Indigenous Health Research
The Centre for Rural and Northern Health Research is committed to research that supports health equity in northern, rural, and remote regions. A cornerstone of this commitment is our community-based, participatory work with Indigenous communities. For over five years, CRaNHR has supported work with Indigenous nations across Ontario and Canada and has developed particularly strong relationships with the First Nations of the Manitoulin Island area.
The foci of these relationships have included community-based diabetes care strategies; improving quality of life with Indigenous people living with dementia and their families; the health and wellbeing of older adults; cultural safety training design, implementation, and evaluation; and most recently, support of Indigenous-governed administrative health data research. We are incredibly grateful to our community partners, and we are always open to developing new relationships with communities, health care organizations, and/or researchers committed to Indigenous health equity.
Current Research Streams
AGE-WELL: Rural/Remote Indigenous Technology needs Explorations (RRITE)
NPI: M. O'Connell
Site leads: D. Morgan (Saskatchewan Rural Lead), C. Bourassa (Saskatchewan Indigenous Lead), K. Jacklin and W. Warry (Ontario Indigenous Leads)
Investigators for Ontario projects: L. Crowshoe, J. McElhaney, and B. Pitawanakwat
Project Elders: Elder B. McKenna and Elder J. Otowadjiwan
Project Staff: M. Blind, K. Pitawanakwat, L. Jones, and R. Trudeau
AGE-WELL NCE (Aging Gracefully across Environments to Ensure Well-being, Engagement and Long Life NCE Inc.) is a national research network in technology and aging. AGE WELL NCE is a five year federally funded initiative with the aim of helping older adults in Canada maintain their independence, improve quality of life, and enhance social participation through accessible technologies. The RRITE team explores use of technology in aging in Rural/Remote and Indigenous populations across regions of Saskatchewan, Ontario, and PEI. Drs. Kristen Jacklin and Wayne Warry lead the Indigenous research component in Ontario, exploring the following questions:
What are the health care technology user needs of older Indigenous adults?
What are the training related needs to facilitate the inclusion of aging technology in health care for older Indigenous adults with cognitive degeneration living in rural and remote locations?
What is the relevance of technologies being developed and proposed by the National Centre of Excellence known as "AGE-WELL" to older Indigenous adults with cognitive neurodegeneration?
Are technology assisted health care and supportive devices cultural relevant, safe, and acceptable to Indigenous people with age-related cognitive decline, family caregivers and health care workers?
Funded by AGE-WELL NCE Inc. (2015-2018) and the Canadian Consortium on Neurodegeneration in Aging (2014-2019).
Best of Both Worlds
Investigators: K. Jacklin, K. Pitawanakwat, W. Warry, L. Jones, R. Trudeau
The Best of Both Worlds (BoBWs) is a multiphase project that seeks to create a culturally safe care model that will improve the quality of care for First Nations people with complex, co-morbid, chronic illness. The need for this project was established through findings that emerged out of previous research on diabetes and dementia in Wikwemikong. Consultation with community partners about the continuation of the diabetes research strategy with a focus on improving cultural safety confirmed that culturally safe care is a priority for Wikwemikong. The initial phases of the project supported development, implementation, and evaluation of a cultural safety training module for health care providers offering services at the Wikwemikong Health Centre. The module is accredited by the Continuing Education and Professional Development (CEPD) office at the Northern Ontario School of Medicine.
Community Based-Emergency Care
Investigators: Aaron Orkin, David VanderBurgh, Stephen Ritchie, Julia Russell
In remote First Nations communities, there is a need for local emergency care from the
time of initial injury or illness through to care at a local nursing station — we call this “pre-nursing station care”. The absence of adequate pre-nursing station emergency care in remote First Nations contributes to well-documented tragedies and inequities. Community-Based Emergency Care (CBEC) is a novel, community-driven approach to delivering essential emergency first response health services in remote First Nations communities. Based on strong collaborations between First Nations and non-First Nations partners, and through First Nations ownership of the resulting program, CBEC builds on the Calls to Action on Health from the Truth and Reconciliation Commission of Canada. The first CBEC courses were delivered in Sachigo Lake First Nation in 2013. Since that time the Windigo First Nations Council (WFNC) has partnered with collaborators, including CRaNHR investigators, to develop a five-year WFNC CBEC Operational Plan. This operational plan was completed in the fall of 2017.
Past funding provided by: Northern Ontario Academic Medicine Association, Canadian Institutes of Health Research, Indigenous Health Research Development Program, and Dignitas
For more information, see 2013 Community-Based Emergency Care. (opens in new window)
Developing educational materials for community-based dementia care
Co-PIs: Dr. Kristen Jacklin, Dr. Wayne Warry
Project Staff: M. Blind, K. Pitawanakwat, L. Jones
The aim of this three year, Health Canada funded project was to develop evidence-based and culturally safe material to inform First Nations communities about age-related cognitive decline. The research methods that supported the development of six health promotional resources included: (1) updating an existing systematic literature review to better understand diverse views of dementia in Indigenous communities in Canada; (2) the review of research findings concerning understandings of dementia in Indigenous communities across Ontario previously undertaken by Drs. Jacklin and Warry, and (3) an environmental scan to uncover any existing health promotion and knowledge translation strategies relating to dementia in Indigenous populations. We also worked regularly with a local Elder, Jerry Otowadjiwan, and a community advisory group made up of representatives of all seven Manitoulin Island First Nations communities. Visit www.i-caare.ca/factsheets to explore the health promotion resources developed through this project.
