity of this model was assessed through the combination of participatory observation, documentation analysis, literature review, semi-structured interviews and iterative feedback with different analytical perspectives. Our study results articulated four distinct programme components: the setting plus inter-relational, educational and experiential actions. FWB is an example of the promotion of both outcome and process pathways towards empowerment. Potential applications of the programme are discussed.

Alcohol and other contextual factors of suicide in four Aboriginal communities of Quebec, Canada.

BACKGROUND: Aboriginal populations worldwide face increasing rates of suicide. Despite this recurring observation, little research has emerged from Aboriginal settings. AIMS: This paper describes the psychosocial and behavioral characteristics of 30 consecutive adult suicides from four First-Nations communities in Quebec, Canada. METHOD: Psychological autopsies guided by the LEDS with family members of the deceased. RESULTS: Suicide among this group is overrepresented by young single men. Alcohol intoxication at the time of death was reported for 22 cases in association with rapid acting out after the precipitating event for 20. All but two cases had a history of alcohol abuse, and drug use was also present in 23 cases. In 16 cases there had been a previous suicide attempt, 14 of which occurred during the previous year. The main socio-demographic characteristics of the communities were overcrowded living arrangements and no job status (90%). Seven cases were incarcerated or locked up at the time of death. Clustering of suicide was observed within seven nuclear families including 16 suicides. CONCLUSION: This study shows that Aboriginal suicide is the result of a complex interweaving of individual, familial, and socio-historical variables. The impact of contemporary social stressors on individual well-being must be addressed to prevent suicide in this community.