Judith Bartlett

An examination of stress among Aboriginal women and men with diabetes in Manitoba, Canada

In this study, a series of focus groups were conducted to gain an understanding of the nature of stress among Canadian Aboriginal women and men living with diabetes. Specifically, attention was given to the meanings Aboriginal peoples with diabetes attach to their lived experiences of stress, and the major sources or causes of stress in their lives. The key common themes identified are concerned not only with health‐related issues (i.e. physical stress of managing diabetes, psychological stress of managing diabetes, fears about the future, suffering the complications of diabetes, and financial aspects of living with diabetes), but also with marginal economic conditions (e.g. poverty, unemployment); trauma and violence (e.g. abuse, murder, suicide, missing children, bereavement); and cultural, historical, and political aspects linked to the identity of being Aboriginal (e.g. ‘deep‐rooted racism’, identity problems). These themes are, in fact, acknowledged not as mutually exclusive, but as intertwined. Furthermore, the findings suggest that it is important to give attention to diversity in the Aboriginal population. Specifically, Métis‐specific stressors, as well as female‐specific stressors, were identified. An understanding of stress experienced by Aboriginal women and men with diabetes has important implications for policy and programme planning to help eliminate or reduce at‐risk stress factors, prevent stress‐related illnesses, and enhance their health and life quality.

Best practices in intercultural health: five case studies in Latin America

The practice of integrating western and traditional indigenous medicine is fast becoming an accepted and more widely used approach in health care systems throughout the world. However, debates about intercultural health approaches have raised significant concerns. This paper reports findings of five case studies on intercultural health in Chile, Colombia, Ecuador, Guatemala, and Suriname. It presents summary information on each case study, comparatively analyzes the initiatives following four main analytical themes, and examines the case studies against a series of the best practice criteria.

iDENTiFyiNG iNDiGENOUS PEOPLES FOR hEALTh RESEARch iN A GLOBAL cONTExT: A REViEW OF PERSPEcTiVES AND chALLENGES

Objectives. Identifying Indigenous Peoples globally is complex and contested despite there being an estimated 370 million living in 70 countries. The specific context and use of locally relevant and clear definitions or characterizations of Indigenous Peoples is important for recognizing unique health risks Indigenous Peoples face, for understanding local Indigenous health aspirations and for reflecting on the need for culturally disaggregated data to plan meaningful research and health improvement programs. This paper explores perspectives on defining Indigenous Peoples and reflects on challenges in identifying Indigenous Peoples. Methods. Literature reviews and Internet searches were conducted, and some key experts were consulted. Results. Pragmatic and political definitions by international institutions, including the United Nations, are presented as well as characterizations of Indigenous Peoples by governments and academic researchers. Assertions that Indigenous Peoples have about definitions of indigeneity are often related to maintenance of cultural integrity and sustainability of lifestyles. Described here are existing definitions and interests served by defining (or leaving undefined) such definitions, why there is no unified definition and implications of “too restrictive” a definition. Selected indigenous identities and dynamics are presented for North America, the Arctic, Australia and New Zealand, Latin America and the Caribbean, Asia and Africa. Conclusions. While health researchers need to understand the Indigenous Peoples with whom they work, ultimately, indigenous groups themselves best define how they wish to be viewed and identified for research purposes.

Leisure-Like Pursuits as an Expression of Aboriginal Cultural Strengths and Living Actions

An Aboriginal-guided decolonizing methodology is employed in this study to examine the leisure-like lived experiences of urban-dwelling Metis and First Nations women and men living with diabetes (N = 42) in Winnipeg, Canada. Directed by the Aboriginal knowledge and world views to ensure cultural sensitivity and relevance, this methodology served as foreground for the voices of the Aboriginal study participants into three key themes of leisure-like pursuits. The first two themes, (1) family, friends, and relationship-oriented pursuits and (2) helping people in community, are closely related within the nature of Aboriginal relationships. The third theme is spiritual and cultural activities. An overarching quality of these leisure-like pursuits is engagement in enjoyable activities that are a meaningful expression of lived culture.

Social Exclusion and Resilience as Frameworks of Stress and Coping among Selected Non-dominant Groups

Despite the growth of stress and coping research and its implications for health policy and practice, one major gap in this research area is that its conceptualizations and measurements are mostly ethnocentric, and give limited attention to the diversity of our society. As a step towards bridging this gap, the purpose of the present study was to reveal lay peoples views and perspectives on lived experiences and the meanings of stress and coping with stress among selected non-dominant groups of individuals (n = 78) in a Western Canadian city. The frameworks of social exclusion and resilience were used conceptually and analytically to ground the examination and synthesize findings about stress and coping across three target groups: Aboriginal individuals with diabetes, individuals with disabilities, and gays and lesbians. As qualitative methods, focus groups were employed as the data collection technique, and phenomenology as an analytic framework. Overall, findings highlighted the interconnected nature of various aspects of social exclusion (for example, economic exclusion, institutional exclusion, cultural exclusion) that reflect the stressful lives of participants unique to their disadvantaged and vulnerable positions in society, mostly due to the prevalence of poverty, poor living conditions, discrimination and oppression, as well as unbalanced/unequal power relations in society. The findings also suggest that human strengths and resilience are core elements of stress-coping which encompass a wide range of valued meanings such as social or collective, spiritual, cultural, attitudinal and transformative/developmental. These findings imply the need for a more culturally or sub-culturally appropriate approach to health policies and practices in order to support people (particularly non-dominant and often marginalized groups) in effectively addressing life adversities/stresses and enabling proactive and culturally relevant coping.

Communicating Risk to Aboriginal Peoples: First Nations and Metis Responses to H1N1 Risk Messages

Developing appropriate risk messages during challenging situations like public health outbreaks is complicated. The focus of this paper is on how First Nations and Metis people in Manitoba, Canada, responded to the public health management of pandemic H1N1, using a focus group methodology (n = 23 focus groups). Focus group conversations explored participant reactions to messaging regarding the identification of H1N1 virus risk groups, the H1N1 vaccine and how priority groups to receive the vaccine were established. To better contextualize the intentions of public health professionals, key informant interviews (n = 20) were conducted with different health decision makers (e.g., public health officials, people responsible for communications, representatives from some First Nations and Metis self-governing organizations). While risk communication practice has improved, ‘one size’ messaging campaigns do not work effectively, particularly when communicating about who is most ‘at-risk’. Public health agencies need to pay more attention to the specific socio-economic, historical and cultural contexts of First Nations and Metis citizens when planning for, communicating and managing responses associated with pandemic outbreaks to better tailor both the messages and delivery. More attention is needed to directly engage First Nations and Metis communities in the development and dissemination of risk messaging.

Conceptions and dimensions of health and well-being for Métis women in Manitoba

Because of the continuing poor health status of Aboriginal populations in Canada, along with increasing opportunity for Aboriginal designed health surveys, it is argued that policies and programs, and the research from which they are derived, should be more solidly grounded within Aboriginal understandings of health and well-being. Survey research for Aboriginal populations usually draws on questions developed by and for mainstream Canadians. This paper stems from the author’s master’s thesis study that elicited adult and elder Métis women’s description of ‘what constitutes health’ and ‘what constitutes well-being’. Outlined are descriptions of Métis women’s Conceptions of Health and Conceptions of Well-being, as well as Dimensions of Well-Being that should be included in health survey research.