Funded by Health Canada, First Nations Inuit Health Branch, 2014-2017.
Issues in Dementia Care for Indigenous Populations (CCNA Team 20)
Co-PIs: K. Jacklin and C. Bourassa
Investigators: W. Warry, J. Walker, J.E. McElhaney, B. Pitawanakwat, and L. Crowshoe
Project Elders: Elder B. McKenna and Elder J. Otowadjiwan
Project Staff: M. Blind, K. Pitawanakwat, L. Jones, and R. Trudeau
The Canadian Consortium for Neurodegeneration and Aging (CCNA) was launched in 2014 by the Canadian Institutes for Health Research (CIHR). The goal of the CCNA is to support research in three areas: primary prevention, secondary prevention, and quality of life. CCNA teams are located across the country, each with their own independent research program. Team 20 has two focus areas: rural and Indigenous. The Indigenous team is the only team within the CCNA investigating neurodegenerative diseases in Indigenous communities. We have received partner funding from the Institute of Aboriginal Peoples Health to research quality of life for Indigenous peoples affected by age-related dementia.
Looking to improve the quality of life experienced by Indigenous people with dementia and their caregivers, we are working directly with First Nations communities to identify and develop culturally grounded and strengths-based approaches to dementia diagnosis, care, and health education. Prioritizing Indigenous knowledge and methodologies, we are working from a "two-eyed seeing" approach in four focus areas:
Access to culturally safe and relevant dementia care for diverse Indigenous people in Canada;
Developing and piloting a cognitive assessment tool that is culturally appropriate for use in Indigenous communities;
Building capacity and awareness concerning Indigenous dementia research;
Administrative health data research aimed at estimating First Nations dementia incidence and prevalence, health service use, co-morbidities, and frailty/validity.
Visit www.i-caare.ca to learn more about CCNA Team 20’s work.
Funded by the Canadian Consortium on Neurodegeneration in Aging, Canadian Institutes of Health Research (2014-2019).
Primary Care Practice Report: Pre-Panel Indicator Survey
Investigators: Noah Ivers, Jennifer Walker, Wayne Warry, Robyn Rowe, Catherine Reis
Health Quality Ontario (HQO) is the provincial advisor on quality health care. In an effort to help doctors, nurses, and other health care professionals provide better care to their patients, HQO provides doctors with confidential ‘practice profiles’ that summarize how well they are performing on key metrics. This has been shown to improve processes of care, which may, in turn, result in improved patient outcomes. Currently, these reports include selected metrics which are informed by the Primary Care Performance Measurement Framework; a measurement of quality developed by HQO with input from numerous stakeholders and experts. The purpose of this project is to determine the indicators that patients and families prioritize for inclusion in near and future versions of this clinician audit and feedback reports in Ontario. By rigorously soliciting the opinions of primary care patients and families from Northern and Southern parts of Ontario, a better understanding of what indicators are important to patients can be obtained.
Funded by: SPOR-OSSU IMPACT, 2016 – 2018.
Reducing the Burden of Diabetes on First Nations People in Ontario: Using Population Level Data to Inform Policy and Practice
Investigators: Michael Green, Jennifer Walker, Kristen Jacklin, Carmen Jones, Baiju Shah, Eliot Frymire, Roseanne Sutherland, Robyn Rowe
Diabetes is a well-known challenge in First Nations (FN) populations. Understanding diabetes and the consequences of diabetes is very important to FN organizations and communities. In particular, decisions made at health systems and policy levels can impact how well FN Peoples and communities can prevent, manage, and cope with the long-term complications of diabetes. In close partnership with the Chiefs of Ontario, this study focuses on exploring the health care experiences of FN Peoples with diabetes in Ontario. The goal of the project is to report on the changes in the rates of diabetes and its complications over the past 20 years. We will produce a first-of-its-kind FN specific report and cover policy-relevant topics including diabetes prevalence, incidence and mortality, acute complications, chronic complications, gestational diabetes prevalence and outcomes, and health services utilization. We work towards addressing how access to healthcare for FN Peoples compares to other Ontarians and how specific policies have affected the health outcomes for FN Peoples with diabetes in Ontario.
Funded by: SPOR-OSSU IMPACT, 2016 – 2018.
Understanding the challenge of dementia in Saskatchewan First Nations
Investigators: Jennifer Walker, Kristen Jacklin, Martin Paul, Tracey Sherin, Jacqueline Quail, Julie Kosteniuk, Carrie Bourassa, Megan O’Connell
This study involves a participatory research collaboration between First Nations in SK and their academic and health system partners to better understand dementia in First Nations populations. We are building our collaboration on the First Nations principles of ownership, control, access and possession (OCAP®) of First Nations data to enable the use of First Nations dementia-specific information collected by First Nations on-reserve in Saskatchewan (SK) and by the SK health system. The goal is to better understand dementia rates, health services use and care considerations that will help First Nations work with their partners to plan for the expected increase in dementia in their communities. To date, the First Nations-identified administrative health data have not been accessed by First Nations in SK. As such, this project will have the added benefit of establishing an effective partnership for the on-going analysis of First Nation-identified health system data related to dementia and other related conditions.
Funded by: Alzheimer Society Research Program, 2017-2019
Unlocking Health Information for Older First Nations Populations
Investigators: Jennifer Walker, Kristen Jacklin, Melissa Andrew, Susan Bronskill, David Henry, Janet McElhaney, Janet Smylie, Wayne Warry, Karen Pitawanakwat, Melissa Blind, Rhonda Trudeau
First Nations populations are rapidly aging and experience multiple, complex health conditions at younger ages than other populations in Canada. Despite this, older First Nations people report high levels of physical, mental, emotional, and spiritual balance. Existing health data and information systems data are analyzed using a medicalized, deficit-based approach largely inconsistent with Indigenous perspectives on well-being and therefore exhibit major gaps in their ability to inform complex solutions to the complex health challenges in older First Nations populations. This study will develop the first population-level profile of the wellbeing of First Nations seniors in Ontario by drawing on two key sources of information to enable First Nations people to tell the contemporary story of aging in their communities. By assessing and quantifying the opportunities and limitations of using existing data to understand older First Nations wellbeing and comparing Western approaches to frailty to First Nations understandings of wellbeing, we will refine a First Nations approach to measuring frailty and wellbeing (based on administrative healthcare data) that reflects Indigenous perspectives on wellbeing and draws on empirically established measures of frailty and multimorbidity. We will then use this new approach to describe, at the population-level, patterns, and outcomes of frailty and wellbeing in the Ontario First Nations population.
Funded by: Canadian Institutes of Health Research, 2015-2018
Validation of the Canadian Indigenous Cognitive Assessment Tool
Investigators: Jennifer Walker, Carrie Bourassa, Lynden Crowshoe, Kristen Jacklin, Roger Beaudin, Gail Boehme, Nicole Eshkakogan, Flora McKenna, Jerry Otowadjiwan, Karen Pitawanakwat, Mary Jo Wabano, Pamela Williamson, Melissa Andrew, Sarah Funnell, David Hogan, Janet McElhaney, Megan O’Connell, Wayne Warry, Melissa Blind, Louise Jones
Age-related dementia is a growing concern for Canada’s First Nations populations; by 2031, the number of First Nations people over the age of 60 with dementia will increase 4-fold, compared to a 2.3-fold increase in the non-First Nations population. However, accurate diagnosis of dementia in Indigenous Peoples remains problematic. To address this problem, the Canadian Consortium on Neurodegeneration in Aging (CCNA) Team 20 adapted a cognitive assessment tool for use in Canadian First Nations populations. This project aims to validate the culturally-adapted tool in three distinct First Nations populations in different regions of Canada using an approach based on community-engagement and adaptation to local Indigenous language. This is one objective in a larger study that aims to lay the groundwork for a nation-wide dementia prevalence study in Indigenous populations (using CICA), and to establish the CICA in clinical use for Indigenous populations in Canada.
Funded by: Canadian Institutes of Health Research, 2017-2021
Naandwe Noojimowin Program Evaluation
Principal Investigator: Jennifer Walker
Co-Investigators: Julia Russell, Robyn Rowe
In order to promote the health and wellness of Indigenous Peoples following the legacy of colonialism, individual and collective healing requires Indigenous-led program development, implementation, and evaluation. Naandwe Noojimowin (previously Beauty from Ashes) is a 5-day residential retreat designed to provide holistic healing approaches to people affected by childhood trauma in an effort to support participants throughout their healing journeys. Naandwe Noojimowin is currently being run as a demonstration program and is offered by the Maamwesying North Shore Community Health Services Inc., an organization that serves seven First Nation communities across Lake Huron. CRaNHR has been invited to partner with this organization in order to document the program implementation process and to evaluate its outcomes. CRaNHR is working closely with program staff and participants in order to provide Maamwesying with an evaluation that will allow them to 1) better understand the immediate impact of the Naandwe Noojimowin program, 2) develop a plan for the future of this program, and 3) provide the necessary tools that will allow this program to grow within other First Nation communities who are working towards their individual and community-level healing journeys.
Funded by: the Ontario Strategy for Patient-Oriented Research, Maamwesying North Shore Community Health Services Inc. and the North East Local Health Integration Network
Culturally Safe Integrated Care Research Phase 2 Report: Evaluation of the Best of Both Worlds Cultural Safety Workshop